Prostrate Cancer

The Function of the Prostate and Complications Associated with Prostate Cancer

The prostate is a small, walnut-sized gland located below the bladder in men. It surrounds the urethra and is part of the male reproductive system. The prostate’s primary function is to produce seminal fluid, which nourishes and transports sperm. It also plays a role in hormone metabolism and urinary control. Any disease affecting the prostate may significantly impact urinary and sexual functions.

Prostate cancer is one of the most common cancers among men, especially those above the age of 50. If not detected early, prostate cancer may lead to urinary obstruction, erectile dysfunction, metastasis to bones (particularly the spine), renal failure, or complications due to hormone suppression. Because prostate cancer often progresses slowly, it can remain undetected for years, highlighting the importance of awareness, screening, and regular urological assessments.

Categories Associated With Primary and Secondary Prostate Tumours

Prostate tumours are generally divided into:

Primary Prostate Cancer:

This originates within the prostate gland. The vast majority of cases are:

  • Adenocarcinomas – arising from glandular tissue and accounting for over 95% of prostate cancers.

Less common types include:

  • Small Cell Carcinoma
  • Neuroendocrine Tumors
  • Squamous Cell Carcinoma
  • Transitional Cell Carcinoma

Secondary (Metastatic) Prostate Cancer:

This occurs when prostate cancer spreads to other parts of the body, commonly to:

  • Bones (spine, pelvis)
  • Lymph nodes
  • Liver
  • Lungs

Metastasis may lead to pain, pathological fractures, organ dysfunction, and systemic symptoms.

Major risk factors include:

  • Advancing age (common after age 50)
  • Family history of prostate or breast cancer
  • African ancestry
  • Diets high in fat and red meat
  • Obesity
  • Sedentary lifestyle
  • Exposure to certain chemicals (e.g., Agent Orange)

Signs And Symptoms of Prostate Cancer

Prostate cancer may develop silently, especially in its early stages. As the disease progresses, common signs include:

  • Difficulty urinating or a weak urine stream
  • Frequent urination, especially at night
  • Incomplete bladder emptying
  • Pain or burning during urination (less common)
  • Blood in urine or semen (hematuria or hematospermia)
  • Erectile dysfunction
  • Pain in the lower back, hips, or thighs (suggestive of bone metastasis)
  • Loss of bowel or bladder control (in advanced cases with spinal involvement)

Due to overlapping symptoms with benign prostatic hyperplasia (BPH), early diagnosis is essential.

Diagnosis of Prostate Cancer

The diagnosis process includes:

Medical History and Physical Exam:

Including digital rectal examination (DRE) to detect abnormal hardening or nodules on the prostate.

Blood Tests:

  • Prostate-Specific Antigen (PSA): Elevated PSA levels may indicate prostate cancer, but are not specific.
  • Free-to-total PSA ratio and PSA velocity aid in determining cancer risk.

Imaging Studies:

  • Transrectal Ultrasound (TRUS): Assists in biopsy guidance
  • MRI (Multiparametric): Provides a detailed image to assess tumour location and size
  • CT Scan or Bone Scan: Used to determine if cancer has metastasized

Prostate Biopsy:

Tissue samples are taken, typically via TRUS-guided needle biopsy. Histological examination and Gleason scoring are used to evaluate aggressiveness.

Staging:

Cancer is staged from I (localised) to IV (metastasised), based on tumour extent, PSA levels, and Gleason score.

Best Treatment for Prostate Cancer

The treatment approach depends on cancer stage, PSA level, Gleason score, patient age, overall health, and patient preferences. The main strategies are:

A. Traditional Treatments

B. Advanced and Alternative Treatments

C. Traditional Treatment for Prostate Cancer

1. Surgical Procedures

  • Radical Prostatectomy: Complete removal of the prostate gland and surrounding tissues. Can be performed via open, laparoscopic, or robotic methods (robot-assisted laparoscopic prostatectomy – RALP).
  • Pelvic Lymph Node Dissection: May accompany surgery to assess cancer spread.

