What is prostate cancer
Prostate cancer is the result of a disordered multiplication of the prostate cells – a gland located between the penis and the urinary bladder. It is the second most common cancer in men, second only to non-melanoma skin cancer.
More than any other type, it is considered a cancer of old age, since about 75% of cases worldwide occur after the age of 65.
Some tumors can grow rapidly, spreading to other organs. Most, however, grow very slowly (it takes about 15 years to reach 1 cm³), which does not show signs during life and does not threaten a man’s health.
Prostate cancer subtypes
When a patient is diagnosed with prostate cancer, it is very likely that the oncologist will refer to adenocarcinoma, which accounts for 95% of the cases of the disease. This type of tumor develops from glandular cells.
There are other types of prostate cancer, which originate in other prostate cells, but they are very rare. Small cell carcinoma, for example, does not reach 1% of the cases, but it requires attention because it is considered a more aggressive subtype of the disease.
There are also neuroendocrine tumors and transitional cell carcinomas.
Symptoms and signs of prostate cancer
Prostate cancer, in its initial phase, presents no signs and develops silently. Symptoms only appear when most of the tumors are in an advanced stage.
In this disease phase, the most common symptoms are:
- Feeling that the bladder has not emptied completely;
- Difficulty in starting the passage of urine or interrupting the act of urination;
- The need to push to keep urine flowing
- Feeling of pain in the lower back or pelvis (below the testicles)
- Difficulty in achieving or maintaining an erection;
- Blood in your urine or sperm (these are rare)
- Pain when you ejaculate;
- Pain in the testicles.
Prostate cancer diagnosis
Since it is a tumor that develops silently, preventive exams are fundamental for the early detection of prostate cancer. Two tests are used: the blood test and the clinical exam.
In the blood test, the prostate-specific antigen (PSA) dosage is performed, an enzyme produced by prostate cells whose increased concentration can indicate changes in the organ – in addition to cancer, it is an indicator for other conditions such as prostatitis and benign prostatic hypertrophy. Therefore, the best diagnostic approach is to associate the blood test with the rectal examination.
Even though it is painless, there is still a lot of prejudice against the rectal examination. But it is essential for the detection of prostate problems. Through the rectal touch, the doctor can palpate the prostate and notice if there are nodules (lumps) or hardened tissues, an indicator of early-stage disease.
When prostate cancer is suspected, other tests come into play to confirm not only the disease, but also its stage. These are the tests:
- Biopsy – the removal of gland tissue samples for analysis is carried out with the aid of ultrasonography. There may be discomfort and blood in the urine or semen in the days following the procedure. The biopsy is the only test that confirms if the tumor is malignant;
- Imaging exams – computed tomography, magnetic resonance imaging and bone scintigraphy can be requested in order to evaluate the extension of the problem and check for the presence of cancerous cells in other organs or bones.
The therapeutic alternatives for prostate cancer depend on the stage of the disease. The treatment to be defined by the physician is always individualized.
In general, for localized disease, which only affects the prostate, the standard scheme is surgery and/or radiotherapy.
For locally advanced disease, the treatment protocol may include radiotherapy or surgery in conjunction with hormone treatment.
In cases of metastatic disease, when the tumor has already spread to other parts of the body, the most indicated treatment is hormone therapy.
There is no specific guidance for the prevention of prostate cancer. Besides performing the preventive tests for early detection of the tumor, the other guidelines are common to most cancerous tumors. They refer to:
- Obesity – excess body weight, which raises the risks of developing various cancers, is also associated with a higher risk of prostate tumors;
- Diet – there is no direct relationship between diet and prostate cancer, but there is evidence that excess calorie consumption and the intake of red meat and fats, as well as cigarettes and alcoholic beverages, increase the risk of developing the disease. On the other hand, consumption of fruits, vegetables rich in carotenoids (such as tomatoes and carrots), and legumes (such as beans, peas, and soybeans) has been associated with a protective effect;
- Age – prostate cancer is rare in men under 40, but the risk of getting prostate cancer increases rapidly after age 50. Approximately 6 out of 10 cases of prostate cancer are found in men over 65;
- Ethnicity – prostate cancer develops more often in African-American men and Caribbean men of African descent than in men of other ethnicities. And when it does develop in these men, they tend to be younger. The reasons for these ethnic differences are not clear;
- Genetics: If there are other risk factors, such as heredity, the disease can appear in younger men. The main criteria for defining whether there is an increased risk associated with heredity are: three or more first-degree relatives affected, or two first-degree relatives diagnosed before the age of 55, or when it occurs in three consecutive generations (grandparent, parent, and child).