Men's Health Week 2021: Understanding Prostate Cancer

Introduction

The National Cancer Institute defines Prostate cancer as "Cancer that forms in tissues of the prostate (a walnut-sized gland in the male reproductive system found below the bladder and in front of the rectum)" . Uncontrolled or malignant growth of cells in the prostate gland leads to prostate cancer. The prostate gland helps to produce and store fluids that aid in semen formation. According to the Cancer Statistics Report of 2020, India had around 41,532 males who had prostate cancer. The cumulative risk of developing prostate cancer at 0-74 years of age, according to the report, was found to be 1 in 125 males. According to the American Cancer Society, prostate cancer is more likely to develop in older men and non-Hispanic Black men. Prostate cancer is known to be the second leading cause of death in the USA. About one man in 41 dies of prostate cancer in the USA. Some prostate cancer grows slowly and is confined to the prostate gland only. They need minimal or no treatment. However, some prostate cancer becomes too aggressive and thus spreads quickly. On Men’s Health Week, we would let you understand prostate cancer through this simple article. This article explains the types of prostate cancer, its causes, risk factors, classification, symptoms, treatment, management, and prevention of prostate cancer, creating awareness among males.

Types of Prostate Cancer

The different types of prostate Cancer gives information about the type of the cell the cancer started in. The different types of Prostate Cancer include:

• Acinar Adenocarcinoma: Most common type of cancer that develops in the gland cells that line the prostate gland.
• Ductal Adenocarcinoma: It is a cancer that starts in the cells that lines the ducts of the prostate gland.
• Transitional cell or Urothelial Cancer: This cancer starts in the bladder and spreads to the prostate.
• Squamous Cell Cancer: Cancers that originate from the flat cells that cover the prostate.
• Small Cell Prostate Cancer: It is a type of neuroendocrine tumor and is made up of small round cells.

Cause of Prostate Cancer

The scientific conclusion on how prostate cancer is caused is still under research. However, a simple explanation that is being put forward is that prostate cancer is caused by changes in the DNA of a normal prostate cell. DNA contains specific genes that help the cells to grow, divide, and increase. These genes are called Oncogenes. There is also another category of genes present inside DNA that keeps cell growth under control, repair damages to the DNA, and cause cells to die at the right time. These genes are called Tumor Suppressor Genes. Thus, when the tumor suppressor genes turn off, and oncogenes remained turned on due to mutations in the DNA, these lead to cancers (uncontrolled growth of cells).

Similarly, inherited mutations in the genes like BRCA1, BRCA2, CHEK2, ATM, PALB2, RAD51D, RNASEL, and HOXB13 also leads to an increased risk of prostate cancer. Some studies have also found that inflammation that leads to cell DNA damage of the Prostate Gland can also lead to prostate cancer.

Risk Factors for Prostate Cancer

The risk factors for Prostate Cancer Includes:

• Men who are older in age (greater than 50 years of age). According to the American Cancer Society, 6 in 10 cases of prostate cancer are found in men older than 65.
• Obese people have higher chance to get prostate cancer. It has been found that the prostate cancer found in obese people is aggressive and returns after initial treatment.
• It has been found that men who are African-American, or Caribbean of African ancestry, are highly vulnerable to have prostate cancer. These racial and ethnic differences are scientifically still under research
• Inherited or Genetic Factor.
• Mutations in the genes as discussed above.

Classification of Prostate Cancer

Prostate cancer is classified depending on how advance stage is the disease. Prostate cancer is classified as follows:

1. Localized Prostate Cancer
   These type of cancer is completely restricted within the prostate gland. It does not spread to anywhere else in the body. It is divided into three groups:
   Group1: Low Risk Prostate Cancer
   Group 2: Medium Risk Prostate Cancer
   Group 3: High Risk Prostate Cancer
2. Locally Advanced Prostate Cancer: When prostate cancer spreads beyond the prostate gland, it is called Locally Advanced Cancer.
3. Metastatic Prostate Cancer: When prostate cancer has spread to other parts of the body and is metastatic by nature i.e. super aggressive.

Prostate cancer is also classified based on its grade according to the Gleason Score:

Gleason score is calculated by addition of two most common Gleason grades from the samples. For example, if the most common grade is grade 4, and the second most common is grade 5, then the overall Gleason score is 9. The Gleason scores in prostate cancer falls in the range from 6 to 10. The higher the Gleason score, the more abnormal or dangerous is the cancer.

Symptoms of Prostate Cancer

Since prostate cancer is very slow in growth, the symptoms in its early stage are not present. However, as the cancer moves to be more advanced tumor, it will lead to the following signs and symptoms:

• Difficulty to urinate
• Presence of blood in urine
• Presence of blood in the semen
• Pain in the bones
• Sudden decrease in weight without any diet or exercise
• Erectile Dysfunction

Diagnosis of Prostate Cancer

Patients who are above 50 years of age and have any family history of prostate cancer or are of African origin, or suffer from obesity, are advised to carry out a prostate screening test. The prostate cancer screening test includes two types of screening:

1. Digital rectal exam (DRE)
2. Prostate-specific antigen (PSA) test

If the doctor finds any abnormality during screening, then he/she may recommend carrying out further diagnostic tests to get confirmation. The diagnostic tests include:

• Transrectal Ultrasound Test that creates a picture of the prostate gland through the sound wave.
• Magnetic Resonance Imaging
• Prostate Biopsy with the help of a thin needle

Prostate cancer is ‘staged’ according to tumour size, whether it has spread to the lymph nodes and whether it has spread into the bones or to other parts of the body. This information is used to help decide the best treatment.

Treatment and Management of Prostate Cancer

The treatment of prostate cancer depends on many factors like the tumor's aggressiveness, whether the patient will receive any benefit if he/she undergoes treatment, and finally, the patient's overall health condition.

When prostate cancer is in its initial stage, immediate treatment is not necessary. Doctors advise patients to be under active surveillance, including regular follow-up blood tests, rectal exams, and prostate biopsies to check the progress of cancer.

The US FDA has approved more than 30 drugs to treat prostate cancer during the advanced stage. AHABIR 250MG TABLET of Hetero Healthcare Limited is also prescribed to treat prostate cancer. The drug contains Abiraterone Acetate as the significant active pharmaceutical Ingredient. It works by stopping the body from producing testosterone (male hormone), thereby slowing the growth of prostate cancer.

Another method that is used to treat prostate cancer is surgery. In surgery, the prostate gland is removed along with few lymph nodes and surrounding tissues by radical prostatectomy. Surgery is done only after the physician thinks it is necessary.

The other methods of treating Prostate cancer include:

1. Radiation Therapy
2. Freezing or heating the prostate tissue
3. Hormone therapy
4. Chemotherapy
5. Immunotherapy and Targeted Drug Therapy

How to Prevent Prostate Cancer?

Prostate cancer can be prevented by the following methods:

• Males should eat healthy diet rich in green leafy vegetables, fruits, and whole grains
• Foods that are rich source of vitamins and minerals should be included in the diet.
• Exercise everyday by going to the gym, jogging, or do yoga, or play physical games outdoor in the field.
• Keep a check of your BMI and avoid street foods and oily foods. Drink sufficient amount of water daily.
• Always do a routine health screening. This will help you in marinating your overall health.