What is Prostate Cancer: Symptoms, Causes, Types, & Treatment
In a matter of just 10 years, India has become the third country in the world with the largest population of cancer patients. While Breast and Pelvic Cancer are more common in women, the most common cancer in men, so far has been Lung Cancer. However, in the recent years, Prostate Cancer or “prostatic carcinoma” has quickly risen to be the second most common cancer in men. As far as estimates of instances go, the number of cases have risen from ~4 per 1,00,000 men being diagnosed with prostate cancer in 2008-2009 to ~10 per 1,00,000 men being diagnosed with prostate cancer in 2016-2017, leading to a population rise of prostate cancer patients from less than 0.20% in 2008 to nearly 9% in 2016. Researchers have claimed that by 2030, number of registered cases for prostate cancer would be around 1.7 million, of which nearly 500,000 would die because of the disease.
- What is Prostate Cancer?
- Causes, Symptoms And Risk Factors of Prostate Cancer:
- Types of Prostate Cancer
- Latest Development in Prostate Cancer Research:
- Prostate Cancer: Screening and Diagnosis
- Staging and Grading of Prostate Cancer
- Stages of Prostate Cancer:
- Things You Should Know About Prostate Cancer:
- Prostate Cancer Treatment:
- Prostate Cancer Myths
What is Prostate Cancer?
Like all cancers, prostate cancer is named after the organ it develops in, this cancer develops in the prostate of a male (a walnut-sized, sack-like structure, placed behind the penis of a male). The prostate is responsible for secreting, nurturing and storing healthy sperms. Like all organs of the human body, the cells of a prostate glands divide and die within a specific time period, ensuring that the gland functions at the optimum level. However, due to certain gene mutations, the cells of the prostate gland are unable to kill old cells, and continue dividing themselves uncontrollably. This uncontrolled division of cell without any means to dispose off the old cells leads to the formation of excess cells in the gland. These excess cells amassed together contribute to the development of prostate cancer.
Causes, Symptoms And Risk Factors of Prostate Cancer:
Researchers everywhere, along with the American Cancer Society claim that there are no documented reasons for the development of cancer in one body, and no changes in the other, when they are exposed to the same environment, nutrition and lifestyle. It is now believed that some human bodies are more sensitive to cancer, and this sensitivity could be caused for various reasons, but the presence of such cells in the body increase the risk factor of the development of cancer in a human body. Some of the common risk factors and symptoms of prostate cancer include:
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1. Is Prostate Cancer Hereditary?
According to the data provided by Memorial Sloan Kettering Cancer Centre nearly 10% of all prostate cancer cases are hereditary. While it is true that anyone can suffer from prostate cancer, it is also true that family history plays an important role in determining the risk of developing prostate cancer.
Researchers have discovered that an inherited mutated BRCA2 gene strand can increase the risk of developing prostate cancer.
Similarly, if there is a family history of prostate cancer, especially among first relatives, a person is at a higher risk of developing prostate cancer. Thus, if a man’s father or brother has been diagnosed with prostate cancer, his chances of developing the disease increases twofold.
However, if both father and brother have been diagnosed with prostate cancer, his chances of developing prostate cancer increase fivefold.
2. Why is Prostate Cancer Common Nowadays?
Incidences of reporting of prostate cancer are higher today because of the following reasons:
- Awareness: The incidents of reporting/recording of prostate cancer cases have increased because of the awareness around the disease.
- Longer lifespan: Prostate cancer is ideally an old age disease, since we have a better survival rate than our ancestors, we have more old people and that increases the chances of more incidences of prostate cancer.
- Hormones and Lifestyle: Prostate cancer is a hormone dependent cancer tumor. Unregulated and unhealthy lifestyle can lead to a hormonal imbalance, which in turn can fuel the growth of tumors causing cancers.
Types of Prostate Cancer
Prostate cancer generally develops inside the prostate cancer and are generally known as adenocarcinoma. There are other types of prostate cancer too but they are very rare, based on their points of origin, prostate cancer has been divided into four types:
Nearly all patients suffering from prostate cancer show symptoms and suffer from adenocarcinoma. Depending on their exact point of origin, adenocarcinoma has been divided into two types:
Cancer develops in the gland cells lining the walls of the prostate gland. This is the most common type of prostate cancer and over 90% of cases are diagnosed with this type of cancer.
Cancer develops in the ducts of the prostate cancer. This type of cancer spreads faster than the acinar adenocarcinoma.
