Prostate cancer

Introduction

The prostate is a gland, the size of a walnut, in males that produces fluid that enriches, protects and transports sperm. ^[1,2,3]

Prostate cancer develops when normal cells in the prostate become abnormal and start growing uncontrollably, forming a tumour or mass. The exact reason why normal cells become abnormal is unclear. If left untreated, these cells continue to multiply uncontrollably and spread to other parts of the body. ^[1,2,3,4]

Prostate cancer is the most frequently diagnosed cancer in men in South Africa. Prostate cancer mainly affects men over the age of 50, and your risk increases as you get older. Prostate cancer is rare in men under the age of 40.  Prostate cancer is not as aggressive as other cancers. If this slow-growing cancer is diagnosed early and treated and managed correctly, the survival rates are high. However, of concern is that in the early stages of the disease there are no symptoms, so it is often diagnosed at a later stage.

Risk factors for developing prostate cancer ^[3,4,6]

Family history

Age

Ethnicity

Diet

Symptoms ^[1,3,4]

Because prostate cancer is slow-growing, it may be asymptomatic for a few years.

The main symptoms include changes in urinary and sexual function:

• More frequent urination
• Weak or slow urination and dribbling
• Burning urination
• Blood in urine and semen
• Difficulty in getting an erection
• Painful ejaculation
• Pain or stiffness in the lower back, thighs or hips

Many of these symptoms are also associated with non-cancerous enlargement of the prostate (benign prostatic hyperplasia). If you experience any of the above symptoms, consult with your healthcare professional.

Diagnosis

Diagnostic methods might include:

Digital Rectal Exam (DRE) ^[1,3,4,6]:

The doctor inserts a gloved, lubricated finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.

PSA blood test ^[6]:

The blood test will determine the level of Prostate Specific Antigen (PSA). PSA is a protein specifically produced by prostate cells. An elevated level may indicate a higher chance of having cancer.

Biopsy ^[6]:

Based on the outcome of the DRE and PSA level from the blood test, a biopsy will be performed to confirm a prostate cancer diagnosis. A tissue sample is taken using a needle and examined by a pathologist during a biopsy.

After a diagnosis is confirmed, cancer will be graded (based on the degree of cell abnormality) and staged (localized in the prostate, local spread to surrounding tissue and lymph and distant spread to other organs and bone). Further tests like computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, bone scan or ultrasound will be performed to establish whether cancer has spread outside of the prostate gland.

Treatment options ^[3,4,5,6]

The treatment of prostate cancer will differ from patient to patient based on age, risk factors, stage of disease and grade.

Treatment options include surgery, radiotherapy, hormone therapy and chemotherapy. 

Surgery:

Removal of the prostate can be done at an early stage but has the potential for side effects like erectile dysfunction.

Radiotherapy: 

External radiotherapy uses radiation to target and destroys cancer.

Internal radiotherapy (brachytherapy): small radio-active implants are placed in the prostate gland to destroy cancer.

Hormone therapy:

Prostate cancer cells need the hormone testosterone to grow. Hormone therapy works by stopping the production of testosterone or by blocking the action of the testosterone on the prostate cancer cells. Both these methods mean that the hormone is not available for the cancer cells to use, and they cannot grow and survive. 

Chemotherapy:

This form of treatment using anti-cancer (cytotoxic = killing cells) medications are usually used in advanced stages of cancer when cancer has spread to surrounding tissue and distant organs and bone.

Awareness, early detection and treatment are key. Consult with your healthcare professional if you have any questions.

References:

1. The Facts about Prostate Cancer v1. Available at: https://za.movember.com/mens-health/ prostate-cancer#the-facts. 
2. Herbst, M. Fact Sheet on Prostate Cancer. (2018). Available at: https://www.cansa.org.za/ files/2018/01/Fact-Sheet-on-Prostate-Cancer-NCR-2013-web-Jan-2018.pdf. 
3. Christiani, I. M. Part 1. What is Prostate Cancer. Available at: http://www.can-sir.org.za/ wp-content/uploads/2013/06/CanSir-Prostate-cancer.pdf. 
4. Beale, R. Understanding Prostate Cancer. Prostate Cancer Foundation (2015). Available at: http://www.prostate-ca.co.za/cake/index.php/info#Understanding the prostate. 
5. South Africa GLOBOCAN Statistics 2018 Fact Sheet. Available at: http://gco.iarc.fr/today/ data/factsheets/populations/710-south-africa-fact-sheets.pdf. 
6. Gurvinder Rull. What is Chemotherapy? Available at: https://patient.info/health/cancer/chemotherapy.