By Dr. Daniel A. Vorobiof, M.D., Medical Director of Belong.Life
The prostate is a walnut-sized gland found in men, situated below the bladder and in front of the rectum. It is connected to the urethra, a small tube that takes the urine and semen from the bladder and prostate to the penis. The prostate is involved in different functions of the body but the principal one is to create seminal fluid which helps in the production and transport of semen.
What is Prostate Cancer (PC)?
When healthy cells in the prostate start to change (differentiate) from normal cells and grow without any specific control, they form a growth, or tumor, in the prostatic area, which may be localized to one side of the prostate gland or present in both sides. If not treated, it can continue to grow without control and eventually might spread to other body parts, close or distant from the primary source.
This tendency to grow is usually very slow and may only start to cause symptoms after many years. That is why most men are unaware of their situation and might delay seeing a doctor until the symptoms are more pronounced and the growth larger and more difficult to treat. The good news is that, despite that, even patients with more advanced disease can continue living a reasonably normal life and preserve a good quality of life for many years.
Over the past decade, doctors mainly manage early cancer of the prostate by monitoring it. Some patients might require earlier treatment than others, but the majority will be able to continue their normal lifestyle for years without the need of specific therapies.
To note, as men get older, the prostate might enlarge and result in symptoms, such as an obstruction of the urethra—which is caused by benign prostatic hypertrophy (BPH), a benign enlargement. Although it can cause difficulty in passing urine—quite an uncomfortable and worrisome situation—it is not related to the development of prostate cancer.
Prostate cancer (PC) is influenced by risk factors, such as:
- Age: PC is more common in men over the age of 65, and rare in younger men.
- Race and Ethnicity: African men or those of African ancestry have a higher risk of developing PC, while it is less common in Asians and Hispanics.
- Family history might also be an important risk factor, but most patients have no genetic or familial history, although those that have a first-degree relative with PC (father, brother, and especially those that developed it at a younger age) do have a higher risk.
- Some mutations have been shown to appear in families with known genetic diseases such as Lynch disease and those who have relatives with cancer related to BRCA1 and BRCA2 gene mutations.
- Additional, less-relevant factors include:
- Diet (increased dairy products, increased calcium intake, etc.)
- Chemical exposures
- Recurrent inflammation of the prostate
- Sedentary lifestyle
Process of Diagnosis
The first step in determining whether there is prostate cancer is having three to four tests, performed by a GP or urologist, including a physical examination with a rectal examination of the prostate. Based on that test, the doctor might request to do a blood test called PSA (prostate specific antigen) and a biopsy of the prostate to determine the type of cell and its aggressiveness. PSA is used mainly to screen for PC in men without symptoms and is also used to monitor those with PC, and screen for recurrences.
It is important to know that PC is often slow-growing and studies on the effects of early screening have been inconclusive. International cancer societies have made some recommendations and guidance about PC screening, covering some of the possible benefits and drawbacks of PC screening.
Following the diagnosis of PC, you will have to do a few specific imaging studies to identify if the disease is localized (early stages) or has spread to other areas such as lymph nodes or bones. For that matter, the treating doctor will request a number of possible imagining tests.
Once all tests are completed, the patient will require a treatment plan, and a multidisciplinary meeting with the involved doctors (urologists, family physician, medical and radiation oncologists, radiologist, and pathologist) should take place. At this meeting, the doctors will consider available treatments and the specifics of each particular case (as not every man with PC needs to be treated right away or in the same fashion).
Here are some of the treatment options available:
- Observation or active surveillance
- Radiation therapy
- Hormone therapy
- Targeted therapy
- Supportive treatments for PC that has spread to bones
If you have early-stage PC, there are many factors to consider, such as your age and general health, as well as what the risks are that the cancer will affect you and cause future problems. Consideration should also be given to the possible side effects of the treatment—as some patients would like to delay them for as long as possible—such as incontinence or erection difficulties. Other men might be less concerned about these side effects and more concerned about removing the cancer.
If you are younger and without any other health problems, you might be willing to accept possible side effects if the treatments could offer you the best chance to get rid of the cancer. Doctors believe that surgery, external radiation, and brachytherapy have about the same success rates for early-stage PC. Please remember that each treatment type has risks and benefits that should be considered and discussed beforehand with your medical team.
If you’re older, or have other serious health problems, and your PC is slow growing, you should think of PC as a chronic disease that will probably not lead to your death. You may think about a watchful waiting time (doctors call it a ‘wait and watch’ approach), and not about treatments that can cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the only factor, as many men are in good mental and physical shape at 70-years and older.
The Right Treatment Plan For You
Choosing among available treatment options can be a complex process. There are many possible options, and in many situations, there is no single best one.
Lately there are newer surgical techniques (for example the use of robotic surgical equipment), and radiotherapy techniques, as well as medical treatments (chemotherapy, immunotherapy, targeted therapies). Many of these techniques and treatments (such as those related to clinical trials) are quite promising, but for some of them, long-term data of their effectiveness and possible side effects are not yet fully understood. These newer techniques and treatments are mostly available in some specialized centres, and therefore not geographically accessible for many patients.
Many patients with PC find it stressful to have to choose between treatment options and are concerned that they will choose the wrong treatment. So, before deciding on treatment, ask yourself the following important questions:
- Do you want to do something about your cancer regardless of possible serious side effects?
- Will you be able to handle a ‘wait and watch’ situation which could require regular appointments and tests, potentially increasing your anxiety levels?
- Would you prefer to consider the newest available technology, or are you satisfied with the existing proven standard of care?
- Are you concerned about certain long-term side effects, and how long you will be receiving treatments and having to recover from them?
You should also consider obtaining more than one medical opinion, and perhaps even from different specialists. Talking to them might give you a better perspective on your options. Speaking with other patients may also help you but remember that each man’s experience with PC is unique to them, and if you know someone who had a good or a bad experience with a certain treatment, it doesn’t mean that you will have the same experience.
Once a PC diagnosis has been confirmed, it’s important to have access to reliable medical professionals and medically verified information that’s relevant to your specific situation, in order to understand your treatment options, contributing to the best outcome on your journey to health.
About the author:
Dr Daniel Vorobiof is the Medical Director of Belong.Life, developer of social network and navigator apps for patients, caregivers, and medical professionals, with apps currently available for cancer, multiple sclerosis and IBD. Dr Vorobiof has published more than 120 peer-reviewed articles in international medical journals.