Nazeer Hospital

Navigating The Journey Of Prostate Cancer Diagnosis And Treatment.

Updated on May 12, 2022
Prostate Cancer
Prostate cancer arises in the prostate gland, a tiny gland in a man’s endocrine cycle. This cancer is one of the most common types of cancer in men, with more than 1,958,310 new cancer cases diagnosed around the globe in 2023 alone.
While prostate cancer is often treatable, it can also lead to various complications, including urinary problems, sexual dysfunction, and even the spread of cancer to other parts of the body. Treatment options include surgery, radiation therapy, chemotherapy, hormone therapy, and immunotherapy.
The stage and grade of the malignancy, the patient’s general health, and the patient’s preferences are all important considerations for determining the optimal course of therapy. While some prostate cancers can be cured, others may be managed with treatment to slow cancer progression and symptoms.
Complications arise when cells in the prostate gland grow uncontrollably. While the precise cause of this disease remains unknown, researchers have identified several risk factors associated with it.
In this article, the following topics will be discussed.

Prostate Cancer Stages:

Cancers are classified into different stages depending on their size within the prostate, metastasis to other parts of the body, and degree of development. The TNM system is the preferred method for staging prostate cancer, where TNM stands for tumor, lymph nodes, and metastasis.
Stage 1: Early-stage cancer is the most treatable kind. In stage 1, the cancer is small and confined to a small part of the prostate gland. Under a microscope, cancer cells resemble healthy cells, and a digital rectal exam reveals no abnormalities in the prostate gland. The PSA level is low, typically less than ten ng/mL. Stage 1 cancer is often slow-growing and may not require immediate treatment. Instead, a man may choose active surveillance or watchful waiting, which involves monitoring cancer with regular checkups and tests to ensure it is not growing or spreading.
Stage 2: Prostate cancer is divided into two sub-stages, stage 2A and stage 2B. In stage 2A, the cancer is still confined to the prostate gland, but it has spread to more than one lobe of the gland or more than half of one lobe. The PSA level is typically between 10 and 20 ng/mL. In stage 2B, the cancer is still confined to the prostate gland, but it has grown larger and may be detectable during a DRE. The PSA level is still below 20 ng/mL.
Stage 3: Extending beyond the prostate gland, prostate cancer is a kind of locally metastatic cancer. In stage 3, cancer has spread to the outer layer of the prostate gland and may involve the seminal vesicles, which are small glands near the prostate gland producing semen. The PSA level can be valuable, and cancer may be detected during a DRE.
Stage 4: The metastatic stage of prostate cancer occurs when cancer progresses to other organs outside the prostate gland. In stage 4, cancer may have spread to nearby lymph nodes, small organs that help fight infection. The PSA level can be valuable, and cancer may be detected during a DRE. Stage 4 cancer is typically more challenging to treat, and the goal of treatment is usually to manage the symptoms and slow the progression of the disease.
In addition to the TNM system, another staging system is called the Gleason score. The Gleason score is a grading system that evaluates the cancer cells under a microscope to determine how aggressive the cancer is. With a Gleason score of 6 representing the least aggressive and a score of 10 representing the most aggressive, the scale covers a wide variety of levels of aggression. A higher Gleason score indicates a higher risk of cancer spreading and a worse prognosis.

Prostate Cancer Causes:

The etiology of prostate cancer is not fully understood, but several risk factors have been identified that increase the likelihood of developing the disease.
Age: The majority of cases of cancer are found in males over the age of 65, making age the single most important risk factor.
Race: Other risk factors include a family history of the disease, African-American race, and specific genetic mutations.
Lifestyle: Diet and physical activity have been associated with a lower likelihood of developing prostate cancer. Evidence suggests that eating lots of red meat and dairy products raises your risk, while eating plenty of fruits, vegetables, and whole grains may reduce your risk. An increased risk of prostate cancer has also been linked to being overweight and not getting enough exercise.
Family History: Risk may be higher in men with a family history of the disease or malignancies of the breast, ovaries, colon, or pancreas.
Genetic Mutations: Inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast, ovarian and prostate cancer in some families.
Chemical Exposure: It is more common in men who work with chemicals like pesticides and herbicides. Veterans exposed to the defoliate Agent Orange are 49% more likely than non-exposed veterans to be diagnosed with prostate cancer.
Firefighter: Recent studies show firefighters are at a 28% greater risk of developing prostate cancer than the general population.
In addition, a growing body of research is exploring the potential link between diabetes and prostate cancer. Some studies suggest that men with diabetes may be at a higher risk of developing prostate cancer, although the exact nature of this relationship is still being studied.

