Prostate cancer

Symptoms Of Prostate Cancer

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

Here are some common signs and symptoms of prostate cancer:

1. Poor bladder control

A person with early-stage prostate cancer will have a lot of trouble regulating his bladder. He would frequently spill his pants as a result of urine leaking before reaching a bathroom. 

Urinary incontinence is a frequent sign of various urinary infections. In case you have this issue, consult a urologist and have your prostate cancer tested.

2. Trouble urinating

Urinary trouble is a common presenting symptom of prostate cancer. Some may even find it painful to empty the bladder.

3. Decreased force in the stream of urine

Due to an enlarged prostate, pressure increases over the urinary bladder, leading to weak flow when you urinate. 

You may feel that your bladder is still full and your urine dribbles after you finish urinating.

4. Urge to urinate

Enlarged prostate obstructs easy emptying of the urinary bladder. So you might feel the need to urinate more often than usual. This urge is more especially at night when you may sometimes spill urine before reaching the toilet.

5. Painful urination 

Having painful urination regularly is a sign that you must seek medical help because this can be a warning sign of prostate cancer.

6. Blood in the urine and semen

It's a symptom of locally advanced prostate cancer. When cancer spreads to other surrounding organs, blood might leak into urine and semen.

7. Bone pain

Advanced prostate cancer may present with symptoms like back pain. Pain in the pelvic region and hip pain is felt when prostate cancer begins to spread.

8. Losing weight without trying

Like malignancies in other organs, prostate cancer patients have unexplained weight loss. The weight loss could be due to other underlying causes. When it is associated with the other symptoms, it could be a warning sign of prostate carcinoma.

9. Persistent pain in the lower back

Persistent pain in the low back, hips, and pelvis is another warning indication. If this symptom is present with the other symptoms listed above, a detailed examination for prostate cancer could be the next step.

10. Erectile dysfunction

Erectile dysfunction is another common symptom seen in several medical conditions. Several drugs can lead to erectile dysfunction. If a person has erectile dysfunction and painful urination, he should get tests done for prostate cancer.

11. Reduced semen

If an individual notices that the amount of semen ejaculated during sex has decreased, he should get his prostate tested for any signs of malignancy. Reduced semen is especially important if the individual is also experiencing other symptoms that could indicate prostate cancer.

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 the growth, division, and survival of cells. 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 parts of the body over time. 

Risk Factors For Prostate Cancer

Some of the factors that elevate the risk of prostate cancer are as follows.

1. Old age

After 50 years of age, prostate cancer becomes more common. Old age acts as a risk factor for prostate cancer.

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. The lowest incidence is typically found in Asian men, associated not only with genetic susceptibility but also with the diet, lifestyle and environmental factors.

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

Some gene alterations (mutations) appear to increase the risk of prostate cancer.

If you have a gene that increases the risk of breast cancer (BRCA1 or BRCA2), your risk of prostate cancer may increase. 

Men with Lynch syndrome (also known as hereditary non-polyposis colorectal cancer or HNPCC), a condition caused by inherited gene mutuations, have an increased risk for prostate cancer.

Other possible risk factors

The following factors are also known to affect the risk of getting prostate cancer. However, more research is necessary to confirm the involvement of these factors.

Obesity: Overweight and obese men may have a higher risk of prostate cancer. Obesity is also thought to be associated with higher prostate cancer progression and mortality.

Alcohol consumption: Alcohol use, particularly heavy use, can be a risk factor of prostate cancer. Alcohol consumption is generally measured in drinks per day, with a usual drink of alcohol containing about 15 g of ethanol irrespective of the type of beverage consumed (beer, wine and liquor, straight or mixed). More than one drink everyday substantially increases the risk of prostate cancer.

Tobacco: Tobacco and cigarette smoke contains over 4,000 chemicals, among which more than 60 are listed as carcinogens. Male smokers are also found to have elevated levels of circulating androsterone and testosterone, which may increase the risk of prostate cancer or contribute to its progression.

Dietary factors: Some of the dietary factors that can increase the risk of prostrate cancer include: 

1. Saturated animal fat: A high-calorie intake of saturated animal fat is often associated with an increased risk of prostate cancer due to increasing testosterone levels.

2. Meat (red, smoked, and seasoned): A high correlation between per capita meat consumption and cancer incidence and mortality has been found.

3. Calcium, Milk and Dairy Products: Studies have reported that a high intake of calcium (above the recommended dietary allowance of ~1000 mg/day) or dairy products is associated with an increased risk of developing prostate cancer.

