Prostate cancer, a disease originating in the prostate gland, remains a meaningful health concern for men. The prostate, located in front of the rectum, produces seminal fluid. While often slow-growing, early detection and comprehensive understanding are crucial for effective management.

understanding Prostate Cancer

Prostate cancer begins when cells in the prostate gland grow uncontrollably.This gland, exclusive to men, sits in front of the rectum and is responsible for producing part of the seminal fluid released during ejaculation. Normally, the prostate is about the size of a walnut, but it can enlarge with age or due to certain conditions, leading to urinary issues. Hormones, especially testosterone, significantly influence it’s growth.

Prevalence and Impact

• Prostate cancer is the most common cancer among men.
• In 2020, approximately 36,074 new cases were recorded.
• Mortality rates decreased by 15.6% between 2015 and 2020, indicating improved outcomes with early diagnosis and treatment.
• The five-year survival rate is high, with about 92% of patients still alive five years after diagnosis.
• Increased testing, such as the PSA (prostate-specific antigen) test, has contributed to earlier diagnoses.

Risk Factors

Several factors can increase the risk of developing prostate cancer:

• age: The risk is minimal before 40 but increases significantly after 50, with most diagnoses occurring in men over 65.
• Family History: Having a first-degree relative with prostate cancer doubles the risk.
• Genetic Mutations: Mutations in genes like BRCA1 and BRCA2, or Lynch syndrome, can elevate risk.
• Lifestyle: A diet high in saturated fats, obesity, and lack of physical activity are increasingly recognized as contributing factors.

Types of Prostate Cancer

The prostate consists of various cell types, each capable of becoming cancerous. most prostate tumors are adenocarcinomas, originating from gland cells. Other rare types include sarcomas, small cell carcinomas, and transitional cell carcinomas.

benign prostate conditions, such as benign prostatic hyperplasia (BPH), are more common than carcinomas, especially after age 50. BPH involves enlargement of the prostate’s central part, compressing the urethra and causing urinary flow difficulties.

Symptoms

Early-stage prostate cancer frequently enough presents no obvious symptoms. It is frequently diagnosed during routine urological exams, including rectal exploration and PSA testing via blood sampling.As the tumor grows, symptoms may include:

• Difficulty urinating, especially when starting
• Frequent urination
• Pain during urination
• Blood in urine or sperm
• Feeling of incomplete bladder emptying

Many of these symptoms can also be related to benign prostate conditions like hyperplasia. Consulting a doctor or urologist is crucial to determine if further diagnostic exams are needed.

Prevention

While there is no specific primary prevention for prostate cancer, adopting healthy habits can reduce the risk:

• Increase consumption of fruits, vegetables, and whole grains.
• Reduce intake of red meat, especially if fatty or overcooked, and foods high in saturated fats.
• Maintain a healthy weight.
• Engage in regular physical activity, such as a brisk walk for at least 30 minutes daily.
• Undergo annual urological visits, especially with a family history or urinary symptoms.

Treatment Options

numerous treatments exist for prostate cancer, each with benefits and potential side effects. The choice depends on patient characteristics (age, life expectancy) and disease specifics (type, stage, risk level). The goal is to tailor the therapeutic strategy to individual needs and preferences.

In certain specific cases, especially for older patients or those with other serious conditions, a “watchful waiting” approach might potentially be chosen, monitoring the disease without immediate treatment until symptoms appear.For low-risk cancer, “active surveillance” involves periodic checks (PSA, rectal exam, biopsy) to monitor disease evolution, postponing treatment until necessary.

When active treatment is pursued, radical surgery is often the primary choice.Radical prostatectomy, involving total removal of the prostate and surrounding lymph nodes, is considered curative if the tumor is confined to the prostate. This can be performed through traditional surgery or robotically, with similar results.

In advanced-stage tumors, surgery alone may not suffice, and additional treatments like radiotherapy or hormonal therapy are used.External radiotherapy is effective in low-risk tumors, with results comparable to radical prostatectomy. Brachytherapy involves inserting radioactive “seeds” directly into the prostate, yielding similar results in low-risk cases.

For metastatic cancer, hormonal therapy (androgen deprivation) is preferred over chemotherapy. This reduces testosterone levels, which stimulate cancer growth, but can cause side effects like loss of sexual desire, impotence, hot flashes, weight gain, osteoporosis, and fatigue.

New hormonal therapies are emerging for patients with castration-resistant prostate carcinoma, combinable with traditional hormonal therapy. Chemotherapy with docetaxel, an intravenous therapy, is suitable for patients with widespread metastases.

In castration-resistant prostate carcinoma with bone metastases, radiometabolic therapy, using radiopharmaceuticals like radio-223, can destroy cancer cells in the bones. Other promising therapies, such as PARP inhibitors, are effective in patients with mutations in the BRCA genes, also involved in breast and ovarian cancers. Additionally, the new radiometabolic therapy with 177Lu-PSMA-617 is showing positive results.

While immunotherapy has not yet reached definitive tests of effectiveness, recent studies suggest that it can become an vital therapy in combination with others, especially for patients resistant to conventional therapies.