Symptoms of Prostate Cancer:

The symptoms may not appear in the early stages and may only become noticeable as cancer grows and spreads. In some cases, as the tumor grows, it may exert pressure on the urethra, blocking urine flow from the bladder and causing urinary symptoms. Occasionally the first warning sign may be blood in the urine. Prostate cancer symptoms often include the following:
Note: Symptoms may not occur until cancer has developed to an advanced stage.
Prostate Cancer Symptoms

Symptoms of Advanced Prostate Cancer:

Stage IV prostate cancer is the most advanced form of the disease and has gone beyond the prostate gland. A variety of symptoms, such as these, may occur in men with advanced prostate cancer:

Diagnostic Tests For Prostate Cancer Prevention:

As a whole, the following diagnostic procedures are used to identify prostate cancer:

Prostate Specific Antigen (PSA) Test:

The prostate-specific antigen (PSA) test is a blood test that may be provided to you by your primary care physician or urologist as part of a standard screening exam. Nonetheless, systematic screening using the test is contentious. Non-cancerous conditions, including an enlarged prostate (also known as benign prostatic hyperplasia [BPH]) or prostatitis [prostate infection], may lead to falsely high PSA test results. Males with high results may be referred for further testing. Thus, the test should only be performed following an academic discussion between the physician and the patient.
The American Cancer Society evaluates PSA values based on the following criteria:
Yet, physicians still need to develop a standardized method for evaluating PSA. Concern and reference thresholds differ significantly. If your PSA test results are high, you may be encouraged to undergo further testing.

Digital Rectal Exam (DRE):

Physical examinations of the prostate gland, known as digital rectal exams (DREs), are conducted by doctors as part of regular checkups and when patients report symptoms that may indicate a problem with the prostate. A DRE involves the insertion of a gloved finger into the rectum and examines the prostate gland for asymmetry, nodules, and other abnormalities in size, shape, and texture that may be precursors to prostate cancer. Worrying DRE readings may not necessarily indicate cancer, similar to the PSA test. Results from the PSA test and the patient’s symptoms are considered in combination with the findings.

Transrectal Ultrasound and Real-Time Biopsy:

If your PSA level is high or your DRE reveals questionable indications, your physician may prescribe a prostate biopsy. Transrectal ultrasound (TRUS), in which an ultrasound probe is introduced into the rectum and sound waves are utilized to generate a picture of the prostate gland, is the most used test for this purpose.
During ultrasonography, needle biopsies are often obtained from many prostate regions. This is known as real-time prostate biopsy or Transrectal prostate biopsy. The biopsies are subsequently examined in a pathology laboratory for the presence of cancer cells.
Among the significant advantages of combining the two techniques are the following:

MRI Ultrasound Targeted Prostate Biopsy:

MRI-guided prostate biopsies are also being used increasingly regularly with ultrasonography or by themselves. MRI scans may detect malignant regions more precisely than ultrasonography.
Emerging research indicates that combining the two methods — utilizing MRI to detect problematic areas before the Transrectal ultrasonography and biopsy operation — might diagnose cancer more precisely than a TRUS biopsy alone.

Myths About Prostate Cancer:

Myth: Prostate Cancer Is for Older Men.
Fact: While most men diagnosed are older, the disease may and does affect younger men. According to the ACS, almost forty percent of all occurrences happen in males younger than 65.
Myth: Prostate Cancer Isn’t Deadly.
Fact: Although the five-year survival rate is quite good — 90% according to the American Cancer Society – it remains the second largest cause of cancer mortality in men.
Myth: There Is No More Treatment Available If The Cancer Comes back.
Fact: Recurrence of cancer may be devastating. Yet, just because cancer returns doesn’t imply you can’t regain remission. What it does indicate is that you’ll likely have to attempt another technique for therapy.
Myth: PSA Tests Are Bad for You.
Fact: Several prostate cancer specialists advise against routine PSA testing, although not necessarily due to the test itself, which is only a basic blood test. PSA screening is imperfect, but it does not threaten your health. When analyzing and acting upon PSA findings, the danger is anxiety and often incorrect decision-making.
Myth: Prostate Cancer Treatment Always Causes Impotence.
Fact: According to a study published in the December 2014 issue of the International Journal of Urology, progress has been made in developing models to predict erectile dysfunction after localized therapy. According to Sartor, preventing impotence relies on various things, including your surgeon’s ability. As surgical procedures improve, however, patients recover quicker and have fewer adverse effects.
According to Sartor, roughly 25% of patients will report normal function one year following surgery, 25% will report mild dysfunction, 25% will report moderate dysfunction, and 25% will report severe impairment.
Myth: Prostate Cancer Treatment Always Causes Incontinence.
Fact: Men are most concerned about urine incontinence due to cancer treatment, second only to sexual function. Sartor believes sexual adverse effects are more prevalent than the urine side effects the year following surgery, and most individuals do not have substantial urinary issues.

