Prostate Cancer: Causes, Symptoms, Diagnosis, and Treatment Methods

Prostate cancer is a malignant tumor that develops when prostate cells multiply abnormally and uncontrollably. Many diagnosed prostate cancers behave in a low-aggression way, but if diagnosis is delayed, the disease can spread to other organs in the body.
Prostate cancer has no symptoms in its early stages, but screening can detect it early. In that situation, the chance of treatment is high, and the disease can be treated and managed with methods such as active surveillance, radiotherapy, prostatectomy, and other options.
Below, we explain the causes, diagnostic methods, complications, symptoms, and treatment options for this disease. Stay with us.

What is prostate cancer?

Prostate cancer is one of the most common cancers in men and forms in the prostate gland. It occurs when prostate cells begin to multiply abnormally and gradually create a tumor in the gland. These cancer cells may grow slowly and remain without symptoms for years, but in some cases prostate cancer can progress rapidly and metastasize to other parts of the body.

From an epidemiologic perspective, prostate cancer is the second most common cancer in men after skin cancer, and it is seen especially more often in men over 50. Factors such as age, family history, race, and diet can affect the risk of developing this disease. The incidence of prostate cancer is higher in Western countries than in Asian countries, and this difference may be related to genetic differences, environmental factors, or lifestyle.

Globally, millions of people are affected by this disease, and prostate cancer rates increase as men age. This has major public health importance because early diagnosis and awareness of risk factors can play an important role in reducing deaths caused by the disease.

Causes of prostate cancer

Cause of prostate cancer is still not precisely known, but research has shown that several factors can increase the risk of developing the disease. The most important of these factors include age, genetics, race, and lifestyle.

Age

Age is one of the most important risk factors for prostate cancer. The likelihood of developing the disease rises with age, with most cases occurring in men over 50. Natural changes in prostate cells that occur with aging can lead to an increased cancer risk.

Genetics

Genetics plays an important role in prostate cancer risk. Men who have a family history of the disease, especially if their father or brother has had prostate cancer, are at higher risk. Certain specific genetic mutations can also increase risk. These findings show that heredity can play a key role in the development of the disease.

Race

Race also affects prostate cancer risk. Research shows that African American men are at higher risk than men of other races, and the likelihood of faster cancer progression is also higher in this group. These differences may be due to genetic or environmental factors, or to access to health care.

Lifestyle

Lifestyle, including diet, physical activity, and weight, can affect prostate cancer risk. Diets high in animal fats and low in fruits and vegetables may increase risk. Low physical activity and obesity are also associated with higher cancer risk. Maintaining a healthy lifestyle can help reduce the risk of developing this disease.

Symptoms of prostate cancer

Because prostate cancer grows slowly, it may be asymptomatic in the early stages. This means many people do not notice symptoms until the disease has reached more advanced stages. Symptoms of prostate cancer appear gradually as the cancer progresses. Some of the most important symptoms include:

1. Changes in urination
   As prostate cancer progresses, urinary problems may develop. These problems include difficulty starting urination, a weak or interrupted urine stream, and a feeling that the bladder has not emptied completely. Some people may experience frequent urination, especially at night.

2. Blood in the urine or semen
   Blood in semen or urine can be a sign of prostate cancer. Although this symptom can occur for other reasons as well, it always requires attention and careful evaluation.

3. Pain or burning during urination
   Prostate cancer can put pressure on the urethra, causing pain or burning during urination. This symptom may also be associated with urinary tract infections.

4. Pain in the pelvic area or lower back
   When cancer spreads to the bones, persistent pain may be felt in the pelvis, lower back, or thighs. This pain is usually severe and lasting.

5. Reduced urine pressure
   Reduced urine pressure is another common symptom of prostate cancer. This problem is caused by tumor pressure on the urethra and can gradually become more severe.

6. Pain during ejaculation
   In some cases, people with prostate cancer may feel pain during ejaculation. This symptom is also caused by tumor pressure on the structures around the prostate.