4. Choline: A positive association is seen between the dietary choline intake or plasma concentration of choline and the risk of prostate cancer. The main dietary sources of choline are eggs, beef, chicken liver and wheat germ.

Chemical exposure: Chemicals which the firefighters are exposed to and herbicides like agent orange are associated with high risk of prostate cancer.

Prostatitis: Inflammation of the prostate gland has been related to an increased risk of prostate cancer in certain studies. The link between the two is still unclear, and research is ongoing in this area.

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Sexually transmitted infections: Research has been done to see if sexually transmitted infections like gonorrhea or chlamydia might increase the risk of prostate cancer, because they increase inflammation of the prostate. So far, studies have not agreed, and no firm conclusions have been drawn.

Vasectomy: Vasectomy is a type of male contraception. Few studies have associated it with slightly increased risk of prostate cancer, but other studies have not found this. Research on this possible link is still under way.

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.

1. Prostate cancer screening tests

• Digital rectal exam (DRE): Your doctor uses a glove and lubricated finger to inspect your prostate gland during a digital rectal examination. If your doctor perceives any anomalies in the prostate gland’s consistency, shape, or size, you may need more tests.
• Prostate-specific antigen (PSA) test: PSA is a substance produced naturally by your prostate gland. This antigen is measured in a blood sample collected from a vein in your arm. It’s normal to have a trace quantity of PSA in your blood. A higher-than-normal level could suggest prostate infection, inflammation, hypertrophy, or malignancy.

2. Additional testing after screening

If your doctor suspects some abnormality during prostate cancer screening, your doctor may offer additional testing to evaluate whether you have prostate cancer, such as:

• Ultrasound: A tiny probe of cigar shape is put into your rectum during transrectal ultrasonography. The probe instrument forms an image of the prostate gland using sound waves.
• Magnetic resonance imaging (MRI): Your doctor may recommend an MRI scan of the prostate in some cases to get a more detailed view. Your doctor may use MRI images to plan a procedure to remove prostate tissue samples.
• Biopsy: Your doctor may recommend a procedure to obtain a sample of cells from your prostate. 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.

3. Tests to determine whether prostate cancer is aggressive

• Gleason score: The Gleason score is the most common scale for determining the grade of prostate cancer cells. 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: Genomic testing examines your prostate cancer cells to see if there are any gene abnormalities. This test can provide you with more information regarding your prognosis. The genomic tests give additional details that help with a treatment plan.

4. Tests to determine whether cancer has spread

Following a prostate cancer diagnosis, your doctor needs to assess the cancer stage. Following imaging tests may be recommended if your doctor feels your cancer has spread beyond your prostate. 

• Bone scan
• Computerized tomography (CT) scan
• Ultrasound
• Positron emission tomography (PET) scan
• Magnetic resonance imaging (MRI)

Your doctor will use the test results to determine the stage of your cancer. Consult Now!

Prevention Of Prostate Cancer

If you're concerned about the risk of prostate cancer, then prostate cancer prevention may be of interest to you.

1. Switch to a balanced diet

Consume all varieties of fruits, vegetables, and whole grains that are known to reduce the risk of prostate cancer. Essential vitamins and nutrients are abundant in fruits and vegetables, which can benefit your overall health.

The possibility of preventing prostate cancer with nutrition has yet to be proven clearly. However, including the following food items have shown to prevent or lower the risk of prostate cancer:

Soy: Soy has been identified as a dietary component that may play an important role in preventing prostate cancer.

Lycopene: Lycopene is a bright red phytochemical that has potent antioxidant properties. Tomatoes are a rich source of lycopene. Cooking tomatoes and consuming them with oil also increases its absorption. 

Besides tomatoes and tomato products, other lycopene-rich foods include watermelon, pink grapefruit, pink guava, papaya, dried apricots and pureed rose hips.

Green tea: The incidence of prostate cancer is very low in East Asian countries where green tea is highly consumed.  Green tea is rich in polyphenols such as epigallocatechin-3- gallate (EGCG) that has preventive effects in prostate cancer. 

Coffee: Coffee is also rich in polyphenols. Coffee consumption is associated with a reduction in the risk of developing lethal prostate cancer and its recurrence or progression. The results are similar for caffeinated and decaffeinated coffee. 

Cruciferous vegetables: Cruciferous vegetables include broccoli, cauliflower, cabbage, brussels sprouts, kale, mustard greens, and chard greens. Studies suggest that metabolites of cruciferous vegetables may detoxify carcinogenic compounds and stop cancer cells from growing and dividing, hence lowering the risk of developing aggressive prostate cancer.