Prostate Cancer Treatment:

Typically, prostate cancer is a slow-growing tumor or cancer. For some men, It generates neither symptoms nor long-term complications; thus, no treatment is required. In such circumstances, physicians may urge active monitoring. They will monitor the tumor’s progression using various techniques and tests.
The following treatments are available:

Surgery for Cancer That Has Not Spread:

The patient is left with a cancer-free organ when the prostate gland, adjacent tissues, and seminal vesicles are entirely removed during radical prostatectomy.
Traditional radical prostatectomy may be done in two different methods. Surgeons perform a retropubic prostatectomy via a lower abdominal incision, removing the prostate gland and any other suspicious tissue.
While operating on a patient with cancer, the surgeon may additionally remove lymph nodes in the region to check for lymphatic metastases.
Doctors cut into the perineum to perform the second kind of prostatectomy, known as a perineal prostatectomy. In some instances, lymph nodes are removed via a third abdominal incision. The American Cancer Society reports that this procedure has a greater risk of post-op erection issues than a retropubic prostatectomy, although being quicker (ACS).
Laparoscopic radical prostatectomy involves making a series of tiny incisions and inserting thin fiber-optic tools to accomplish the procedure. Robotic prostatectomies refer to using a robotic system to conduct a laparoscopic prostatectomy.
There is less discomfort after a laparoscopic treatment; patients usually leave the hospital sooner and return to normal activities.

Radiation Treatment for Several Conditions:

Radiation treatment, in which high-energy X-rays or other forms of radiation are used to kill and inhibit the growth of cancer cells, is commonly used in the following instances:
The treatment may be administered via an external machine or radioactive chemicals surgically inserted into or near the cancerous tissue (brachytherapy). The disease has progressed to the bones, and one treatment option is alpha emitter radiation therapy, which consists of injecting radioactive chemicals (often radium-223) into a vein.

Hormone Therapy: A Mainstay for Many Patients

Hormone therapy is not an independent treatment. Typically, it is used to shrink cancer before therapy or to treat cancer that has gone beyond the prostate, returned after earlier therapies, or is high-risk and likely to return after treatment.
The growth-promoting hormones that these treatment targets are either eliminated or blocked. Treatments include the following:
Prostate Cancer Treatment

Other Prostate Cancer Treatments:

A wide variety of treatments are now accessible, and each has its own benefits and drawbacks.
These include the following therapies:

Dietary Tips For Patients:

No specific diet will help you prevent or treat it. Still, good nutrition may be associated with a lower risk of developing cancer and a reduced risk of the disease progressing after a diagnosis. The UCSF cancer center created dietary recommendations for prostate cancer.

How to Boost Quality of Life During Treatment?

Regarding male malignancies, This is by far the most common and second leading cause of cancer death. Yet, its progression is often more gradual than that of other tumors. You may take your time looking for a treatment plan for your cancer that won’t severely impair your standard of living. Many options for doing so are provided below.

Keep Up With Your Regular Schedule As Best You Can:

Do all you can to show up for work, even if it’s not for the whole day. Talk to your manager, colleagues, or other volunteers if you need help determining how much you can take on. Remember that those who appear unhelpful might be afraid of cancer themselves. You must choose whether to remain silent about cancer or discuss it openly. Just follow your gut instinct. Go on a vacation or hang out with your loved ones.

Eat Well And Exercise:

Being active can give you more energy, says the NCI. Try swimming, walking, or doing yoga. According to the NCI, exercise keeps your muscles toned, speeds healing, decreases fatigue, controls stress, and increases your appetite. To be active in any way is beneficial.
The more generally healthy a man is, the better he may live and battle his condition, even if he has been diagnosed with prostate cancer.

Learn What to Expect:

The news that you have prostate cancer may completely alter your life. You never know when your plans may change; the unknown can be terrifying. If this sounds like your situation, it’s vital that you see your doctor and get as much information as possible regarding your condition. The National Cancer Institute recommends that your doctor document your cancer diagnosis and stage (NCI). With this test, learn the tumor’s size and whether it has spread to other organs. You and your doctor can then decide what course of therapy is best for you.

Healthcare Team For Treatment:

Treatment requires more than a good urologist. In addition to your primary care doctor, who may have given you the diagnosis, you may also want other consultants for effective treatment. Here are four people to add to your healthcare team.