Methods for diagnosing prostate cancer

The most important goal in diagnosing prostate cancer is to identify it in the early stages and evaluate how far it has spread. The main diagnostic methods for prostate cancer are as follows:

1. Prostate-specific antigen (PSA) test

Prostate cancer blood test is one of the first steps in diagnosing this disease. The PSA test is performed to measure the level of prostate-specific antigen. PSA is a protein produced by the prostate and found in the blood. A high PSA level can be a sign of prostate cancer, although PSA may also rise for other reasons, such as prostate inflammation or benign prostatic hyperplasia.

2. Prostate examination

In digital rectal examination of the prostate (DRE), the physician examines the prostate through the rectal wall using a finger. This examination allows the physician to identify any abnormality or firmness in the prostate. Although this method may not detect some small tumors, it is used as one of the basic methods in the initial evaluation of the prostate.

3. Imaging with advanced methods

If cancer is suspected, imaging methods such as prostate ultrasound, MRI, and CT scan are used for more detailed evaluation. These methods help determine the exact location of the tumor and assess whether it has spread to other areas of the body.

4. Prostate biopsy

Biopsy, or sampling of the prostate, is a definitive method for diagnosing cancer. This sampling can be done through the rectum or through the perineum. For a more accurate result, the biopsy is performed under image guidance such as MRI and transrectal prostate ultrasound. In prostate fusion biopsy, which is the most accurate method, MRI images are combined with live ultrasound images.

5. Genetic tests

In some cases, especially when there is a family history, genetic testing for prostate cancer may be recommended to identify specific genetic mutations that increase cancer risk. These tests can help the physician make better decisions about disease management.

Diagnosing prostate cancer metastasis

In the past, prostate cancer staging often used a combination of 2 imaging methods:

1. CT scan: evaluation of soft tissues and lymph nodes;

2. Bone scan: to examine the bones.

At present, the PET scan is more effective for diagnosing metastasis and, with one whole-body imaging session, provides the necessary information with higher accuracy.

Types of prostate cancer

Prostate cancer can be grouped by its origin and by the stage of the disease. Below, we review the types of prostate cancer on this basis.

1. Based on origin and tissue type

Based on which cells give rise to the disease, prostate cancer is divided into 6 groups:

1. Prostate adenocarcinoma (most common): This cancer originates from glandular cells and, when diagnosed in time, can be managed and treated well.

2. Neuroendocrine tumor (Neuroendocrine): A rare but highly aggressive type of prostate cancer with a very poor prognosis.

3. Transitional cell carcinoma: This cancer originates from the lining tissue of the urinary tract (urothelium) and is rare as a primary prostate cancer; it often spreads to the prostate from the urinary tract.

4. Small cell carcinoma: A rare and aggressive type of neuroendocrine tumor with a very poor prognosis.

5. Squamous cell carcinoma of the prostate: A very rare and aggressive type that originates from squamous cells. This cancer is often diagnosed in advanced stages.

6. Prostate sarcoma (tissue cancer): A rare tumor that originates from connective tissues. These tumors are highly aggressive, and even with treatment, the 5-year survival rate is less than 50%.

2. Benign and malignant prostate cancer

In scientific terminology, the term "benign cancer" has no meaning; cancer is inherently malignant. This principle also applies to prostate cancer. However, because the disease has a high chance of management and treatment in early stages, some people may mistakenly call it benign cancer.

3. Staging of prostate cancer

Prostate cancer is categorized into four stages, each determined by the extent and progression of the disease. These stages help physicians better understand the cancer status and make appropriate treatment decisions.

Stage 1

In stage 1, prostate cancer is limited to the prostate gland and is usually in its earliest and smallest form. At this stage, the tumor is usually not detectable by physical examination or imaging tests and is often found incidentally during other surgeries or specific tests.

Stage 2

Stage 2 indicates that the cancer has spread within the prostate but has not yet gone beyond the gland. This stage is divided into two subgroups:

• Stage 2A: The tumor is still small and is found in only one part of the prostate.

• Stage 2B: The tumor has become larger and may be present in both lobes of the prostate, but it has not yet spread outside the prostate.