2. External Beam Radiation Therapy (EBRT)

Uses high-energy X-rays to target prostate cancer. It is non-invasive and used in:

  • Localized cancer
  • Post-surgical cases (adjuvant therapy)
  • Advanced cancer (palliative intent)

Side effects may include fatigue, urinary frequency, erectile dysfunction, and bowel irritation.

3. Systemic Chemotherapy

Chemotherapy is usually reserved for advanced, hormone-resistant prostate cancer. Common drugs include:

  • Docetaxel
  • Cabazitaxel

Side effects depend on dosage, regimen, and patient tolerance, including fatigue, neutropenia, nausea, and hair loss.

4. Androgen Deprivation Therapy (ADT)

Also known as hormone therapy, ADT reduces androgen (testosterone) levels, which prostate cancer cells depend on to grow.

Options include:

  • LHRH agonists (leuprolide, goserelin)
  • Anti-androgens (bicalutamide, enzalutamide)
  • Surgical castration (orchiectomy)

B. Advanced Treatments for Prostate Cancer

Several novel therapies have been introduced to improve patient outcomes and minimize side effects:

1. Microinvasive Therapies and Surgeries

  • Cryotherapy (Cryoablation):
  • Freezing cancerous tissues using probes inserted into the prostate. Especially useful for small tumours or localized recurrence.
  • NanoKnife (IRE):
  • Irreversible electroporation uses electrical pulses that selectively kill cancer cells while sparing nearby nerves and vessels.

2. Targeted Therapies

  • PARP Inhibitors (e.g., Olaparib):
  • Effective in patients with BRCA1/2 or similar gene mutations.
  • Radioligand Therapy (e.g., Lutetium-177-PSMA):
  • Combines radiation with a molecule that binds to prostate-specific membrane antigen (PSMA) on cancer cells.

3. Immunotherapy and Biologic Therapies

  • Sipuleucel-T (Provenge):
  • A cancer vaccine has been approved for certain cases of advanced prostate cancer. It stimulates the immune system to attack prostate cancer cells.
  • Checkpoint Inhibitors:
  • Drugs like pembrolizumab (anti-PD-1) are used in specific genetic profiles or clinical trials.

4. Brachytherapy (Internal Radiation Therapy)

  • Low-Dose Rate (LDR): Permanent seed implants (e.g., Iodine-125, Palladium-103) emit localized radiation.
  • High-Dose Rate (HDR): Temporary placement of radiation source via catheters into the prostate.

This therapy delivers precise radiation with minimal impact on surrounding organs.

Prevention and Lifestyle Management

While not all cases can be prevented, lifestyle changes can reduce risk and support early detection:

  • A healthy diet rich in fruits, vegetables, and omega-3s
  • Regular physical activity and weight management
  • Limiting red meat and dairy fat consumption
  • Routine screening (PSA + DRE) after age 50, or earlier for high-risk individuals
  • Avoidance of smoking and excessive alcohol consumption
  • Management of chronic diseases like diabetes and hypertension

Men with a family history should begin screening as early as 40–45 years.

Prognosis and Survival Rates

Prostate cancer typically grows slowly, and the outlook is very favourable when diagnosed early. The 5-year survival rate for localized and regional disease exceeds 99%. For distant (metastatic) cases, the 5-year survival drops to around 32%, but newer treatments continue to improve outcomes.

Lifelong monitoring is often needed due to the risk of recurrence, especially in aggressive or advanced cases.

Conclusion

Prostate cancer is a highly prevalent yet highly treatable condition when detected early. The prostate’s role in male reproductive health and urinary function makes cancer in this gland particularly impactful. Combining traditional treatments with modern innovations such as HIFU, targeted therapies, and immunotherapy enhances treatment efficacy and minimizes side effects. Public awareness, routine screening, and personalized care plans are key to reducing mortality and improving the quality of life for men worldwide.