Frequently Asked Questions About Gestational Diabetes:

If you have any of the following symptoms, see your doctor immediately:

• Trouble trying to urinate.
• Weak or intermittent urine flow.
• Frequent urination, particularly at night.
• Difficulty voiding the bladder entirely.
• Urinary discomfort or burning sensations
• Blood present in the urine or sperm

Prostate cancer is most commonly diagnosed in men who are over the age of 50. As men age, their chance of acquiring prostate cancer rises, with the majority of cases occurring in men over 65. However, prostate cancer can also occur in younger men, although it is less common.

It is essential for men to discuss their risk factors for prostate cancer with their healthcare provider, as there are several factors that can increase the risk of developing the disease.
The curability of prostate cancer depends on several factors, including the cancer stage at diagnosis, the grade of cancer, and the patient’s overall health. In general, prostate cancer is regarded as a very treatable and often curable disease, mainly when diagnosed and treated at an early stage.
The diagnosis of prostate cancer usually begins with a physical exam and a medical history. The doctor may also do a digital rectal exam (DRE) to feel the prostate gland’s size and structure and screen for abnormalities.

If the results of the physical exam or medical history suggest the possibility of prostate cancer, the doctor may order further tests to confirm the diagnosis. These tests may include the following:

Prostate-specific antigen (PSA) test: A blood test that measures the level of PSA, a protein produced by the prostate gland. Elevated levels of PSA can indicate prostate cancer but can also be caused by other conditions.

Biopsy: A technique involving the removal of a tiny sample of prostate tissue for analysis. Often, ultrasound guidance is used to guide the needle into the prostate gland. The tissue sample is then analyzed under a microscope to detect the presence of cancer cells.

Imaging tests: Tests such as a bone scan, CT scan, or MRI may be used to determine the extent and location of cancer.

After a prostate cancer diagnosis has been confirmed, the doctor will identify cancer’s stage and grade, which will determine treatment recommendations. Treatment options may include surgery, radiation therapy, hormone therapy, or a combination of these treatments, depending on the specifics of each individual case.
In the absence of a home PSA blood test, there is currently no simple means of self-diagnosing prostate cancer. The best action is to see a doctor for a digital rectal exam since doctors are trained to detect prostate abnormalities, including lumps and enlargements.
Prostate pain can be felt in and around the prostate gland, a small gland in the male reproductive system, just below the bladder and in front of the rectum. The prostate gland is located around the urethra, which is the tube that transports urine from the bladder to the penis.

Pain in the prostate can be felt in various areas, such as the groin, lower abdomen, lower back, perineum (the area between the scrotum and anus), and the tip of the penis. However, it’s important to note that pain in these areas does not necessarily mean that the pain originates from the prostate gland. If you are experiencing pain in this area, it’s recommended to speak with a healthcare professional for proper diagnosis and treatment.
The prostate gland can be the source of several problems, but the most common issue is benign prostatic hyperplasia (BPH) in aging men.

BPH is a noncancerous prostate gland growth that may produce urinary symptoms such as difficulties beginning and ending urination, weak urine flow, frequent urination, and the sensation that the bladder is not entirely emptied. BPH occurs as the prostate gland grows larger and presses against the urethra, which can affect urine flow.

Prostate cancer is another potential problem associated with the prostate gland, although it is less common than BPH. Prostate cancer is a malignant tumor that can grow in the prostate gland and be slow-growing or aggressive. Prostate cancer symptoms may not manifest until the disease has progressed significantly but may include difficulty urinating, pain during urination or ejaculation, blood in the urine or semen, or pain in the lower back, hips, or thighs.

Other less common problems with the prostate gland may include prostatitis, inflammation or infection of the prostate gland, or prostate abscess, which is a collection of pus within the prostate gland. These conditions can cause pain, discomfort, and urinary symptoms.

Doctor Saad Aziz

Dr. Saad Aziz
As a graduate of University of Health Sciences Lahore, I have acquired extensive expertise in medicine and hospital settings. I excel in accurate diagnosis and creating effective patient treatment plans.

I am known for my empathetic and professional attitude, with a commitment to providing my patients with the highest standard of care. I have served at several prominent hospitals, including:

  • Divisional Headquarter Hospital Mirpur
  • Combined Military Hospital Rawalpindi
  • Pak Emirates Military Hospital Rawalpindi
  • Fauji Foundation Hospital Rawalpindi
My wealth of medical knowledge is complemented by my focus on patient counseling and promoting positive lifestyle changes. I am also proud of my contributions to medical research and the several articles I have published.
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