Prostate Cancer

  • Occurs in the prostate.
  • Small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports the sperm.
  • Situated below the bladder and in front of the rectum.
  • One of the most common types of cancer in men.
  • Treatable if found in the early stages.
  • Regular testing is crucial as the cancer needs to be diagnosed before metastasis.

Statistics

  • 1 in 23 South African men will develop prostate cancer in their lifetime.
  • On average, 5 South African men will die from prostate cancer every day.
  • More than 4 300 South African men are newly diagnosed with prostate cancer each year.

Signs and Symptoms

  • May cause no signs/ symptoms in its early stages (usually completely asymptomatic).
  • If symptoms appear, it will involve one of the following:
    • frequent urges to urinate, including at night.
    • Difficulty commencing/ maintaining urination.
    • Painful urination.
    • Decreased force in stream of urine.
    • Blood in urine and semen.
    • Discomfort in pelvic area.
    • Erectile dysfunction.
  • More advanced
    • Bone pain often in spine, femur, pelvis or ribs.
    • Bone fractures.
  • If spread to the spine and compresses the spinal cord
    • Leg weakness.
    • Urinary incontinence.
    • Faecal incontinence.

Diagnosis

  • Doctor carries out physical examination and enquires about ongoing medical history.
  • If there are symptoms or if routine blood test shows abnormally high PSA (Prostate-Specific Androgen) levels, further examinations may be requested.
    • Digital rectal examination (DRE) – doctor manually checks for any abnormalities of the prostate.
    • Biomarker test checking blood, urine, body tissues of person with cancer for chemicals unique to individuals with cancer.
  • If tests show abnormal results, further tests include:
    • PCA3 test examining urine for PCA3 gene found in prostate cancer cells.
    • Transrectal ultrasound scan providing imaging of affected region using probe that emits sounds.
    • Biopsy/ removal of 12-14 small pieces of tissue from several areas of prostate for examination under microscope.
    • These tests will help confirm the stage of cancer, whether it has spread or what treatment is appropriate.
  • To track the spread or metastasis doctors may use a bone scan, CT scan or MRI scan.

Risk Factors

  • Age
    • Risk increases as you age.
    • Rare among men under age of 45.
    • More common after age of 50.
  • Family history
    • 10% of prostate cancer is inherited.
    • Risk may be increased if men in your family have had prostate cancer.
    • If you have family history of genes that increase risk of breast cancer (BRCA1/ BCRA2)/ strong family history of breast cancer, your risk may be higher.
  • Obesity
    • Obese men diagnosed may be more likely to have advanced disease that’s more difficult to treat.
  • Diet
    • Diet high in red meat/ high-fat dairy products may increase a person’s chance of developing prostate cancer (Link is neither confirmed nor clear).

Treatment

Early stage prostate cancer (small/ localised)

  • Watchful waiting/ monitoring
    • PSA blood levels regularly checked, but there is no immediate action.
    • Risk of side-effects sometimes outweighs the need for immediate treatment for this slow-developing cancer.
  • Radical prostatectomy
    • Prostate is surgically removed.
    • Traditional surgery – Requires hospital stay of up to 10 days, recovery time off up to 3 months.
    • Robotic keyhole surgery – shorter hospitalisation a recovery period, can be more expensive.
  • Brachytherapy
    • Radioactive seeds implanted into the prostate to deliver targeted radiation treatment.
  • Conformal radiation therapy
    • Radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ/ region that requires treatment.
    • Minimises healthy tissue exposure to radiation.
  • Intensity modulated radiation therapy
    • Beams with variable intensity are used.
    • Advanced form of conformal radiation therapy.
  • In early stages, patients may receive radiation therapy combined with hormone therapy for 4 – 6 months.

Advanced prostate cancer (more aggressive/ spread throughout the body)

  • Chemotherapy
    • Recommended as it kills cancer cells around the body.
  • Androgen deprivation therapy (ADT)/ Androgen suppression therapy
    • Hormone treatment that reduces effect of androgen.
      • Androgens are male hormones that can stimulate cancer growth.
    • ADT can slow down or stop cancer growth by reducing androgen levels.
    • Long term therapy.