Prostate cancer

Symptoms Of Prostate Cancer

In the early stages of prostate cancer, there may or may not be any signs or symptoms. However, as cancer progresses, some of the symptoms may appear which include:

• Poor bladder control

• Trouble urinating

• Decreased force in the stream of urine

• Urge to urinate frequently

• Painful urination 

• Blood in the urine and semen

•  Lower back pain

• Pain in the pelvic region 

• Losing weight without trying

• Erectile dysfunction

• Reduced semen.

Stay proactive about your prostate health. A PSA (Prostate-Specific Antigen) test measures PSA levels in the blood, which may arise due to prostate cancer or other conditions like an enlarged prostate or prostatitis. Get your PSA levels checked regularly for early detection.
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Causes Of Prostate Cancer

• The specific cause of prostate cancer is unknown. However, it is generally a result of mutation and uncontrolled division in the normal prostate cell. 

• Oncogenes are genes that aid in cell growth, division, and survival.

• Tumor suppressor genes are the ones that usually regulate cell growth, repair DNA errors, or induce cells to die at the appropriate moment.

• Prostate cancer starts to form when cells in the prostate gland have alterations in their DNA.

• These abnormal cells group together to create a tumor. This tumor can spread and invade neighboring tissue. Some abnormal cells can break away and move to other body parts over time. 

• Certain risk factors can increase the likelihood of prostate cancer, which are discussed in the next segment.

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Risk Factors For Prostate Cancer

Some of the factors that elevate the risk of prostate cancer include:

1. Old age

• Prostate cancer becomes more common after age 50, with advancing age being a significant risk factor.

2. Race

• African American men, West African ancestry from the Caribbean and South American men have an increased risk of prostate cancer than those of other races. 

3. Family history

• If a blood relative has been diagnosed with prostate cancer, such as a parent, brother, or kid, your risk may increase for cancer. 

4. Gene changes

• Certain gene mutations can increase the risk of prostate cancer. 

• Men with BRCA1, BRCA2, or Lynch syndrome are more likely to develop the disease.

5. Other possible risk factors

• Obesity
• Alcohol consumption
• Diet (saturated animal fat, red or smoked meat, high calcium/dairy intake, and dietary choline)
• Chemical exposure
• Prostatitis (Inflammation of the prostate gland) 
• Sexually transmitted infections
• Vasectomy (it is a type of male contraception)
• Tobacco use

Note: Tobacco smoke contains over 60 carcinogens, and male smokers have higher androgen levels, potentially raising prostate cancer risk or aiding its progression.

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Diagnosis Of Prostate Cancer

Most doctors advise men in their 50s to talk to their doctors about the benefits and drawbacks of prostate cancer screening. An evaluation of your risk factors and screening preferences should be part of the discussion. It consists of:

1. Prostate cancer screening tests

• Digital rectal exam (DRE): Your doctor inserts a lubricated, gloved finger into your rectum to feel your prostate gland for abnormalities in size, shape, or texture. If any irregularities are detected, further tests may be necessary.
  
  

• Prostate-specific antigen (PSA) test: PSA, a prostate gland protein, is measured through a blood test, with high levels possibly indicating infection, enlargement, or cancer. 
  
  

2. Imaging tests

• Ultrasound: The probe instrument forms an image of the prostate gland using sound waves. It helps detect prostate abnormalities and guide biopsies for prostate cancer diagnosis.
  
  
• Magnetic resonance imaging (MRI): It provides detailed prostate imaging to detect cancer, assess its extent, and guide biopsies.
  
  

3. Biopsy

• A prostate biopsy helps to find if there are cancer cells present. 

• During a prostate biopsy, a tiny needle is inserted into the prostate to collect tissue which is examined for the presence of malignant cells.
  