Sarcoma or soft tissue sarcoma develops in the soft, connecting tissues of the body like fat, blood vessels, nerves, deep skin and so on. Nearly 50% of this rare cancer patients are over the age of 65 years.
3. Transitional Cell Carcinoma:
Transitional Cell Carcinoma originates on the connecting tissue that guides urine to the urethra. Generally, the cancer in this case originates in the bladder and spreads to the prostate gland. In rare cases, the cancer emerges from the prostate gland and spreads to the bladder.
4. Small Cell Carcinoma:
Small Cell Carcinoma or Oat Cell Carcinoma look like small and round cells when observed under a microscope. This type of cancer is extremely rare, only 2 patients in 100 cases ever suffer from small cell carcinoma. The symptoms of this kind of cancer are similar to those of adenocarcinoma.
Latest Development in Prostate Cancer Research:
In 2015, the journal EBioMedicine published a study conducted by the Cancer Research UK Cambridge and Addenbrooke’s Hospital. Researchers analysed samples from 250 subjects consisting of both healthy and cancer patients. The researchers used different methods, which they claim are much more effective than those used by diagnostics today. The methods employed by the researchers resulted in the possibility of dividing prostate cancer into 5 types.
This research report is considered path-breaking as it can potentially bring healthcare providers closer to understanding and effectively treating prostate cancer, improving the quality of life in the process.
Prostate Cancer: Screening and Diagnosis
Prostate cancer screening is a precautionary step to identify early signs of cancer and as such, its requirement is heavily contested. While some physicians argue that men must start planning regular screening for prostate cancer as soon as they reach 50 years of age. Men who have a family history of prostate cancer must start with the screening process much before reaching 50 years of age. The screening for prostate cancer is conducted in two ways:
1. Digital Rectal Examination (DRE):
Digital Rectal Examination or DRE is a physical test. The doctor or nurse inserts a gloved and lubricated finger inside the rectum of an individual. The prostate gland is next to the rectum in the human body, by inserting a finger in the rectum, the doctor or nurse can examine the prostate and detect any changes in the shape of the prostate.
2. Prostate Specific Antigen (PSA):
Prostate Specific Antigen test is a blood test. This test measures the amount of PSA present in the body. PSA is an agent produced by the prostate gland in trace amounts, if there is an increased level of PSA in the bloodstream, it does not conclusively point to prostate cancer, but makes it a possibility. Other reasons for high SA levels may include, prostate infection, prostate enlargement, medicines and medical treatments.
It is important to remember that the screening process in itself is only indicative of changes in the prostate, they do no diagnose or determine the presence of cancer cells. The doctor plans diagnostic exams for a patient, only if the screening tests are positive for changes in the prostate. A doctor may ask the patient to plan for any one or more of the following diagnostic tests to effectively determine the presence of cancer-
3. Transrectal Ultrasound or TRUS:
Transrectal Ultrasound is a small probe is inserted in a patient’s rectum. The probe uses sound waves to create an image of the prostate gland, this method can be used to determine the change in shape of the prostate gland. The TRUS can also be used to create an image of the of the tumor present inside the prostate gland. This test is opted for when the patient’s PSA levels are very high and the DRE results are abnormal.
While TRUS can create an image of cancer, to get more accurate details the doctor may plan for a biopsy. During the biopsy, the doctor will use the TRUS probe to guide his needle to the prostate. A sample of skin, from the centre of the prostate or the affected area of the prostate, would be extracted via a needle. This extracted skin would then be sent to the lab to be observed under a microscope. This process will help determine the stage and grade of cancer.
Staging and Grading of Prostate Cancer
Before we start understanding the metrics for grading and staging prostate, we must first understand what staging and grading prostate cancer mean. Staging of cancer involves understanding the spread of the disease. Staging helps determine the course of treatment for a patient. Grading, on the other hand, predicts the aggression levels of cancer, this is specifically important during the early stages of cancer, as it can help design an effective treatment course. Both the grade and stage of a cancer are necessary to map out an effective treatment plan for the patient.
The score employed for grading prostate cancer is also known as Gleason Grade Score. This grading depends on how much the cancer cell resembles a normal healthy cell when observed under a microscope. This grading system is the most common grading system for prostate cancer. The table below is an analysis of the Gleason Grades for Prostate Cancer:
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4. Nodes (N):
“N” in the TNM system stands for Lymph Nodes. Lymph nodes are generally responsible for prevention of infections in the human body. The lymph nodes present at the prostate gland are known as regional lymph nodes. There three types of Lymph Node stage determination:
- N0: The cancer is present in the organ but it has not spread to the lymph nodes.
- N1: The cancer has spread to regional lymph nodes, in the case of the prostate gland, it is the pelvis.
- NX: Inability to evaluate the regional lymph node.
5. Metastasis (M):
Metastasis is the “M” in the TNM system, this represents the spread of the cancer from the point of origin to other parts of the body. There are three types of Metastasis:
- M0: Despite the presence of cancerous tumor, the cancer has not yet begun to spread on other parts of the body.
- M1: The cancer has spread to distant organs of the body. Depending on the nature and trajectory of the spread of cancer, it is divided into three parts:
- M1a: The cancer has spread to distant lymph nodes.
- M1b: The cancer has spread to distant organs like the bones.
- M1c: The cancer spread to another part of the body, it may or may not have spread to the bones.
- MX: Inability of the evaluation of metastasis to distant organs or lymph nodes.
Stages of Prostate Cancer:
Doctors and diagnostic experts generally club the results from the TNM system testing, PSA levels and the Gleason Grading to assign a particular stage to the patient’s malignant tumor or cancer cells. Depending on the combination of the TNM system, PSA levels and the Gleason Grading system, prostate cancer is divided into 4 stages:
Stage I Prostate Cancer:
Cancer is at the earliest stage at this stage. It most likely is confined to less than one half of one side of the prostate gland, the growth of the cancer is slow, even the PSA levels are low at this stage. The tumor cannot be felt during a physical examination and the cancer cells resemble healthy cells the most here.
Stage II Prostate Cancer:
At this stage, the tumor is contained within the prostate glands, however, there is an increased risk of the growth and spread of the tumor and cancer cells. The size of the tumor is small though, at this the PSA levels are either borderline high or medium-high than normal levels. This stage is divided into three sub-stages:
- Prostate Cancer Stage IIA
At this stage, the tumor cannot be felt during a physical examination and is contained within one half or less than one half of one side of the prostate gland. The determining factor for this stage is the well differentiation of the cancer cells, even if the tumor is larger and medium PSA levels.
- Prostate Cancer Stage IIB
The tumor is still contained inside the prostate gland but is large enough to be detected during DRE, the PSA levels are medium, but the telling factor is the cell differentiation, which is moderate at this stage.
- Prostate Cancer Stage IIC
The tumor is limited to the prostate gland, it is large enough to be detected through DRE. PSA levels are medium, cell differentiation may be either poor or moderate, but leaning towards poor.
Stage III Prostate Cancer
The cancer has grown locally, this stage is generally considered as an advanced stage. The PSA levels at this stage are high, and the cancer is likely to spread to nearby organs. This stage is divided into three sub-stages:
- Prostate Cancer Stage IIIA
At this stage, the cancer has spread outside the prostate, it may also have penetrated the seminal vesicles or the tube that carries the semen. PSA levels are also high.
- Prostate Cancer Stage IIIB:
Cancer has spread much wider than it does at stage IIIA and has now invaded nearby organs like colon, rectum and bladder.
- Prostate Cancer Stage IIC:
The cancer has spread to other parts of the body and the cancer cells observed under a microscope are poorly differentiated.
Stage IV Prostate Cancer
Stage IV of cancer is also known as the last stage of cancer. The cancer at this stage has spread beyond the prostate gland and has invaded distant organs. This stage is subdivided into two types.
- Prostate Cancer Stage IVA
At this stage the cancer has spread from the prostate gland to the local/regional lymph nodes.
- Prostate Cancer Stage IVB
At this stage the cancer has spread to distant lymph nodes and distant organs like bones.
Repetitive cancer is the cancer which returns after the successful treatment of the same. In the case of prostate cancer, this cancer can either repeat itself in the prostate gland itself or evolve in some other body part. New tests would be conducted to formulate a new treatment plan for the patient.
Things You Should Know About Prostate Cancer:
1. Is Prostate Cancer Curable?
To be very precise, yes, prostate cancer is curable. PSA screening tests ensure that prostate cancer is generally detected at an early stage, which means that non-invasive treatments can be employed to cure a person of prostate cancer. However, one needs to understand, that in medical sciences, prostate cancer is considered cured, if the patient doesn’t face any side effects or relapse in the next five years from the date of the last treatment session.
This explanation by definition means that if a person, treated for prostate cancer, does not show any symptoms of relapse then he is considered a cure. However, it is also a fact that high-intensity treatment methods for early-stage cancer do not immune a patient from the likelihood of a relapse, and a patient could relapse at any point, before or after five years of the last treatment session date.
2. Prostate Cancer Survival Rate:
Senior doctors from AIIMS assert that if prostate cancer is detected early, it can be managed and controlled like all other chronic diseases, meaning that a person can easily lead a normal life for 10-15 years after being diagnosed with prostate cancer, according to medical practitioners at AIIMS the survival rate among men with prostate cancer is 60%. However, according to a report published by the Business Standard in 2017, nearly 70% of cancer patients consult a doctor only when their cancer is at the terminal stage.
A large portion of this 70% population belongs to rural India where lack of awareness and access to quality healthcare results in ignoring the symptoms till they are unmanageable. If cancer is detected at the terminal stage, no treatment can help contain the damage.
Prostate Cancer Treatment:
Mainstream medicine uses a mix of several approaches to design a treatment plan for a patient. Depending on the stage of a man’s prostate cancer, a combination of two or more following approaches can be employed to treat cancer.
1. Regular Surveillance:
If cancer is detected at an early stage, the doctor may suggest that the patient wait and monitor the progress of the cancer. Regular surveillance would require frequent screening tests to ensure that the cancer has not spread or changed. This exercise is generally suggested for patients who are comparatively younger in age. Another version of regular surveillance is waiting. Patients who are slightly older and diagnosed with early stage cancer are expected to wait for the cancer to show any signs of progression. This controlled observation allows the doctor to take necessary action at the correct time.
Surgery is an invasive action, where a part of the prostate or the entire gland is removed from the body of the patient. However, removal of the prostate gland interferes with the normal bodily functions of the individual leading to urinary incontinence or erectile dysfunction. A patient may be given further medicines to help aid the body in its normal functions.
Chemotherapy again is an invasive therapy where chemicals that destroy cancer cells are introduced into the body via an IV drip. The side effect of chemotherapy is that the chemicals also destroy other normal growth cells like hair, leading to hair fall. Chemotherapy can also cause nausea and vomiting as well as lack of appetite.
4. Radiation Therapy:
Traditionally radiation therapy is the exposure of the affected portion of the body to high-intensity heat waves, which then kill off any cancer cells that might have been left behind despite the surgery. In the case of prostate cancer, it is even more difficult to pinpoint the exact area for radiation therapy, which results in the radiation from damaging healthy cells in the process too.
However, in 2017 the Institute of Cancer Research, London put forward a clinical trial report claiming that Intensity Modulated Radiotherapy (IMRT) can help cure even incurable stages of cancer. The trial was conducted with 447 men, of which many patients were incurable. The clinical trial, which comprised of giving high dosage of radiation directly to the cancer cells, this protects the surrounding healthy cells. The result of this clinical trial was that 71% of the patients were cured i.e. the cancer cells were destroyed without any side effects faced by the patient, and did not relapse for the next five years.
More research is being conducted by scaling the number of participants to determine the effectivity of this therapy.
5. High Intensity Focused Ultrasound (HIFU):
High Intensity Focused Ultrasound is the conversion of low energy sound waves to the heat source. This high intensity and highly focused heat source protect the surrounding healthy cells but lead to the destruction of malignant cancer cells. This kind of cell death leaves behind a scar tissue at most. Also, low energy sound used in this treatment does not damage any healthy cells. However, more research is underway to understand the impact of this therapy.
6. Hormone Therapy:
Prostate cancer is a cancer which is dependent on male hormones called androgens for growth. Hormone therapy is a process by the number of androgens is reduced in a man’s body to contain the growth of cancer. The side effects of hormone therapy include loss of sexual drive, insulin resistance, the growth of breast tissue, weight gain, mood swings, loss of bone density among others.
Homeopathy believes that like cancels like and prepares all treatment plans along these same lines. Dr. Hahnemann was the proprietor of the Homeopathic approach to healing the body. Homeopathic practitioners believe that symptoms of a disease are also indicators of deeper health issues and that the body can be healed as a whole by identifying the root of the disease. Homeopathic practitioners generally provide a patient with trace amounts of the disease causing agent as medicine, the underlying belief being that trace amounts of the disease causing agent can help build the body’s resistance to the disease in the long run. Homeopathy is a time-taking medical approach.
India recognizes homeopathy as an alternate path of medicine, the western world maintained that homeopathy was quackery, till very recent times. However, the effects of homeopathic treatments, especially in the case of cancer reversion is now leading to a change in the way western medicine views homeopathy.
