Prostate – The prostate is a small gland located around the neck of the bladder. It secretes fluid which forms part of the semen and helps keep the sperm healthy for fertilization

What is prostate cancer?

Cancer of the prostate is an abnormal cell growth / division in the prostate, resulting in abnormal enlargement of the organ. These cells, unlike the normal cells of the prostate which have limited lifespan, continue to live and divide. With time, some of them break away and are taken far away to other parts of the body, where they settle down; continue to grow and multiply. This is known as metastasis.

How common is prostate cancer?

Prostate cancer is relatively common, affecting about 1 in 10 men on the average.

What are the risk factors for prostate cancer?

The cause of prostate cancer, just like most cancers in the body, is not known. However, some factors have been shown to predispose men to having prostate cancer. These may be modifiable or non-modifiable factors

Non-modifiable risk factors are those factors which no one has control over. They include:

1. Age – Prostate cancer is common in men above 50 years of age. The risk increases as men get older.
2. Race – Prostate cancer has been noted to be more common among the black race. The risk of metastasis is also higher in blacks.
3. Genetics – Inheritance of certain mutated genes from the parents is also a factor.
4. Family history – The risk of a man having prostate cancer is doubled or more if a close relation (father, brother, uncle etc) has it.

Modifiable risk factors are factors which can be controlled. These include:

1. Smoking
2. Obesity
3. Sexually-transmitted infection
4. Prostate infection (prostatitis)

What are the symptoms of prostate cancer?

In the early stage, affected persons may not feel any symptom. However, as the disease progresses, some of the following symptoms may begin to manifest:

1. Poor urine stream which may stop intermittently while urinating
2. Painful urination
3. Frequent urination
4. Blood in urine / semen
5. Loss of the ability to hold urine or delay urination
6. Low back pain / hip pain; chest pain (depicting metastasis)
7. Painful ejaculation

What are the treatment modalities for prostate cancer?

The treatment for prostate cancer depends on the:

1. Stage of the disease
2. Rate of cancer growth
3. Presence of metastasis
4. Overall health status of the affected individual

Treatment options include:

1. Surveillance – This method is employed in those with slowly-growing cancers which do not cause symptoms and no metastasis. In this case, screenings, prostate scans and biopsies are done every one to three years in order to monitor the rate of cancer progression.
2. Surgery – The prostate gland can be removed (prostatectomy) in early disease. This may successfully cure the cancer if it has not spread. Surgery may also be done to remove the testicles which supply hormones to the prostate cancer cells to grow. Removing the testicles removes the source of nutrients (hormones) for the cancer cells. This is done for advanced disease.
3. Radiotherapy – This involves the use of radiation to kill cancer cells. It may be used alone or in combination with other treatment modalities such as surgery, chemotherapy or hormone therapy.
4. Chemotherapy – This is the use of drugs to destroy cancer cells both on the gland and any other location in the body where it has spread to.
5. Hormone therapy – This refers to the use of hormone to counter the effects of testosterone (the male hormone upon which the growth of the prostate cancer cells depends). The drugs work by blocking testosterone from reaching the cancer cells or by reducing the level of testosterone in the body. Removal of the testicles can also be a form of hormone therapy.
6. Immunotherapy – This treatment modality improves the immune system so that it is better able to identify cancer cells and destroy them. This modality is used for advanced or recurrent prostate cancer.

What are the complications of prostate cancer treatment?

Following treatment, patients may experience:

1. Urinary incontinence – This may be due to the effect of the treatment modalities on the urethral sphincter. Incontinence occurs mostly, when there is sudden increased pressure in the abdomen such as that produced by coughing or laughing.
2. Erectile dysfunction – Surgery or radiation therapy may cause damage to the nerves responsible for erection, leading to inability to achieve or sustain erection. This effect may be temporary as erection may be restored within one or two years or treatment.
3. Infertility – Treatment for prostate cancer may result in inability to produce sperm or ejaculate. Men who are still interested in childbearing may donate their sperm for banking before treatment. Sperm aspiration directly from the testes for in vitro fertilization may also be done.

How can prostate cancer be prevented?

Prevention of prostate cancer is difficult due to the non-modifiable factors involved in its development. Some of the preventive measures that may be taken include:

1. Maintenance of healthy weight by avoiding obesity
2. Regular exercise
3. Eating balanced diet
4. Avoiding smoking
5. Regular prostate screenings