  

4. Tests to determine whether cancer has spread

• Bone scan

• Computerized tomography (CT) scan

• Ultrasound

• Positron emission tomography (PET) scan

• Magnetic resonance imaging (MRI)

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Grading Of Prostate Cancer

Once a biopsy confirms the presence of cancer cells, the next step is to assess the progress of the cancer. A higher grade indicates cancer that is more aggressive and likely to spread quickly.

The following are some of the methods used to determine the grade of cancer:

• Gleason score:  Gleason scoring is a numeric system of a scale of 1 to 10. In Gleason, score two means non-aggressive cancer, whereas ten means aggressive cancer. 

• Genomic testing: It examines your prostate cancer cells to see if there are any gene abnormalities. The genomic tests give additional details that help with a treatment plan and prognosis.

Prevention Of Prostate Cancer

If you're concerned about the risk of prostate cancer, then prostate cancer prevention may be of interest to you. Here’s what you can do

1. Focus On Diet

• Consume all varieties of fruits, vegetables, and whole grains. 
• The possibility of preventing prostate cancer with nutrition has yet to be proven clearly. 
• However, including the following food items has been shown to prevent or lower the risk of prostate cancer:
• Soy
• Lycopene
• Green Tea
• Coffee
• Cruciferous Vegetables
• Omega-3 Fatty Acids
• Folate
• Vitamin D
  
  

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2. Follow An Exercise Routine

• Exercise is one of the modified lifestyle therapies that appear to offer many benefits and relatively few side effects. 

• Lack of exercise has also been linked to an increased risk of prostate cancer.

3. Maintain Healthy Weight

• Maintaining a healthy weight reduces inflammation and hormone imbalances linked to prostate cancer risk. 

• Regular exercise and a balanced diet play a crucial role in prevention.

4. Discuss Your Prostate Cancer Risk

• If you're at high risk, consult your doctor. 

• Conditions like diabetes and hypertension can increase your risk.            

Doctor To Visit

As a thumb rule, men over 40 years of age need to consult a doctor if they experience prostate cancer symptoms. One can initially consult a general physician, who might refer the following specialists:

• Oncologist
• Urologist
• Oncosurgeon
  
  

An oncologist specializes in managing prostate cancer using systemic treatments like chemotherapy, hormone therapy, and immunotherapy.

An urologist diagnoses and treats prostate cancer through medical management and surgical procedures involving the urinary and reproductive systems.

An oncosurgeon performs surgeries, such as prostatectomy, to remove cancerous tissues from the prostate and surrounding areas.

Symptoms like blood in the urine and extreme pain could be alarming signs that need immediate medical advice. Seek professional help if you are experiencing these symptoms.Book An Appointment

Treatment Of Prostate Cancer

Prostate cancer treatment includes standard therapies, watchful waiting, or active surveillance. They include:

1. Surgery

• Pelvic lymphadenectomy: A pathologist examines the tissue for cancer cells under a microscope. If cancer is present in the lymph nodes, the doctor will not remove the prostate gland and advise other treatments.
  
  
• Transurethral resection of the prostate (TURP): This technique is used to treat benign prostatic hypertrophy and relieve symptoms caused by a tumor before further cancer treatments. A thin, lighted tube with a cutting tool, called a resectoscope, is inserted into the urethra (the tube that carries urine from the bladder out of the body) to remove prostate tissue.
  
  
• Radical prostatectomy: During surgery, the prostate, nearby tissue, and seminal vesicles are removed, and sometimes the surrounding lymph nodes are also taken out. Here are the most common types of radical prostatectomy:
  - Open radical prostatectomy
  - Radical laparoscopic prostatectomy
  - Laparoscopic radical prostatectomy

2. Radiation therapy

• External radiation therapy: Radiation therapy uses a machine outside the body to send radiation to the cancerous part of the body. This therapy allows a high dose of radiation to reach the tumor while causing minimal damage to healthy tissue in the surrounding area.

• Hypofractionated radiation therapy: In this type of radiation therapy a higher-than-usual total radiation dose is delivered once a day for a shorter time (fewer days). This therapy may have more side effects than regular radiation therapy.

