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In conjunction with the Movember movement during November, we will be covering men’s health issues to raise awareness on men’s wellbeing. Today’s article is about prostate cancer, the second most common cancer in men, after skin cancer.⁵
What is a prostate and what does it do?
A prostate is a walnut-sized gland behind a man’s penis. It is a part of the male reproductive system. Prostate’s main function is production of an alkaline fluid that comprises 70% of seminal fluid. This fluid makes up semen, together with sperm cells and fluids from other glands. It provides lubrication and nutrition for sperm. Its alkaline nature also helps neutralise the acidic vaginal environment, making fertilisation more favourable.
How does prostate cancer happen? Who is at risk?
Normally, the growth and death of cells are regulated and kept in check. Prostate cancer begins when healthy cells change and grow out of control, due to mutation of cells. Usually, prostate cancer will not spread quickly to other parts of the body. Some grow very slowly and may not cause any symptoms for years. In fact, if effectively managed, men with prostate cancer can live long with good quality of life.
The risk factors of prostate cancer includes:
Being a man (women do not have a prostate!)
Age over 50 years
Has family history of prostate cancer
Eating habits. Obesity is indirectly associated with many cancers, including prostate cancer. A healthy diet to avoid weight gain is recommended, to prevent prostate cancer
What are the symptoms likely to be experienced?
Early stages of prostate cancer are mainly asymptomatic. At an early stage, they are found during screening tests. Some are found incidentally, e.g in patients who undergo transurethral resection due to benign prostatic hyperplasia (BPH).
At later stages of cancer, patients may experience constitutional symptoms, including fatigue, loss of appetite and unexplained weight loss, even without change in lifestyle or diet.
One may also experience urinary symptoms, including:
Frequent urination (unable to hold urine)
Weak/ interrupted urine flow, or the need to strain to empty the bladder
Blood in urine
Blood in semen
New onset of erectile dysfunction
Discomfort or pain when sitting, caused by an enlarged prostate
If the cancer is at advanced stage and spread to other parts of body, a man may experience:
Bone pain, in the back, hips, thighs, shoulders or other bone, due to spreading of cancer to bones
Swelling, accumulation of fluid in the legs, due to obstruction of lymph flow
The urinary symptoms above can also be experienced in BPH, a benign condition with enlargement of the prostate. So, do not panic if you have those symptoms, instead go and see a doctor to get your condition checked.
Screening and diagnosis of prostate cancer
Two tests are commonly done for screening of prostate cancer:
Digital rectal examination (DRE), in which the doctor inserts a gloved, lubricated finger into the man's anus, to feel the surface of the prostate through rectum, looking for any abnormalities.
Prostate specific antigen (PSA) blood test. Total PSA greater than 4ng/ml suggests malignancy. But it can be elevated in other conditions, e.g BPH, urinary tract infection, prostatitis (inflammation of prostate), trauma, manipulation of prostate gland (after a DRE). