Prostate Cancer - Symptoms, Stages, Diagnosis & Treatment

Written By: Dr. Amgad Farouk

Dr. Amgad Farouk is an expert on minimally invasive surgery in the Urology Department of Medcare. He holds a PhD from Cairo University, Egypt, & the Cleveland Clinic Foundation Fellowship in Advanced Laparoscopy, USA.

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What is Prostate Cancer?

Prostate cancer is a common type of male cancer that occurs in the prostate, a small walnut-shaped gland which produces the seminal fluid that transports sperm. Many prostate cancers develop slowly, confined to the prostate gland, where they may not cause serious harm. Others are aggressive and spread quickly. Prostate cancer detected early — when still confined to the prostate gland — has a good chance of successful treatment.

Causes of Prostate Cancer

Medical experts are not clear what causes prostate cancer. What we do know is that prostate cancer begins when cells in the prostate develop changes in their DNA – the part that tells cells what to do. These changes tell the cells to grow and divide more rapidly than normal cells do. The abnormal cells then form a tumor that can attack nearby tissue. In time, some abnormal cells can break away and spread (metastasize) to other parts of the body.

Like many cancers, a healthy lifestyle, exercise, avoidance of smoking and drinking can all help in staying in optimal health.

Prostate Cancer Signs & Symptoms

Prostate cancer may display no signs or symptoms in the early stages.

However, more advanced prostate cancer may show signs and symptoms, including:

  • Trouble urinating
  • Decreased force in the urine stream
  • Bone pain
  • Losing weight without trying
  • Blood in the urine
  • Blood in the semen
  • Erectile dysfunction

When to see a Doctor for Prostate Cancer

Your Medcare doctor can provide advice, diagnosis and a range of appropriate treatments in the case of suspected prostate cancer. Many men suffer from prostate cancer without knowing, and with no discernible side effects. However, like all conditions, early diagnosis allows for early prognosis, advice awareness and a treatment plan. Do not hesitate to call your local Medcare clinic if you have any of the signs and symptoms associated with prostate cancer, such as blood in the urine, trouble passing water and a weaker flow of urine.

Diagnosis of Prostate Cancer

Regular screening – advice suggests annually – is the best way to monitor any issues arising in the prostate. However, if symptoms suggest testing needs to be conducted to ascertain the presence of prostate cancer, below, we list some of the testing which will be conducted.

Screening for prostate cancer

Screening for prostate cancer is possible for men over 50. At Medcare, we encourage men in their 50s to discuss the pros and cons of prostate cancer screening with our team. The discussion should include a review of any risk factors and personal preferences about screening. You might consider starting the discussions earlier if you have family history of prostate cancer or other risk factors.

What do prostate screening tests include?

Prostate screening tests may include:

  • A digital rectal exam (DRE): hich involved inserting a gloved, lubricated finger into the rectum to examine the prostate, adjacent to the rectum.
  • A Prostate-Specific Antigen (PSA) test: A blood sample is analyzed for PSA, a substance that's naturally produced by the prostate gland. Higher PSA levels can be indicative of prostate infection, inflammation, enlargement or cancer.

Further Diagnosis of prostate cancer

If screening detects an abnormality, further tests may be recommended to help determine the presence of prostate cancer, such as:

  • Ultrasound scanning: to create a picture of your prostate gland
  • Magnetic resonance imaging (MRI); An MRI scan of the prostate provides a detailed picture. MRI images may help your Medcare doctor plan a procedure to remove prostate tissue samples
  • Prostate biopsy: Prostate tissue sampling allows tissue sample from the prostate gland to be lab-analyzed for the presence of cancer cells

If diagnosed, the level of aggressiveness (grade) of the cancer cells will be determined.

Determining stages and grade of prostate cancer

Measures used to determine cancer level include:

  • The Gleason score: Gleason scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer)
  • Genomic testing: This analyzes prostate cancer cells to determine which gene mutations are present, providing more information about the prognosis. Genomic tests might help in treatment decisions in certain situations.

If your doctor suspects the prostate cancer may have spread beyond your prostate, one or more of the following imaging tests might be recommended:

  • A bone scan
  • An ultrasound test
  • A computerized tomography (CT) scan
  • A Magnetic resonance imaging (MRI) scan, or a
  • Positron emission tomography (PET) scan

Information from these tests is used to assign the prostate cancer a stage. Prostate cancer stages are designated by Roman numerals, ranging from I to IV. The lower figure indicates the cancer is only affecting the prostate. At stage four, the cancer will have spread elsewhere.

