What is prostate cancer?

The prostate is a gland found only in males. It is located in front of the rectum and below the urinary bladder. Several types of cells are found in the prostate, but almost all prostate cancers develop from the gland cells. Some prostate cancers can grow and spread quickly, but most grow slowly. In many Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it.

What are the risk factors for prostate cancer?

  1. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors. Some of these factors include:
  2. Race/Ethnicity: Prostate cancer occurs more often in African-American men than in other races. African-American men are also more likely to be diagnosed at an advanced stage.
  3. Family history: Having a father or a brother with prostate cancer more than doubles a man’s risk of developing this disease.
  4. Genes: Inherited mutations of the BRCA1 or BRCA2 genes are the reason that breast and ovarian cancers are much more common in some families. Mutations in these genes may also increase prostate cancer risk in some men.
  5. Diet: Men who eat high quantities of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer.

When should I begin screening?

Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man’s blood. Another way to find prostate cancer is by a digital rectal exam (DRE), in which the doctor puts a gloved finger into the rectum to feel the prostate glands. Discussions about prostate cancer screening should begin:

  • At age 50 for men who are at average risk of prostate cancer
  • At age 45 for men at high-risk of developing prostate cancer (including African-American men and men who have a first degree relative (father, brother or son) diagnosed with prostate cancer at an early age (younger than 65).
  • At age 40 for men at higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Overall health status, and not age alone, is important when making decisions about screening.

What are the signs and symptoms of prostate cancer?

Early prostate cancer usually has no symptoms. Some advanced prostate cancer can slow or weaken your urinary stream or make you need to urinate more often, especially at night. If prostate cancer is advanced, you may find blood in the urine or have trouble getting an erection. Advanced prostate cancer commonly spreads to the bones, which may cause pain in the hips, back, chest or other areas. Cancer that has spread to the spine can also press into the spinal nerves causing weakness or numbness in the legs or feet, or even loss of bladder or bowel control.

How is prostate cancer diagnosed?

Actual diagnosis can only be made after a prostate biopsy.

If you are found to have prostate cancer, your doctor will use your digital rectal exam (DRE) results, prostate-specific antigen (PSA) level and a Gleason Grade to determine the likelihood that the cancer has spread outside your prostate.In addition, imaging testscan help to create a picture of the inside of your body:

  • Ultrasound: Use of sound waves to make an image of the prostate
  • Bone scan: A bone scan can help to show whether cancer has spread to distant bone sites
  • Computed tomography (CT): Provides a detailed, cross-sectional image of your body. CT scan can often tell whether it is growing into other organs or structures in your pelvis
  • Magnetic resonance imaging (MRI): Produces a clear picture of the prostate and shows whether the cancer has spread outside the prostate

What are my treatment options?

The treatment chosen for you in collaboration with your medical oncologist will take into account:

  • Your age and expected life span
  • Any other serious health conditions you may have
  • The stage and grade of your cancer
  • Your likelihood that each type of treatment will cure your cancer

Surgery: Surgery is a common choice for treatment of prostate cancer if it is not thought to have spread outside the gland.The main type of surgery is known as a radical prostatectomy.

Radiation therapy: Radiation therapy can be used to shrink the tumour, whether alone or in combination with hormone therapy. Lastly, in cases where the cancer has not completely been removed or if there is a reoccurrence, radiation therapy may be used.

Hormone therapy: Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. The goal is to reduce levels of the male hormones, called androgens, in the body, or to prevent them from reaching prostate cancer cells. Hormone therapy may be used if you are not able to have surgery or radiation, to shrink the size of the tumour, and in some cases where the cancer has already spread beyond the prostate gland.

Chemotherapy: Chemotherapy uses anti-cancer drugs injected into a vein or given by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment potentially useful for cancers that have spread (metastasized) to distant organs.Chemotherapy is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of the time they are taken. These side effects may include hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, lowered resistance to infection, easy bruising/bleeding and fatigue.

Bisphosphonates: Bisphosphonates are a group of drugs that can help relieve pain and high calcium levels caused by cancer that has spread (metastasized) to the bones. These drugs may also slow the growth of the metastases and help delay or prevent fractures. Bisphosphonates can also help strengthen bones in men who are receiving hormone therapy.

Following PSA levels during and after treatment

The prostate-specific antigen (PSA) level is often a good indicator of how effective treatment is or has been. Generally speaking, your PSA level should get very low after treatment.

It is also important to know that PSA levels may fluctuate a bit on their own in some cases.

” Courtesy of the Aga Khan Hospital”