Prostate cancer is the most common cancer in men. The malignant tumor in the prostate initially does not show symptoms, that is why it is often discovered when it is already in an advanced process.
Therefore, men should be screened regularly to advance the diagnosis – the chances of recovery from prostate cancer are better the sooner the malignancy is discovered and treated.
Read here what symptoms appear in prostate cancer, how the disease is treated, and if sex life plays a role in the development of cancer.
What is prostate cancer?
Prostate cancer is the most common cancer in men and the second most common fatal tumor (breast cancer). About 60,000 men develop a malignant tumor in the prostate gland each year.
The mean age of onset is around 70 years and rarely occurs before 50 years.
Prostate cancer should not be confused with benign enlargement of the prostate (benign prostatic hyperplasia). This is found in one out of every two men over 50 and from the age of 80 in almost all.
Prostate anatomy and function
The prostate (prostate gland) is about the size of a chestnut. It is located under the bladder and completely surrounds the upper part of the urethra.
If the prostate enlarges (such as benign prostate enlargement and prostate cancer) and the urethra is squeezed, problems with urination may occur.
The prostate is one of the male reproductive organs. Their main task is to train produce semen, along with the testicles and seminal vesicles.
A component of this secretion is the so-called prostate-specific antigen or PSA for short. This enzyme makes the seminal fluid thinner. PSA is made exclusively of the prostate and is used for the diagnosis and progression of prostate cancer.
Prostate cancer develops in many men without even noticing anything at first.
Symptoms only appear in later stages of the disease when the tumor has spread to neighboring regions such as the bladder, rectum, or coccyx.
Signs of prostate cancer include:
- Painful urination
- Weakened urine flow
- Pain during ejaculation
- Erection problems
- Blood in the urine or semen
- Prostate pain
- Problems with bowel movements
- Back pain, especially in the coccyx or lumbar vertebrae area
These symptoms are not unique to prostate cancer! They can also have other causes. For example, urination problems can also arise from generalized benign prostate enlargement (benign prostatic hyperplasia). And behind the back pain, there may also be signs of wear and tear on the spine, which is not uncommon for older men.
If you have any of the symptoms mentioned above, it is recommended that a urologist examine you. He can tell you if you really have prostate cancer or not. If so, he will immediately start treatment so that you can recover as quickly as possible.
Causes and risk factors
The exact cause of prostate cancer is unknown. Contrary to the above assumptions, high testosterone levels are not responsible for the development of prostate cancer.
While testosterone promotes the growth of an existing cancer, it does not trigger it.
However, the following factors may increase the risk of developing prostate cancer:
- Age: Advanced age is the most important risk factor for prostate cancer. About 90 percent of all men diagnosed with prostate cancer are over the age of 60.
- Genetic predisposition: First-degree relatives (father, son, brother) of patients with prostate cancer are at least twice as likely to get sick. If two or more close blood relatives are affected, the probability increases even more. Even if the female ancestors have breast cancer, the risk of cancer in the male offspring increases.
- Ethnic Factors: Prostate cancer is much more common in the dark-skinned population of North America than in the white population. Globally, Scandinavian men are most often affected by prostate cancer. In contrast, people of Asian descent rarely develop prostate cancer. There is a north-south divide within Europe regarding the incidence of prostate cancer: men in the Mediterranean are less frequently affected by the disease than men in Central and Northern Europe.
- Diet and lifestyle: Diet and lifestyle can also influence the development of prostate cancer. Some studies suggest that a diet low in fiber, high in calories, and high in fat (animal fats) increases the risk of getting cancer. Many grains, vegetables, and soy products, on the other hand, appear to have a protective effect, because not only in Asians but also in vegetarians, the risk of disease is significantly lower. Exercise regularly is also important in preventing prostate cancer.
Occupational risk factors such as heavy metals and radiation, or a lack of vitamin D could be a trigger for prostate cancer. However, there are not yet enough studies available for this.
According to some studies, very active sex life or frequent ejaculations seem to reduce the risk of prostate cancer. However, this is controversial: from a scientific point of view, there is no reliable explanation for this connection.
Exams and diagnosis
The sooner prostate cancer is found, the better. However, many victims only become aware of the malignant tumor when it is more advanced since it does not cause any symptoms beforehand.
Therefore, men definitely get a preventive checkup regularly.
Prostate cancer prevention
Start with a conversation: The doctor usually asks about health problems like urination problems, constipation, high blood pressure, erection problems, etc. , as well as any previous illness and the use of medications.
He also asks if there are known cases of prostate cancer in the man’s family.
Then there is a tactile exam: The doctor scans the man’s prostate with a finger over the rectum (digital rectal exam).
The examination is completely painless and very important: it can be used to feel the enlargement and nodular hardening of the prostate gland if it exceeds a certain level.
The last one is the digital rectal exam: which can provide information about important changes in the prostate gland. These changes may be due to advanced prostate cancer (the changes are not palpable in the early stages) or they may have a more harmless cause.
This can only be clarified by further research.
Prostate Cancer Diagnosis
Anyone who discovers possible symptoms of prostate cancer should definitely go to the doctor. The person to contact is the urology specialist.
You will first speak to the patient to determine their medical history.
Common questions the doctor might ask include:
- Are there any cases of prostate cancer or breast cancer in your family?
- Have you trouble urinating? Do you experience pain during ejaculation?
- Have you accidentally lost weight lately?
- Have you had a fever or night sweats recently?
- What is your overall physical performance?
- Do you have digestion problems?
