Introduction
According to Prostate Cancer UK, prostate cancer is the most common cancer affecting men. More than 47,500 men get prostate cancer annually in the UK and it takes the lives of over 11,500 men each year. Meanwhile, one in eight men will be diagnosed with prostate cancer in their lifetime.1
Affecting such large numbers of people and makes prostate cancer a public health concern. Unfortunately, the incidence of prostate cancer corresponds to efforts to detect it.2 As a result, more people might be affected in developing countries than is recorded.
Developing countries may not have the logistics for mass screening and detecting prostate cancer freely. Meanwhile, many individuals may struggle to pay for regular screening. These hindrances contribute to poor early detection in developing countries. Therefore, more cases are likely to be diagnosed at later stages of the disease, if diagnosed at all.
Prostate Cancer
Prostate cancer affects the prostate. The prostate is a gland found in biological males. The prostate produces seminal fluids, which help to nourish sperms. Therefore, it plays an essential role in male fertility.
The risk of prostate cancer still exists in transgender women because transgender surgeries do not include removing the prostate. As such, transgender women could potentially be affected by prostate cancer.
Although prostate cancer tends to occur in older men, it does not rule out younger men. Prostate cancer mainly affects men over 50 and the risk increases as men age.1 The American Cancer Society also states that prostate cancer rarely occurs in men under 40 years. Furthermore, about 6 out of 10 cases occur in men older than 65.3
Prostate cancer could occur primarily in the prostate. In this case, it is called primary prostate cancer. However, when cancer from a different body part spreads to the prostate, it is called secondary prostate cancer. For example, cancer that begins in the lungs and spreads to the prostate causes secondary prostate cancer. In this scenario, cancer in the lungs would be primary lung cancer.
Causes
There is no definite cause of prostate cancer known presently. However, DNA damage could lead to prostate cancer, similar to other cancers. The DNA controls the growth, development and maturity of the cells which make up our bodies. Changes in the DNA could hamper regulating the cells.
Unfortunately, damaged DNA may be genetically heritable, making biological male children of such an individual susceptible. However, not all DNA damage is inherited. These may be acquired during the lifetime of the affected individual.
Risk factors
Some things increase your risk of developing prostate cancer. As discussed earlier, old age increases the risk of prostate cancer. The most typical age group with a prostate cancer diagnosis is 65 to 69 years.1 However, prostate cancer in adolescents and young men has increased in recent times, increasing in all ages between 15 and 40 years.4
In addition, black men seem to be more prone to developing prostate cancer for unknown reasons. Black men have higher prostate cancer incidence and mortality than men of other races.5 Since this could be due to genes, people of mixed black ethnicity may also be at higher risk of prostate cancer.
Obesity is also a contributing factor. A study concluded that obese men are at a significantly increased risk of dying from prostate cancer.6
The Stages of Prostate Cancer
There are several ways of staging cancers, including prostate cancer. One common way is the TNM (Tumour, Node, Metastasis) system:
- T (tumour): how big the original cancer is.
- N (node): the spreading of cancer to lymph nodes and the location and number of affected lymph nodes.
- M (metastasis): if cancer has spread to other parts of the body, which parts are affected, and how much they are involved.
The results from the above three considerations are combined to give stages 0 to 4, depending on the severity.
Stages 0-4 (Symptoms, key differences, prognosis if diagnosed at each stage)
Prostate Cancer staging:1
- Stage 0: no cancer.
- Stage 1: this is early-stage cancer. A health professional would not feel the tumour during the examination. It involves at most half of one side of the prostate. The cancer cells look healthy, and the PSA (Prostate-Specific Antigen) test is low.
- Stage 2: the cancer is restricted to the prostate. PSA levels may be low or medium. Stage 2 is divided into three sub-stages. In stage 2A, the tumour involves at most half of one side of the prostate, cannot be felt, and the cancer cells still look like prostate cells. In stage 2B, the tumour is restricted to the prostate, but can be felt during digital rectal examination (DRE). The cancer cells moderately look like prostate cells. In stage 2C, the tumour is still restricted to the prostate and can be felt during DRE, but cancer cells may moderately or poorly look like prostate cells.
- Stage 3: The PSA is high, and the cancer is growing. In stage 3A, the cancer has spread to nearby tissues, and PSA is high. In stage 3B, the tumour may have invaded nearby structures like the rectum and bladder, and in stage 3C, the tumour cells look very different from normal cells.
- Stage 4: Cancer has spread far beyond the prostate. In stage 4A, the cancer has spread to regional lymph nodes, and in stage 4B the cancer has spread to distant lymph nodes and other body parts or bones.
Secondary Prostate Cancer
Secondary prostate cancer is prostate cancer that has spread to other parts of the body. Another way of describing this is metastatic prostate cancer. Cancer may extend through the bloodstream or the lymphatic system. The lymphatic system forms part of the immune system. The fluid lymph flows through the lymphatic system, similar to how blood flows through the veins.