Omega-3 fatty acids: Replacing saturated fat with unsaturated fat is beneficial for overall health. Saturated fat intake is associated with an increased risk of developing prostate cancer, while omega-3 fatty acids are associated with lower risk. Fish such as salmon, sardines, mackerel, and herring are good animal sources of omega-3 fatty acids. Plant sources include walnuts and flax seeds.

Folate (Vitamin B9): It occurs naturally in some foods such as green vegetables, beans and orange juice. The risk of prostate cancer is found to be lower in men who had enough folate through their diets and not by taking folic acid supplements. 

Vitamin D: Vitamin D acts as a regulatory hormone for multiple cell activities in the human body. It is concluded that Vitamin D production in the skin reduces the risk of several tumors including prostate cancer.

2. Follow an exercise routine regularly

Exercise benefits your general health. 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 increased risk of prostate cancer.

Here are more reasons why elderly people should opt for a fitness regimen. 
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3. Keep a healthy body weight

If your weight is healthy, make an effort to keep it that way by eating well and exercising most days of the week. For ideal weight loss, increase your exercise and cut down your daily calorie consumption. Consult your doctor and dietician for guidance in devising a weight-loss plan that is both healthy and effective.

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4. Talk to your doctor 

If you have a high risk of prostate cancer, discuss it with your doctor. Certain health problems can up your risk of prostate cancer. These include a clinical history of diabetes mellitus and hypertension. 

Specialist To Visit

One must see a doctor if he experiences one or more symptoms of prostate cancer. As a thumb rule, men over 40 years of age need to consult a doctor if they experience prostate cancer symptoms.

Symptoms like blood in the urine and extreme pain could be alarming signs which need immediate medical advice. One can initially consult a general physician, who might refer the the following specialists:

• Oncologist
• Urologist
• Oncosurgeon

Oncologist: Specializes in managing prostate cancer using systemic treatments like chemotherapy, hormone therapy, and immunotherapy.

Urologist: Diagnoses and treats prostate cancer through medical management and surgical procedures involving the urinary and reproductive systems.

Oncosurgeon: Performs surgeries, such as prostatectomy, to remove cancerous tissues from the prostate and surrounding areas.

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Treatment Of Prostate Cancer

Patients with prostatic cancer might get a variety of treatments. Some treatments are standard (already in use). However, watchful waiting and active surveillance are treatments for older men who have no indications or symptoms of prostate cancer. 

The term "watchful waiting" refers to the practice of closely observing a patient's status. Here no intervention is done until signs or symptoms arise or change. 

Active surveillance is closely monitoring a patient’s status without administering any treatment unless test findings change. It is helpful to detect early indicators that the disease is progressing. 

Patients are recommended to have various exams and tests during active surveillance. The tests include DRE, a PSA test, a transrectal ultrasound, and a biopsy to see if cancer is progressing. 

When cancer starts to spread, treatment is given to try to cure it. The treatment plan will depend on your age, the stage of cancer, as well as the preferences to side-effects, long term effects and treatment goals.

1. Surgery

Patients in good health who simply have a tumor in their prostate gland may be treated with surgery to remove it. The surgical procedures are:

Radical prostatectomy: The prostate, surrounding tissue, and seminal vesicles are all removed during surgery. It is possible to remove surrounding lymph nodes at the same time. The following are the most common forms of radical prostatectomy: 

• Open radical prostatectomy

• Radical laparoscopic prostatectomy

• Laparoscopic radical prostatectomy

Pelvic lymphadenectomy: Under a microscope, a pathologist examines the tissue for cancer cells. If cancer is present in the lymph nodes, the doctor will not remove the prostate gland and advise other treatment.

Transurethral resection of the prostate (TURP): This technique is known to treat benign prostatic hypertrophy. It helps to reduce symptoms caused by a tumor before further cancer treatments. In this, a resectoscope (a thin, illuminated tube with a cutting tool) is placed into the urethra, which helps remove tissue from the prostate. 

2. Radiation therapy

Radiation therapy is a cancer treatment that involves high-energy x-rays or other forms of radiation to kill cancer cells from growing. Different types of radiation therapy include:

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: It is a 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

For the treatment of prostate cancer, radioactive material is used. 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. They are biological chemicals produced by glands and transmitted through the bloodstream. 

Prostate cancer progression is accelerated due to the male sex hormones, and to limit the number of male hormones, drugs, surgery, or other hormones is used. The term for this therapy is androgen deprivation therapy (ADT).