• Internal radiation therapy: Internal radiation therapy uses a radioactive substance filled in needles, seeds, or catheters inserted into cancer tissue. After the radioactive seeds are implanted in the prostate, the needles are removed after the procedure.
  
  

3. Radiopharmaceutical therapy

This therapy uses radioactive drugs to target and destroy cancer cells while minimizing damage to healthy tissue. The following are examples of radiopharmaceutical therapy:

• Alpha emitter radiation therapy treats prostate cancer that has spread deep to the bones. 

• Radium-223, a radioactive material, is administered into a vein and circulated through the bloodstream. It gathers in cancerous parts of the bone and destroys the cancer cells.
  
  

4. Hormone therapy

Hormone therapy treats cancer by inhibiting cancer cell growth or blocking hormones. The term for this therapy is androgen deprivation therapy (ADT). The following are some hormone therapies for prostate cancer:

• Abiraterone acetate is a drug that inhibits the production of androgens in prostate cancer cells.

• Orchiectomy is a surgical treatment that involves the removal of one or both testicles, which are the source of male hormones like testosterone, to reduce the quantity of hormone produced.

• Estrogens (hormones that promote feminine sex characteristics) can inhibit the production of testosterone in the testicles. Estrogens are unlikely to be used in treating prostate cancer nowadays due to their adverse effects.

• Luteinizing hormone-releasing hormone agonists inhibit testosterone production in the testicles. Leuprolide, Goserelin acetate, and Buserelin are among the examples.

• Antiandrogens can block the activity of androgens. Flutamide, Bicalutamide, Enzalutamide, Apalutamide, and Nilutamide are a few examples of these compounds.

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5. Chemotherapy

• Chemotherapy is a cancer treatment that involves administering drugs to cancer cells to limit their growth, either by killing them or preventing them from growing. 

• Chemotherapy medications enter the blood circulation, reach cancer cells throughout the body, and are administered by mouth or injected into a vein or muscle.
  
  

6. Immunotherapy

• Immunotherapy is a cancer-fighting treatment that makes use of the patient’s immune system. 

• So, substances manufactured by the body or in the lab are used to restore the body's natural defenses. 
  
  

7. Bisphosphonate therapy

• When cancer has spread to the bone, bisphosphonate medications like clodronate or zoledronate are known to prevent bone damage. 

• Bone loss is more common in men treated with antiandrogen treatment or orchiectomy.

Clinical trials to explore new types of treatment include

• Cryosurgery: A treatment that freezes and destroys abnormal or cancerous cells using extremely cold temperatures.

• High-Intensity Focused Ultrasound (HIFU) Therapy: Uses focused ultrasound waves to heat and destroy cancerous tissues without harming surrounding areas.

• Proton Beam Radiation Therapy: Targets tumors with high-energy proton beams to destroy cancer cells while sparing nearby healthy tissue.

• Photodynamic Therapy (PDT): Combines a light-sensitive drug and laser light to kill cancer cells with minimal damage to healthy tissue.

Home-care For Prostate Cancer

Some herbs and spices may support cancer management, but they should never replace conventional treatment. More research is needed, so always consult your doctor before trying any new remedies. Home remedies that support prostate health include:

• Soy products: Soybean products contain the highest quantities of isoflavones. Isoflavonoids provide a variety of health benefits, including the ability to protect against prostate cancer.

• Pomegranate (Anaar) extract: The antioxidant properties of pomegranate extract have an anticancer effect on carcinogenic cells.

• Green tea: Green tea contains polyphenols. It is an antioxidant associated with the prevention of many ailments, including prostate cancer. 
  
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• Tomatoes (Tamatar): Tomatoes are rich in lycopene. Lycopene compounds reduce the risk of prostate, lung, and stomach cancer.
  
  Not just prostate cancer, tomatoes can reduce the risk of skin cancer as well.
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• Cruciferous vegetables: Cruciferous vegetables including broccoli, cauliflower, cabbage, etc lower the risk of developing aggressive prostate cancer.

