All you need to know about prostate cancer

by Tshepy Matloga-Malope
All you need to know about prostate cancer
Reading Time: 4 minutes

South Africa has one of the world’s highest rates for prostate cancer spreading to other parts of the body because men don’t get screened. Tshepy Matloga-Malope presents the facts.

Prostate cancer is the most common cancer among men. According to CANSA, there’s a 98% survival rate with early detection, but only a 30% chance once it has spread to other parts of the body.

What is prostate cancer?

Prostate cancer occurs when cells in the prostate gland grow uncontrollably, forming a malignant tumour. Unlike benign tumours, malignant tumours can invade nearby tissues and spread to other parts of the body through the lymphatic system or bloodstream, a process known as metastasis. The most common type of prostate cancer is acinar adenocarcinoma, originating from the gland cells.

Risk factors

Several factors increase the risk of developing prostate cancer:

  • Age is the most significant, with the likelihood rising dramatically after age 50.
  • Genetics also play a crucial role; men with a family history of prostate cancer or BRCA1/BRCA2 gene mutations are at higher risk.
  • Prostate cancer incidence is higher in African men compared to other racial groups, possibly due to genetic and environmental factors.
  • Diet, obesity, and lifestyle choices such as high red meat consumption and low physical activity have also been linked to increased risk.

Symptoms of prostate cancer

According to Dr. Mulalo Radzuma a Urologist at Dr George Mukhari Academic Hospital says, “Patients with prostate cancer may present with a variety of symptoms, some of which may overlap with those of a ‘big prostate’ (a condition known as benign prostate hyperplasia).

Men with localised prostate cancer generally have no symptoms. They may present with symptoms of benign prostate hyperplasia that are unrelated to the cancer. The symptoms occur when the prostate blocks the urine pipe, resulting in urinating frequently and having a poor urine flow.

Constipation can also occur as the big prostate blocks the rectum. Blood in the urine can occur when there is local spread of the cancer to the urethra. When the cancer is metastatic, the most common presenting symptoms are lower back bone pain; weight loss and cachexia can also occur.”

Early-stage prostate cancer often has no symptoms, making regular screening essential for early detection. When symptoms do occur, they can include difficulty urinating, frequent urination (especially at night), pain during urination, and blood in urine or semen. Advanced prostate cancer may cause bone pain, swelling in the legs or pelvic area, and unexplained weight loss.

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Screening and diagnosis

“The earlier the cancer is detected, the better the outlook for the patient in terms of cure and arresting cancer progression,” says Dr. Radzuma. “Hence the annual drive to get men to see their general practitioners for prostate examinations. The GP takes an elaborate history and does a thorough examination. A digital rectal examination will be done; this is a simple, safe, and most effective means of detecting prostate cancer.

This will be followed by a simple Prostate Specific Antigen (PSA) blood test. An elevated PSA (>4) will prompt the GP to refer the patient to a urologist. Depending on the availability of resources, an MRI can be done to further examine the prostate. This guides the urologist on whether a biopsy is warranted or not and to also help in planning the biopsy procedure.”

Treatment options

There are various treatment options for men with localised disease. Dr. Radzuma emphasises, “It’s  important to keep in mind that not all prostate cancers have to be actively treated. Treatment decisions depend on numerous factors (patient factors and disease factors).

The aim of treatment for localised cancer is curative if the man has a reasonable life expectancy. Active surveillance is becoming popular in men with small volume cancers. These men would be eligible for curative treatment, but it’s deferred until objective signs of disease progression, thus sparing these men the side effects of curative treatment.”

  1. Active surveillance: Monitoring the cancer closely with regular PSA tests and biopsies, opting for treatment only if the cancer shows signs of progression. This is often recommended for older men or those with low-grade cancer.
  2. Surgery: The most common surgical procedure is a radical prostatectomy, which involves removing the entire prostate gland and some surrounding tissue. This approach is typically used for localised cancer. “The advantage of surgery is that it excises all prostatic tissue and provides precise histology. Side effects associated with radical prostatectomy are erectile dysfunction and stress urinary incontinence,” says Dr. Radzuma.
  3. Radiation Therapy: This involves targeting the cancer cells with high-energy rays. Techniques include external beam radiation therapy (EBRT) and brachytherapy where radioactive seeds are implanted in the prostate.
  4. Hormone therapy: Also known as androgen deprivation therapy (ADT), this treatment reduces the levels of male hormones that stimulate cancer growth. It is often used in advanced or recurrent cases.
  5. Chemotherapy: Used primarily for advanced prostate cancer, chemotherapy involves drugs that kill rapidly dividing cancer cells.
  6. Emerging therapies: Advances in medical research are leading to new treatments, including targeted therapies and immunotherapy, which aim to enhance the body’s immune response against cancer cells.

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Diet and Lifestyle

Diet and lifestyle are clearly linked to the risk of prostate cancer. “Obesity and a western diet are risk factors for the development of prostate cancer. Lycopene (found in tomatoes and watermelon for example) has been found to reduce the risk of prostate cancer by 20%. We generally educate men to live a healthy lifestyle that involves daily exercise and a good, balanced diet, advises Dr Radzuma.

Advancement in cancer treatments

Cutting-edge treatments in prostate cancer care continue to evolve and a lot of advancements have been made. “Doing an MRI before the actual biopsy has been a game-changer. As far as treatment goes, robotic surgery is up there for localized disease. Patients don’t have to bear long and ugly surgical scars.

They stay for fewer days in the hospital and experience less pain post-surgery. The bulk of the research right now is in metastatic disease. Newer ‘smart drugs’ are being developed and showing great results, allowing those men with metastatic disease to live longer” says Dr Radzuma.

Ongoing research continues to refine screening methods and develop more effective treatments, offering hope for better management and outcomes for those affected by prostate cancer. Lastly, women, take note and get your men to get screened! It could save his life

Also read: All you need to know about colorectal cancer

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