Stage 3

The cancer has moved outside the prostate and spread to surrounding tissues such as the seminal vesicles, but it has not yet reached lymph nodes or other distant parts of the body.

Stage 4

Stage 4 is the most advanced stage of the disease. At this stage, prostate cancer metastasis occurs; that is, the cancer has not only spread to tissues near the prostate, but may also have metastasized to lymph nodes, bones, lungs, or other distant organs.

At this stage, new symptoms and complications appear depending on the organs to which the cancer has metastasized. For example, if prostate cancer spreads to the bones, complications such as bone pain, bone fragility, spinal cord injury, and resulting leg weakness or numbness can occur.

Treatment methods for prostate cancer

Prostate cancer treatment depends on many factors, including the stage of the disease, the patient's age, overall health, and personal preferences. Different treatment methods are available to manage this disease, each with its own use.

1. Active surveillance and follow-up

For slow-growing prostate cancers limited to the prostate, immediate treatment is not performed. Instead, the patient is regularly monitored with periodic evaluations such as PSA testing, digital rectal examination, and sometimes biopsy. If symptoms begin to progress, treatment methods are used.

2. Drug treatment

Drug treatment for prostate cancer includes multiple medicines and methods and is used at different stages of the disease, from early-stage to metastatic prostate cancer. Below, we review these methods.

Hormone therapy

In hormone therapy for prostate cancer, different medicines are used to suppress production of male sex hormones or prevent them from entering the blood. Various prostate cancer injections that are given periodically, monthly or every three months, fall into this group.

Targeted therapies

Targeted therapies use medicines that specifically target cancer tissue:

• Genetics-based targeted therapies: These medicines attack specific molecules or pathways in cancer cells. This method can be personalized based on the patient's genetic mutations.

• Lutetium treatment for prostate cancer: This method is a type of "targeted radiotherapy" in which a radioactive substance called lutetium is injected into the patient. This substance attaches to cancer cells and destroys them.

Palliative treatments

These methods are used to reduce pain and complications and improve the daily experience of people whose cancer has metastasized to their bones. Treatment of metastatic prostate cancer focuses more on reducing symptoms and complications, increasing life expectancy, and delaying cancer progression.

Chemotherapy

Chemotherapy for prostate cancer destroys cancer cells using powerful medicines. The type and duration of medicine use depend on the opinion of the treating oncologist and urologist and on the tumor grade.

Immunotherapy

Immunotherapy for prostate cancer stimulates the immune system to attack cancer cells. The prostate cancer vaccine is one of the medicines prescribed for this purpose.

3. Radiotherapy

Radiotherapy for prostate cancer includes several methods, such as external or internal radiotherapy (prostate cancer brachytherapy). These methods use X-rays or protons to destroy cancer cells.

4. Laser therapy

Laser treatment for prostate cancer (FLA) is a minimally invasive method performed through the skin, usually through the perineum, and targets only the cancerous tissue. This method is used only in early stages when the cancer is limited to the prostate and is often not as effective as surgery.

5. Surgery

In the treatment process for prostate cancer, the goal of surgery may be removal of the prostate (prostatectomy) or removal of the testicles.

Prostatectomy

Prostate cancer surgery by prostatectomy is an effective method for cancers limited to the prostate. This surgery can be performed with minimally invasive and open methods, which we describe below:

• Laparoscopic prostate cancer surgery: A minimally invasive surgery in which several small openings are made for instruments and a camera instead of one large incision.

• Robotic prostate cancer surgery: A type of laparoscopic surgery in which the physician controls surgical instruments through robotic arms.

• Open surgery: In this method, the physician makes an incision in the lower abdomen or in the area between the anus and the scrotum, called the perineum, to access the prostate.

Orchiectomy, or removal of the testicles

With the patient's consent, orchiectomy in prostate cancer is an alternative to drug-based hormone therapy. Also, when testosterone levels need to be reduced urgently, removing the testicles is the most effective option.

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Is prostate cancer screening possible?

Prostate cancer screening is performed to identify the disease early in its initial stages. This allows physicians to intervene in time and prevent disease progression and complications. One of the main challenges in prostate cancer screening is that lower-grade tumors rarely cause clear symptoms, so the disease may not be diagnosed until advanced stages.

