The prostate is a small walnut shaped gland in the pelvis of men. It is located next to the bladder. It helps control urine flow, produces fluid components of semen and produces prostate specific antigen (PSA).
Prostate cancer (CaP) is a form of cancer that develops in the prostate gland. Approximately 60–70% of cases of CaP originate in the peripheral zone of the prostate. More than 95% of the prostate cancers are adenocarcinomas, which develop in the glands that line your organ. The axial skeleton is the most usual site of distant metastases, with the lumbar spine being most frequently implicated.
Prostate cancer numbers and deaths vary around the world but are higher in North America and Northern Europe.
Prostate Cancer is the second most common cancer in males and major health concern, especially in developed countries.
About 1 in 7 men will be diagnosed with prostate cancer during his lifetime.
About 1 in 41 men will die of prostate cancer.
Prostate cancer is rare before the age of 40.
Mean age at diagnosis is 66.
Prostate Cancer has a 99% 5 year survival rate when detected early.
There are three well-established risk factors for prostate cancer;
Increasing age: Most common in men over 40 years of age.
Damage to the genetic material (DNA) of prostate cells is more likely for men over the age of 55.
Ethnic origin: African-American men and Caribbean men of African ancestry.
One in six African American men will get prostate cancer. African American men are more likely to get prostate cancer at an earlier age. Men within this population are also more likely to have aggressive tumors that grow quicker, spread and cause death.
Genetic predisposition: Men with a strong family history of prostate cancer, especially multiple first-degree male relatives who were diagnosed at a young age.
A man with a family history of prostate cancer is 2 to 3 times more likely to get prostate cancer if his father, brother or son had it.
Moreover, lifestyle factors such as, smoking and a high caloric diet have been linked to a higher risk of developing prostate cancer. Studies have shown that prostate cancer risk may double for heavy smokers. In addition smoking, poor diet choices, a hypercaloric diet and obesity have all been linked to a higher mortality rate in men with prostate cancer.
In addition, the intake of certain vitamins and antioxidants such as, lycopene, selenium, omega-3 fatty acids, and vitamin E have been shown to be protective against prostate cancer, whereas, vitamin D and calcium increase risk.
In its early stages, prostate cancer often has no symptoms. When symptoms do occur, the most common are as follows:
Dull pain in the lower pelvic area
Trouble urinating, pain, burning, or weak urine flow
Blood in the urine (Hematuria)
Pain in the lower back, hips or upper thighs
Loss of appetite
Loss of weight
Prostate cancer is usually suspected on the basis of digital rectal examination (DRE) and/or prostate specific antigen (PSA) levels. However, a definite can only be made through histological verification in prostate biopsy cores, specimens from transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP) , Thulium laser enucleation of the prostate (ThuLEP), Prostatectomy or prostatectomy for benign prostatic enlargement.
"Screening" means testing for a disease even if you have no symptoms. The two tests that are commonly used to screen for prostate cancer.
The prostate specific antigen (PSA) blood test: Prostate-specific antigen (PSA) is a protein produced by benign and malignant cells of the prostate gland. PSA is used both as a diagnostic (screening) tool and as a means of risk-stratifying known prostate cancers.
A “normal” PSA has traditionally been defined as ≤4 ng/mL, and the positive predictive value of a serum PSA between 4 and 10 ng/mL is approximately 20–30%.
Digital rectal examination (DRE): During the digital rectal examination the doctor will evaluate the size, consistency, symmetry of the prostate.
A prostate biopsy should be considered in men with an elevated serum PSA, abnormal DRE, or a combination of the two.
Screening is recommended to:
All men over 40 with or without risk factors
Men with African–American descendant
Men with a family history of prostate cancer
European Association of Urology. EAU-EANM-ESTRO-ESUR-ISUP-SIOG GUIDELINES ON PROSTATE CANCER 2021. www.uroweb.com
American Association of Urology. Early Detection of Prostate Cancer (2018). www.auanet.org
World Cancer Research Fund & American Institute if Cancer Research.https://www.wcrf.org/dietandcancer/prostate-cancer-statistics/
Smith & Tanagho’s General Urology. Chapter 23. Neoplasms of the Prostate Gland.
Urology Health Foundation. https://www.urologyhealth.org