- Have you noticed blood in your urine or feces?
- Do you have pain in your lower back (“sciatica pain”)?
- Do you have erection problems?
After the questions, you will go to the physical examination. Prostate cancer can cause the testicles and lymph nodes to swell. Therefore, the doctor will scan the corresponding area. The digital rectal tactile examination is then performed.
In addition to the tactile examination, a certain blood value is often determined: the PSA value.
PSA (Prostate Specific Antigen) is a protein that is only produced by prostate cells.
Its blood value is the criterion for the activity of the prostate tissue. This is used to diagnose cancer and to assess the course of the disease.
The PSA value is undoubtedly useful as a control parameter for evaluating the course after treatment for cancer. Its benefits in early detection are controversial.
PSA values are also used to determine cellular changes in the prostate that would otherwise have never been felt and would not cause prostate cancer.
The test result, therefore, means unnecessary mental strain and treatment for the men involved.
In addition to rectal palpation examination and determination of PSA value, additional examinations are generally necessary to diagnose prostate cancer. This includes a transrectal ultrasound.
The prostate is examined by an ultrasound examination of the rectum, which allows the doctor to more accurately assess the size and shape of the prostate gland.
Prostate carcinoma can be discovered by ultrasound since it is oriented laterally or towards the abdominal side and therefore cannot be felt with a digital rectal examination.
Removing tissue from the prostate
If past exams (rectal exam, PSA measurement, ultrasound) reveal evidence of prostate cancer, the next step is to take a sample of prostate tissue and examine it in the laboratory.
Only then can you say for sure if the cancer really exists or not.
The doctor obtains a tissue sample by removing several cylinders of prostate tissue with a thin, hollow needle under ultrasound control over the rectum (prostate biopsy).
Since the needle is very thin and shoots into the tissue in an instant, the patient feels little or no pain. There is also no risk of cancer cells scattering into the surrounding tissue due to tissue removal.
Prostate tissue samples are examined by a pathologist under a microscope for cancer cells (histopathological examination).
You can also see how much cancer cells have changed (degenerated) compared to normal prostate tissue.
The extent of degeneration is determined by the so-called Gleason scoring system: it can have a value between two and ten. Value two represents the lowest possible value and value ten for the greatest possible degeneration of cancer cells.
So the higher the value, the more aggressive the tumor will be and the greater the chances of cure.
Another possibility of tumor classification is the TNM System. T describes the size of the tumor, N the involvement of the lymph nodes, and M the metastasis. All letters or factors are numbered from 0 to 4, depending on the existing expression of the respective patient.
Prostate Cancer Staging
If the histopathological examination of the tissue samples confirms the suspicion of prostate cancer, the spread of the tumor in the body (formation of daughter tumors = metastasis) should be examined.
In this way, the stage of the cancer can be determined (staging). Planning for individual therapy depends on this.
Several exams are necessary for the staging:
- An ultrasound of the kidneys shows if the tumor blocks the urine from draining from the kidneys.
- A chest x-ray can show if metastases have developed in the lungs.
- A computed tomography (CT) or magnetic resonance imaging (MRI) is performed on more metastases (metastases from prostate cancer) found in the body and to determine if surgery is appropriate.
- With the help of a bone scan, the doctor determines if cancer has already affected the bones.
- Blood tests can provide information about the general condition of the patient. In addition, the concentration of the enzyme alkaline phosphatase (FA) and the level of calcium is important: they can increase in bone metastases.
Prostate cancer: treatment
Prostate cancer treatment in individual cases depends on several factors. Such as the stage of cancer and the age of the patient.
A physician will also consider any requests for therapy the patient may have (for example, refusal of chemotherapy).
The goal of treatment is complete cure if the cancer has not yet spread beyond the prostate capsule.
A doctor tries to achieve this, for example, by surgery, cold therapy, or radiation therapy. The latter is also used when cancer has already spread.
Radiation can inhibit the growth of malignant tumors. Chemotherapy and hormone therapy can also be used to treat advanced cancer.
If the tumor grows very slowly and the patient is elderly, cancer may never cause health problems. In this case, cancer can remain untreated and should only be checked regularly by a doctor.
As with any cancer, follow-up exams follow the actual treatment.
You have two objectives:
- Recognize a recurrence of prostate cancer (relapse) as soon as possible. A physical exam and blood tests (such as determining the PSA value) help with this.
- Discuss the possible consequences and side effects treatments. For example, after prostate surgery, patients may experience impotence (erectile dysfunction) and have trouble holding urine (urinary incontinence). Such sequences of operations can be very stressful for those affected. Aftercare can be specifically treated, for example, with incontinence medications or training.
Follow-up exams are usually done every four months in the first two years after diagnosis. After that, it depends largely on the individual course of the disease, how often a follow-up examination is advisable.
If possible, follow-up should be done by a urologist experienced in caring for cancer patients (oncology practice).
Disease course and prognosis
The chances of recovery from prostate cancer crucially depend on how soon the symptoms are discovered and whether it has already developed in other organs (metastasis).
Furthermore, the course of the disease is influenced by the severity of the degeneration of the tumor cells and the speed with which they grow.
At the time of prostate cancer diagnosis, it is generally impossible to predict how the disease will progress. An experienced urologist can at least roughly estimate the chances of a cancer cure.
In general, the prognosis is often favorable. Statistically speaking, 87 to 92 percent of patients are still alive five years after diagnosis (five-year survival rate).
Therefore, life expectancy for is relatively good compared to other cancers.