In theory, prostate cancer can spread to any part of the body like other cancers. However, it frequently spreads to the lymph nodes and bones.8 Usually, the symptoms you get will be dependent on the area it has spread to. For example, you may have problems with your bowel movement if it extends to your rectum, or you may experience bone pain if it spreads to your bones.
The prostate tends to get bigger as men age. Nevertheless, some symptoms of prostate cancer include problems with urinating, unexplained weight loss, pain in your hip, pelvis, or back, and erectile problems. Although these symptoms are in no way restricted to prostate cancer, it would be beneficial to check with your doctor if you experience such symptoms, especially if you are older.
Treatments and Prevention
The treatments available for prostate cancer include surgery, radiotherapy, and hormone therapy. In surgery, the prostate may be removed. Radiotherapy involves targeting cancer cells with high radiation to destroy them. Alternatively, hormone therapy seeks to cut off the hormone stimulation to cancer cells.
Treatment could involve one or a combination of the above options depending on personal circumstances. It is also possible that prostate cancer can occur again after it has been treated.
Prostate cancer which has already spread to other body parts may be challenging to treat. In advanced prostate cancer, your doctor may manage your symptoms to help improve your quality of life and control the cancer as much as possible.
Many risk factors of prostate cancer are uncontrollable. These include your genes from your parents, growing older, and your race. Have regular checkups with your doctor after you turn 40 so that any sign of prostate cancer is caught early.
Regular checks are also essential for people with relatives who have prostate cancer. Therefore, be sure to disclose this information to your doctor. It is also good to report any unexplained body changes to your doctor. It may be easier to treat when cancer is caught in its early stages.
Living With Terminal Prostate Cancer
Terminal prostate cancer is advanced prostate cancer. In such a situation, prostate cancer is likely to have spread to other parts of the body. As mentioned earlier, the focus of treatment at this stage is improving the individual's quality of life while controlling cancer as much as possible.
The physiological decline one is likely to experience, mental health, and further support.
Prostate cancer is a severe illness, both mentally and physically. Apart from this psychological challenge, there are many adverse effects on your body that are significant and life-transforming changes.
Some organisations may be of support during such difficult times. Age UK is a charity that provides support to the elderly in the UK. Macmillan Cancer Support also provides support to patients suffering from all forms of cancer.
There are several support groups available for people affected by cancer. Your doctor might be able to refer you to an appropriate support group. The experiences shared by other people in these groups may be helpful in your journey with prostate cancer.
Summary
Increasing numbers of younger men are getting prostate cancer. While there are many things that are outside of your control when it comes to prostate cancer, try to make healthy lifestyle choices to reduce your risk.
Avoid eating a lot of processed foods, as these have been linked to increased risk of cancer. Consciously try to incorporate fruits and vegetables into your meals. They have essential vitamins and minerals to boost your immune system. Obesity is also linked to cancer, so staying on top of your diet and maintaining a healthy lifestyle is essential to reducing your risk.
Regular check-ups cannot be over-emphasised for people who have significant risk due to hereditary factors, ageing or their race. Detecting it early is key to increasing your chances of beating cancer.
References
- Prostate Cancer UK. About prostate cancer. [internet]. 2019. [cited 2022 Feb 2]. Available from: https://prostatecanceruk.org/prostate-information/about-prostate-cancer
- Haas G.P., Delongchamps N., Brawley O.W., Wang C.Y., de la Roza G. The worldwide epidemiology of prostate cancer: perspectives from autopsy studies. Can J Urol. 2008 Feb;15(1):3866-71. PMID: 18304396; PMCID: PMC2706483. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706483/
- American Cancer Society. Prostate Cancer Risk factors. [internet]. [cited on 2022 Feb 3]. Available from: https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html
- Bleyer A., Spreafico F. and Barr R. Prostate cancer in young men: An emerging young adult and older adolescent challenge. 2020 January 1;126(1):46-57. Available from: https://doi.org/10.1002/cncr.32498
- Chinegwundoh F. I. The relationship between black men with prostate cancer and their health-care providers. Nat Rev Urol 18. 2021 October 4. 18. 701–702. Available from: https://doi.org/10.1038/s41585-021-00525-6
- Freedland S.J. and Aronson W.J. Examining the relationship between obesity and prostate cancer. Rev Urol. 2004. 6(2):73-81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550782/
- Cancer.Net. Prostate cancer: stages and grades. [internet]. 2021. [2022 March 6]. Available from: https://www.cancer.net/cancer-types/prostate-cancer/stages-and-grades
- Prostate Cancer UK. Advanced prostate cancer. [internet]. [2022 March 6]. Available from: https://prostatecanceruk.org/prostate-information/just-diagnosed/advanced-prostate-cancer