Prostate cancer is one of the most common cancers among men in the United States. It is the second leading cause of death in 2014, behind lung cancer and there are more than 200,000 new cases. If prostate cancer is found early, it can be treated and cured.

Prostate gland

Prostate gland is part of a man’s reproductive system. It is located at the base of the urinary bladder. The prostate surrounds the urethra, the tube through which urine flows. The function of prostate gland is to secrete seminal fluid, one of the components of semen.

Prostate cancer

Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the prostate. Normal cells in the prostate and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong and damaged cell will build up as cancer cells or tumor. These cancer cells can also spread to other organs.

There are 4 stages of prostate cancer.

Stage I : The cancer is only in the prostate. It might be too small to feel during a digital rectal exam.

Stage II : The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It can be feel during a digital rectal exam.

Stage III : The tumor extends beyond the prostate to surrounding tissues.

Stage IV : The tumor may have invaded the adjacent organs. It may have spread to lymph nodes or other parts of the body. The most common metastatic sites are bone and lung.

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Risk factors

• Age
  Common in men older than 65 years
• Family history
  A man with a father, brother, or son who has had prostate cancer is more likely to develop the disease himself
• Race
  Prostate cancer is more common in African-American men and less common in Asian

“Difficulty starting urination, weak or interrupted flow of urine, and blood in the urine in men older than 65 years might be symptoms of prostate cancer. If you have such symptoms, you should go to see the doctor. The earlier it is caught, the better it can be treated.”

Diagnosis

• History taking
  Identify risk factors, physical examination, digital rectal examination, cystoscopy
• Prostate-specific antigen (PSA) level
  45-50 year old men are recommended to test for PSA level if they have a family history of prostate cancer. If the PSA level is higher than 10 ng/mL or the doctor found hard or bumpy prostate gland during digital rectal exam, biopsy is needed for diagnosis.
• Prostate Health Index (PHI)
  Prostate Health Index (PHI) is a new test for detection of prostate cancer. It can be done by a simple blood test. PHI comprises a combination of three tests: PSA, Free PSA, and [-2]pro-PSA. The PHI score provides 3.5 time better risk stratification than normal PSA level test.
• Prostate biopsy
  Needle biopsy of the prostate is indicated for tissue diagnosis in patients who present with elevated PSA levels or abnormal digital rectal exam findings.
• Others
  Imaging studies such as CT-scan and MRI can be a valuable part of pretreatment staging of prostate cancer, helping to differentiate clinically localized disease, which is generally amenable to local therapy, from more advanced disease that may require multimodal therapy.

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Prostate cancer treatment

Prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, how much it has spread and your overall health, as well as the potential benefits or side effects of the treatment.

• Surgery
• Radiotherapy
• Hormonal therapy
• Chemotherapy

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Taking care of prostate cancer patients

The aim of prostate cancer treatment is to treat each patient according to risk group and stage of the disease.

• Low risk group
  Local treatment: radical prostatectomy, external beam irradiation, brachytherapy
• Moderate and high risk group
  Local and regional treatment: pelvic lymph node dissection, pelvic lymph node irradiation, systemic treatment (androgen deprivation therapy and chemotherapy)
• Metastatic disease
  In patient with poor overall health or metastatic disease, the aim of the treatment is to control prostate cancer and maintain patient’s quality of life. Palliative care might be offer as it focuses on patient’s physical, psychological and spiritual needs. It helps patient to get the best quality of life by relieving suffering and controlling pain and symptoms.

Prostate cancer screening

Prostate cancer screening is recommended in men older than 40-45 years and who have a family history of prostate cancer and younger ages at diagnosis.

“Regular health check-up is important in order to detect prostate cancer early. The earlier it is caught, the better it can be treated.”

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