Prostate cancer – risk factors, symptoms and treatments

Prostate cancer is a malignant tumor of the prostate, a male gland located below the bladder and surrounding the urethra.

It is one of the most common cancers in men, and is also the second leading cause of cancer death in men. It is usually a silent disease that only shows symptoms in its advanced stages.

Prostate cancer is caused by alterations or mutations in the DNA of prostate cells, which become more aggressive and begin to multiply uncontrollably and at a faster rate than normal.

The malignant prostate tumor can grow locally, invade other organs, or metastasize and reach more distant organs. These behaviors are due to the rapid spread of malignant cells through the lymphatic system or bloodstream.

The most common type of prostate malignancy is adenocarcinoma. Only in less than 1% of cases is it small cell carcinoma or sarcoma.


Risk factors

Certain aspects can increase the likelihood of getting prostate cancer. Some of these risk factors are:

  • Age over 50 (most prostate cancers occur in people around 66 years old);
  • A close relative who has had prostate cancer;
  • Black race;
  • High levels of testosterone, the male hormone;
  • Diet high in saturated fat and protein, such as red meat;
  • Obesity;
  • Exposure to pollution and/or contact with toxic products, chemicals or fertilizers.

 

Symptoms

As previously mentioned, prostate cancer is usually asymptomatic, depending on the manifestation of symptoms of the stage of the disease.

Initial phase

When symptoms do appear, they are primarily due to local enlargement of the tumor and thus affect primarily lower urinary tract function.

There are thus three major groups of symptoms that we can name: emptying, filling, and post-voiding symptoms.

Emptying symptoms

  • Weak and/or thin urine flow;
  • Interrupted stream (not urinating all at once);
  • Takes a long time to urinate;
  • Taking a long time to start urinating;
  • Burning to urinate;
  • Need to make an abdominal effort to achieve urination.

Filling symptoms

  • Sudden urge to urinate;
  • Inability to hold urine;
  • Increased frequency of urination (urinating often);
  • Increased number of times you urinate during the night;
  • Pain/feeling of heaviness below the belly button.

Post-micturition symptoms

  • Sensation of not emptying the bladder completely;
  • Dripping of urine at the end of urination.

Rare symptoms

There are also less common symptoms that can occur and some examples include:

  • Presence of blood in urine and/or semen;
  • Frequent lower back pain;
  • Pain on ejaculation;
  • Urinary tract infections;
  • Acute urinary retention.

Advanced/metastatic stage

If the cancer has metastasized to other organs, other symptoms may appear, such as:

  • Bone pain, back pain or pain in other places;
  • Weight loss;
  • Lack of strength;
  • Fatigue;
  • Anemia;
  • Spinal cord compression;
  • Altered sensation of the lower limbs;
  • Impaired bowel and bladder control;
  • Pathologic bone fractures.

 

Diagnosis

Starting at age 50, all men should be screened for prostate cancer. However, if there is a family history of the disease, screening may be recommended earlier.

Diagnostic tests not only detect the possible presence of a tumor, but also assess its degree of progression and characteristics. The main complementary diagnostic tests available are:

  • Digital rectal exam (palpation of the prostate for nodules or irregular, hard areas);
  • PSA (prostate specific antigen) analysis;
  • Transrectal ultrasound of the prostate;
  • Prostate biopsy;
  • Nuclear magnetic resonance (NMR)
  • Computed tomography (CT);
  • Bone scintigraphy.

 

Treatments

Treatment for prostate cancer varies depending on the stage at which the disease is discovered. Thus, the recommended treatment may be aimed at eliminating the cancer and curing the patient or, in more advanced cases, at controlling the disease, preventing its progression and allowing the patient to have the best possible quality of life.

Available treatments include:

  • Surgery (removal of the prostate and seminal vesicles): open, laparoscopic or robotic prostatectomy;
  • Hormone therapy (to reduce testosterone levels);
  • Cryotherapy;
  • Internal radiation therapy or brachytherapy;
  • External radiotherapy;
  • Chemotherapy.

 

Side effects

All prostate cancer treatments can have side effects. Learn more about some of them.

Prostatectomy

    • Hemorrhage;
    • Tightening (stenosis) of the bladder neck;
    • Sexual impotence;
    • Urinary incontinence.

Radiotherapy

  • Fatigue;
  • Sexual impotence;
  • Irritation during urination or cystitis.

Hormone therapy

  • Decreased sexual desire;
  • Fatigue;
  • Sexual impotence;
  • Weight gain;
  • Hot flashes (decreasing over time);
  • Diarrhea;
  • Osteoporosis;
  • Breast tenderness and/or growth;
  • Nausea.

Chemotherapy

  • Fatigue;
  • Loss of appetite;
  • Tingling sensation in hands and feet (with prolonged treatment).

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