Don’ts

• Vegetable oils containing omega-6 fatty acids and a diet high in saturated fats can increase the risk and severity of prostate cancer.

• Processed red meat including foods such as salami, bologna, sausage, bacon, and hot dogs should be avoided.

• Eating grilled and fried meat or meat cooked at high temperatures may alter DNA. It also increases the risk of cancer.

• Sugar and carbohydrates correlate with the risk of prostate cancer.

• Increased intake of food rich in choline such as beef and chicken liver, eggs, and wheat germ increases the risk of lethal prostate cancer.

• A high intake of dairy/calcium products is also associated with an increased risk of prostate cancer.

Note: The SELECT trial studied whether selenium and vitamin E supplements could prevent prostate cancer. Results showed no benefit, and researchers advised against taking high-dose selenium above the recommended intake.

Complications Of Prostate Cancer

Prostate cancer, if undiagnosed or untreated in early stages, might spread to surrounding tissues. The spread can further complicate the disease. A few complications are mentioned below:

• Spreading of prostate cancer (Metastasis): Prostate cancer can spread to neighboring organs, such as your bladder. It can travel to your bones or other organs through your bloodstream and lymphatic system. 

• Urinary incontinence: It can be a side effect of prostate cancer and its treatment. Treatment for incontinence varies depending on the kind, severity, and possibility of recovery over time. 

• Erectile dysfunction: It is the inability to achieve or maintain an erection firm enough for sexual activity. It is a common complication of prostate cancer and its treatments, which can affect nerves, blood flow, or hormone levels.

Possible complications after prostate cancer surgery include the following:

• Sterility
• Leakage of urine from the bladder 
• Leakage of stool from the rectum
• Shortening of the penis
• Inguinal hernia

Probable complications of hormone therapy include:

• Hot flashes 
• Impaired sexual function
• Loss of desire for sex
• Weak bones
• Diarrhea
• Nausea
• Itching

Alternative Therapies For Prostate Cancer 

It’s important to remember that complementary and alternative cancer treatments cannot replace medical treatment. When you try a supplemental treatment, always tell your doctor.

1. Yoga

Yoga may help with weariness caused by cancer therapy, according to some scientific research. Men under treatment for prostate cancer who participated in twice-weekly yoga lessons had fewer sexual side effects and urine issues than those who did not.

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2. Meditation

People with cancer can benefit from the calming effects of meditation and other relaxation practices. Mindfulness and meditation effectively relieve anxiety, fear, and depression in men with prostate cancer in a small study.

3. Acupuncture

Acupuncture, which involves a trained practitioner inserting thin needles into specific points on your body, may help relieve prostate cancer pain. Some cancer patients report that it helps them feel better.

Living With Prostate Cancer

Any diagnosis of cancer is not easy physically or mentally. However, a few lifestyle changes can help you sail through the treatment. Here’s how to have a better quality of life even if you have prostate cancer.

1. Manage complications

• Perform pelvic and Kegel exercises to strengthen bladder muscles.

• Try bladder training and consider anticholinergic medications or artificial sphincter surgery for urinary incontinence.

• Consult a urologist specializing in male sexual dysfunction for tailored treatment.

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2. Focus On Emotional Well-Being

• Address frustration or loss of manliness with professional counseling or support groups.

• Engage in stress-reducing activities like yoga, mindfulness, or relaxation techniques.
  
  

3. Prioritize Physical Health

• Maintain regular physical activity to improve overall strength and stamina.

• Follow a balanced diet to support recovery and manage the side effects of treatment.
  
  

4. Get All The Support 

• Join prostate cancer support groups for shared experiences and advice.

• Communicate openly with loved ones and healthcare providers to address challenges.

5. Managing Cancer Care Costs

• Cancer treatment can be costly, adding stress to individuals and their families.

• Unexpected expenses may arise, making treatment continuity difficult.

• Seek help from social workers for financial aid, grants, and claims.

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