At present, there is no fully reliable method for prostate cancer screening. However, many urologists believe that the prostate-specific antigen (PSA) test is the best available screening tool. This test is not costly and can measure the PSA level in the blood. A rise in PSA may be due to prostate cancer, but other factors such as use of certain medicines, benign prostatic hyperplasia, urinary tract infections, and prostatitis can also increase this protein.

The American Urological Association recommends prostate cancer screening for men aged 55 to 70 once every two years.

Effect of prostate cancer on fertility

The prostate gland plays an important role in male reproduction. Prostate cancer and its treatments can have significant effects on fertility. For example, if a man undergoes surgery to remove the prostate or the testicles, semen production and fertility decrease. Radiotherapy can also affect prostate tissue, damage sperm, and reduce the amount of semen. Hormone therapy also has a negative effect on fertility. For men who want to have children after treatment, methods such as sperm banking before surgery or direct sperm extraction from the testicles for assisted reproduction can be used.

The effect of sexual intercourse and masturbation on prostate cancer risk

Research shows that a higher frequency of ejaculation can reduce the risk of prostate cancer. This risk reduction may be due to removal of harmful chemicals from semen through ejaculation.

However, it is still not clear whether ejaculation through sexual intercourse has different effects on reducing prostate cancer risk compared with masturbation.

Some urologists believe that men who ejaculate more often may have healthier lifestyles, which generally reduces the risk of prostate cancer.

Effect of prostate cancer progression on patient life expectancy

The progression of this disease has a direct effect on life expectancy in prostate cancer patients. Because this disease can progress without specific symptoms, men over 50 should have comprehensive annual checkups of the urinary tract, kidneys, and prostate. The risk of death from prostate cancer varies between 3% and 18% depending on cancer grade and the patient's health status. If the patient also has other diseases, this risk increases.

Nevertheless, 99% of men with prostate cancer live at least 5 years after diagnosis, and many patients are completely treated.

Prostate cancer usually grows slowly, and even if it spreads to other parts of the body, one out of every three affected men will still be alive after 5 years.

Exercise and prevention of prostate cancer

Exercise can play an important role in preventing prostate cancer and even managing the disease. Studies have shown that moderate to vigorous physical activity can reduce the likelihood of benign prostatic hyperplasia and help manage symptoms of benign prostatic hyperplasia. There is also a strong association between metabolic syndrome, abdominal obesity, high blood sugar, high triglycerides, low HDL cholesterol levels, and prostate enlargement.

Resistance exercises

Strength training can reduce prostate cancer risk by increasing muscle mass and reducing excess body weight. However, some strength exercises such as weightlifting and abdominal crunches may worsen stress incontinence in affected patients. These exercises can also help counter complications such as osteoporosis caused by hormone therapy.

Aerobic exercises

Aerobic exercises such as swimming, cycling, and running improve heart, lung, and cardiovascular function. These exercises can help improve prostate cancer symptoms. In general, adults should have at least two hours of moderate activity or 75 minutes of vigorous activity per week. Combining these two types of physical activity can be ideal.

Effect of nutrition on prostate cancer

Nutrition plays an important role in preventing and managing prostate cancer. Research has shown that high intake of saturated fats and high-fat dairy products can increase the risk of prostate cancer. In contrast, diets rich in fruits, vegetables, whole grains, and fish can reduce the risk of this disease.

In particular, foods such as tomatoes, which contain lycopene, cruciferous vegetables such as broccoli and cabbage, and green tea may have protective effects.

Summary

Prostate cancer is one of the most common and important cancers in men and is associated with increasing age and various factors such as genetics and lifestyle. Early diagnosis of this disease through regular screening can play a vital role in reducing deaths caused by it.

The availability of multiple treatment methods, along with awareness of causes, symptoms, and prevention strategies, can help improve quality of life and reduce the risks related to prostate cancer. The appropriate treatment method should be chosen through careful consultation with specialist physicians to achieve the best possible outcome.

Frequently asked questions