Some of the hormone therapies for prostate cancer are:

• Abiraterone acetate, which inhibits the production of androgens in prostate cancer cells.

• Orchiectomy, 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 and 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, which inhibit testosterone production in the testicles. Leuprolide, goserelin, and buserelin are among the examples.

• Antiandrogens, which can block the activity of androgens. Flutamide, bicalutamide, enzalutamide, apalutamide, and nilutamide are a few examples of these compounds.

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

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

• High-intensity–focused ultrasound therapy

• Proton beam radiation therapy

• Photodynamic therapy

Home-care For Prostate Cancer

1. Add these to your diet

• 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 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.
  
  
• Tomatoes: Tomatoes are rich in lycopene. Lycopene compounds reduce the risk of prostate, lung, and stomach cancer.
  
  
• Cruciferous vegetables: Cruciferous vegetables including broccoli, cauliflower, cabbage, brussels sprouts, kale, mustard greens, and chard greens lower the risk of developing aggressive prostate cancer.
  
  
• Omega-3- fatty acids: A diet rich in Omega-3 fatty acids is associated with lower risk. Fish such as salmon, sardines, mackerel, herring are good animal sources whereas walnuts and flax seeds are the plant sources of omega-3 fatty acids.

2. Avoid these in your diet

• 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.

3. Reduce stress

When stressed, some men unconsciously tense their pelvic muscles. Chronic tightness of the pelvic floor muscles can produce pelvic floor muscle dysfunction and is one of the reasons for chronic prostatitis.

4. Exercise regularly

Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, can yield benefits.

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. Few complications are:

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. 

Prostate cancer can still respond to treatment and can be limited even after spreading to other parts of the body. But it is unlikely to be reversed and cured.

Urinary incontinence

Urinary incontinence 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. Medication, catheterization, and surgical intervention are some of the treatment options. 

Erectile dysfunction

Erectile dysfunction is a side effect after surgery, radiation therapy, or hormone therapy. Erectile dysfunction is treated with medications. Vacuum devices also aid in the treatment of erectile dysfunction.

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.

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.

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.

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. Managing the complications 

Urinary incontinence

Prostate cancer and its treatment might make your bladder weak. The fear of urine leaking, smelling of urine, bowel accidents and having to use diapers is humiliating to many men. Both supportive psychotherapy and behavioral therapy can assist a man in coping with this change. 

In order to help men cope with this symptom, it is important to identify the etiology of incontinence and educate patients and families about this problem, and offer ideas to improve symptoms.

Certain pelvic and kegel exercises can strengthen the muscles in your bladder and learn to control it. Urinary incontinence can also be alleviated with pelvic muscle reeducation, bladder training, anticholinergic medications and even artificial sphincter surgery.

Erectile dysfunction

For men who are bothered by sexual dysfunction, the first step should be a consultation with an urologist who specializes in male sexual dysfunction.

Men also go through the feeling of ‘lack of manliness’, oftentimes increasing their distress or frustration over the loss of erections. Sex therapy with a trained therapist along with psychological help can help a man express and manage the feelings caused by this dysfunction. 

2. Making lifestyle changes

• Living with prostate cancer can be challenging. You can live for a long time. You might even be able to cure it if you get treatment in time. It is essential to maintain a healthy lifestyle.

• Keep yourself up-to-date. Enquire with your doctor about the chance of cancer returning or worsening. Also, look out for signs and symptoms of cancer.

• Keep yourself updated about your health status. Inquire with your doctor about the risk of cancer returning. Look out for signs and symptoms of recurrence of cancer.

• Continue to take follow-up care. Take up the tests recommended by your doctor and attend all of your medical appointments.

• Exercise regularly. Exercise provides several advantages and is essential for good health.

• Get a good night’s sleep and manage stress by meditation and mind relaxing exercises.

3. Ensuring diet modifications

• Consume nutritious foods. Increase frequency and portion sizes of fruits and vegetables.

• Eat whole grains and avoid processed grains and white flour. Add more fiber to your diet.

• Avoid high-fat dairy products and processed meats like bacon, sausage, and baloney. 

4. Getting emotional support

Cancer is a huge change in anyone’s life. Feelings of worry, anxiety and depression are normal when prostate cancer is a part of your life. Work on adapting to the new normal. Work on your masculine identity conflicts. Accept that you can’t do everything like before. Allow your body to adapt with time. Take the help of a psychologist or counselor to deal with self-esteem issues. Take support from other people, whether friends and family, support groups, or others.