Understanding Prostate Cancer

Prostate cancer is the 3rd most prevalent cancer among Filipino men, next to lung and colorectal cancer.

Despite the high prevalence of the disease, there is a lack of awareness and considerable confusion and misinformation surrounding prostate cancer.

Trinity believes that the prevention of diseases like prostate cancer begins with a greater understanding of the disease itself. In celebration of the prostate cancer awareness month, we have prepared this article to spread more awareness of this disease.

What is Prostate Cancer?

Prostate cancer is a type of cancer that develops in the prostate – a gland present in men only, so only men can develop this type of cancer. The prostate gland produces some of the fluid that protects and nourishes the sperm cells.

Prostate cancer starts when cells in the prostate grow and divide abnormally.

Risk Factors

The exact cause of prostate cancer is not known, but several risk factors have been identified to contribute to its development. Some of the common uncontrollable risk factors for prostate cancer include:

• Age. The older the man is, the higher the chances of getting prostate cancer. About 6 out of 10 cases of prostate cancer are diagnosed in men 65 years of age or older. It is rare to occur in men before 40 years old.
• Family History. A man may have an increased risk of getting prostate cancer if he has a close relative who has had the disease. Prostate cancer risk is 2-3 times higher if a man has a first-degree relative (father or brother) with prostate cancer and 2 times higher if he has a second-degree relative (grandfather, uncle, nephew, or half-sibling) who has had the disease. Having family members with breast and ovarian cancer also raises a man’s risk for prostate cancer. That is because breast, ovarian, and prostate cancers share some of the same genes, including BRCA1 and BRCA2.

Signs and symptoms

Prostate cancer is mainly asymptomatic during its early stages. Symptoms most often show up later, as cancer grows.

The most common symptoms that a patient may experience in the later stages include the following:

• Difficulty starting urination
• Weak or interrupted flow of urine
• Frequent urination, especially at night
• Difficulty emptying the bladder completely
• Pain or burning during urination
• Blood in the urine or semen
• Pain in the back, hips, or pelvis that doesn’t go away
• Painful ejaculation

If you have these symptoms, book a consultation with your doctor immediately. Keep in mind, though, that these symptoms may also be caused by conditions other than prostate cancer.

Screening and Diagnosis

Like most cancers, prostate cancer can be cured when detected and treated early. Early cancer detection is possible with a screening test. Screening helps find cancer before they have symptoms and while it is still easier to treat.

There are two screening methods commonly used to detect prostate cancer as described below:

• Prostate-specific antigen (PSA) blood test – this is a blood test that can detect abnormalities in the PSA levels of a man. PSA is a substance produced by the prostate. The levels of PSA can be higher in men who have prostate cancer.
• Digital rectal exam (DRE). - in this test, the doctor puts a gloved, lubricated finger in the rectum to feel whether the prostate gland is abnormally enlarged and hard.

When the doctor sees abnormalities in either the PSA levels or DRE test, a patient will be advised to undergo more targeted procedures such as ultrasound and prostate biopsy to confirm if there is really cancer. This is because abnormalities that may be found in both tests may also be caused by other conditions.

Considerations before screening

The decision to get screened for prostate cancer must be discussed properly with the doctor as there are many factors to consider including age, health, and family history.

For example, if a man is already old and in poor health, screening to find early prostate cancer may not be necessary and beneficial. This is because prostate cancer is slow-growing, and he may die from his other health condition before they could even treat the cancer after screening is done.

On the contrary, if a man is still relatively young but at risk, the screening will be recommended depending on the level of risk. The following are the considerations for screening according to the Philippine Cancer Society:

• The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes those who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
• This discussion should take place at age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age)

Treatment

There are various treatment options for prostate cancer depending on the stage it is in upon diagnosis. Possible treatment options for each stage are as follows:

• For very early stage and elderly men with co-morbidities – observation (watchful waiting) or active surveillance may be advised. Watchful waiting means having a less intensive type of follow-up. The doctor may require fewer tests, and the decision to start treatment will rely on the man’s symptoms. This treatment is most often meant to control symptoms from the cancer, but not to cure it. With active surveillance, the patient will be closely checked often by the doctor and advised to undergo tests to see if the cancer is growing. If the situation changes and symptoms begin to show up, the patient and doctor may then decide to start treatment.
• For local stage (cancer has not spread outside of the prostate) – If cancer has not yet spread outside of the prostate, surgery, cryosurgery, and hormone therapy are the possible treatment options.
• For regional stage (cancer has spread outside the prostate but only to nearby tissues) – Treatment options for the regional stage include surgery, radiotherapy, hormone therapy, and chemotherapy.
• For distant stage (cancer has spread to distant lymph nodes, bones, or other organs) – treatment options are similar to the regional stage, with possible bone-directed treatment.

Prostate cancer is a complex disease, and doctors may differ in their opinions regarding the best treatment options. It is important to speak with doctors who specialize in different kinds of treatment to help sort through the treatment options. Together, weigh the benefits of each treatment against its possible outcomes, side effects, and risks.

Many men diagnosed and treated at the local or regional stages can be disease-free after five years. The distant stage of prostate cancer is no longer curable but undergoing treatment can help slow prostate cancer progression.

Prevention

Since most of the risk factors for prostate cancer such as age and family history are uncontrollable, there is no surefire way to prevent the disease. However, adopting a healthy lifestyle might still help lower the risk of developing and even dying from cancer.

The healthy behaviors that can be done include avoiding tobacco products, achieving, and maintaining a healthy weight, staying active throughout life, and eating a healthy diet.

References:

• https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf
• https://www.cdc.gov/cancer/prostate/basic_info/index.htm
• https://www.urologyhealth.org/urology-a-z/a_/advanced-prostate-cancer
• http://www.philcancer.org.ph/wp-content/uploads/2014/06/Si-Mang-Jun-Ay-Nailigtas-sa-Prostate-Cancer2.pdf
• https://www.cancer.org/cancer/prostate-cancer/about.html
• https://www.healthline.com/health/mens-health/age-for-prostate-exam#age