The Banerji Protocol proved that given the correct amount of time, homeopathy can contain, reverse and cure cancer. Further research is being conducted in the field, however, most homeopathy practitioners argue, that homeopathy does not stand in opposition of modern medicine. In fact, to most homeopathic practitioners, an effective approach of dealing with chronic diseases is to combine modern medicine practices with homeopathic practices.
To know more about Homeopathy Read: All About Homeopathy: History, Benefits and Side Effects
Ayurveda is the wealth of knowledge of the ancient world. Ayurvedic medicines are herbal and safe, and ayurveda is suddenly becoming popular in the western world as a form of soul to body healing medicine. Ayurveda recognises four types of tumors, Granthi, Gulma, Utsedha and Arbuda. Of these, Arbuda is recognized as a malignant tumor.
Before modern science defined cell life, structure and activity, the ancient Indians believed that every cell is a life source in itself, with a conscious mind and ego. In a healthy body, cells communicate with each other, however, when there is an unhealthy imbalance in the body, cells may get isolated from each other, leading to the formation of an uncooperative ego in a cell. This uncooperative cell would start creating its own ecosystem revolving around it. It is this unregulated expansion of the egoistical cell which leads to the formation of malignant cancerous cells.
Prostate is a symbol of the shukra dhatu, and the development of cancer in this organ speaks volumes about the disrespect with which one treated his own body.
Ayurvedic solutions to controlling and healing the body from prostate cancer involves dietary changes more intake of androgen reducing foods, use of essential oils to calm and heal the body, Yoga, change of lifestyle and use of herbs for healing. Many of these herbal solutions are available in the market today. However, we would suggest consulting your ayurvedic physician along with your modern medicine health care provider before embarking on an ayurvedic treatment plan.
Also Read: 7 Super Foods for a Healthy Prostate
Prostate Cancer Myths
- Prostate Cancer is caused because of STDs
While sexually transmitted diseases like gonorrhea can cause inflammation of the prostate gland, researchers have been unable to establish a link between the development of prostate cancer and history of sexually transmitted diseases. In simple words, all research conducted in this field prove that STDs do not cause prostate cancer.
- Prostate Cancer is caused because of prostate Inflammation
Prostate inflammation disease or prostatitis is believed to cause prostate cancer, however, it should be noted that this premise is still under research. The research reports so far have no established any link between the development of prostate cancer and the presence of prostate inflammation disease.
- Prostate Cancer is a geriatric disease
It is true that prostate cancer is the most prevalent in men above the age of 65 years, however, one should remember that there are other risk factors to account for. A family history of prostate cancer among primary relatives may lead to the development of the same in an individual at a much younger age.
- Vasectomy causes prostate cancer
This is a highly contested premise, while some studies have merely suggested that vasectomy might increase the risk for prostate cancer, other studies have vehemently denied this association. Effects of vasectomy in the development of prostate cancer is still a highly researched topic, the results of which are awaited.
- PSA Test is the ultimate cancer test
Several people mistakenly believe that raised levels of PSA in a PSA test conclusively indicates prostate cancer. While it is true, that PSA test can point the doctor in the correct direction, it is also true that PSA levels could also be raised because of prostate inflammation caused by other diseases. PSA test only indicates the possibility of prostate cancer, a definitive diagnosis is made only after carrying out diagnostic tests.
- No family history of prostate cancer means no chances of developing the disease
This is not true. It is however true that family history is the most common contributor to the development of prostate cancer in a person, there are other risk factors that one must keep in mind. Regular screening after the age of 50 should be planned by all men, as the real causes of the development of cancer in the human body is unclear, thus, everyone should consider themselves at risk.
- Lack of cancer symptoms means absence of disease
Prostate cancer is an asymptomatic cancer. The initial stages show no symptoms, even the inflammation of prostate is often mistaken as other diseases. Even urinary incontinence and erectile dysfunction are assumed to be some other disease. By the time a patient feels bone pain, lethargy, pain in the pelvis, the cancer has already developed to the terminal stage. This asymptomatic tendency of prostate cancer makes regular screening all the more necessary.
- Prostate Cancer is a slow growing disease and hence is no cause of worry.
This again is not true. Yes, some types of prostate cancer are slow growing and their symptoms can be managed through regular screening and medication, allowing the patient to lead a normal healthy life. Other types on prostate cancer, on the other hand, are extremely aggressive and if not treated in time can reach the terminal stage quickly. It is best to consult your healthcare provider about the nature and type of your prostate cancer and the most effective treatment plan for it.