If you’re concerned you might have prostate cancer, make an appointment with Medcare to narrow down what’s causing your symptoms.

Prostate Cancer Treatment

Treatment options for prostate cancer are dependent on several factors, including the speed the cancer is growing at, if it has spread and overall health. Potential benefits and side effects will also be considered. Early prostate cancer may not need immediate treatment. In some cases, treatment might never be needed. Careful monitoring – regular follow-up blood tests, rectal exams and prostate biopsies – can be all that’s needed.

If tests show cancer progression, you may choose prostate cancer treatment such as surgery or radiation.

Prostate removal surgery

Surgery is an option for treating cancer confined to the prostate. Sometimes it’s used to treat advanced prostate cancer in combination with other treatments. Prostate cancer surgery involves radical prostatectomy – removal of the prostate gland, some surrounding tissue and lymph nodes.

Radiation therapy

This treatment involves using high-powered energy to kill cancer cells. Radiation therapy treatments might involve the following:

  • External beam radiation: High-powered energy beams, such as X-rays or protons, are aimed at the body to kill the cancer and relieve symptoms, such as pain. This treatment can last every day for several weeks.
  • Brachytherapy: Rice-sized radioactive seeds are placed in the prostate tissue, delivering a low, metered dose of radiation over time. Brachytherapy is an option for treating cancer that hasn't spread beyond the prostate.
  • Both external and internal radiation therapy treatments: In some situations, doctors may recommend both types of radiation therapy.

Heating or freezing

Prostate tissue can be treated with cold or heat, in very small prostate cancers when surgery isn't possible. Options may include:

  • Freezing prostate tissue: Known as cryoablation or cryotherapy, this treatment involves freezing the prostate tissue using a very cold gas, which kills cancer cells
  • High-intensity focused ultrasound (HIFU) treatment: This treatment uses concentrated ultrasound energy to heat prostate tissue, causing it to die.

Hormone therapy

Hormone therapy is used to stop the body from producing the male hormone testosterone, because prostate cancer cells need this hormone in order to grow.

Options include:

  • Medications to halt testosterone production
  • Anti-androgen medications: Block testosterone from reaching cancer cells
  • Orchiectomy: Surgery to remove the testicles, which reduces testosterone levels quickly and significantly

Chemotherapy

Chemotherapy:

  • Uses drugs to kill fast-growing cells
  • Can be delivered via a vein in the arm, in pill form or both
  • Is a treatment option for treating prostate cancer that has spread
  • Is an option for those cancers unresponsive to hormone therapy

Immunotherapy

Immunotherapy uses your own immune system to fight cancer. Prostate cancer immunotherapy can involve:

  • Engineering your cells to fight cancer: Sipuleucel-T treatment takes immune cells, genetically engineers them to fight prostate cancer, then injects them back into the body.
  • Helping immune system cells identify cancer cells: This type of immunotherapy drug is an option for treating advanced prostate cancers that are unresponsive to hormone therapy.

Risk Factors for Prostate Cancer

Factors that can increase risk of prostate cancer include:

  • Age: The risk of prostate cancer increases as we get older, and is most common after 50.
  • Ethnicity: For undetermined reasons, Black people have a greater risk of prostate cancer than people of other races and it is more likely to be aggressive or advanced.
  • Family history: If a blood relative is diagnosed with prostate cancer, your risk may increase.
  • Obesity: Obese people may have a higher risk of prostate cancer compared with those of healthy weight, though studies show mixed results.

Prostate Cancer Complications

Complications of prostate cancer and its treatments include:

  • Cancer that metastasizes (spreads): Once prostate cancer has spread, it may still respond to treatment and may be controlled, but is unlikely to be cured.
  • Incontinence: Prostate cancer and treatment might cause urinary incontinence. Treatment will depend on type, severity and likelihood of improvement.
  • Erectile dysfunction: Can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments.

Prostate Cancer Prevention

There are some simple lifestyle changes that reduce the risk of prostate cancer:

  • Eat more fruit, vegetables and wholegrains: A healthy diet helps provide vital minerals, vitamins and boosts overall health
  • Choose whole foods over supplements: An unprocessed, healthy diet is better than reliance on supplements
  • Take regular exercise
  • Maintain a healthy weight
  • Preventative medication: If you have a very high risk of prostate cancer, you and your doctor may consider medications to reduce that risk. Studies suggest taking 5-alpha reductase inhibitors may reduce overall risk.

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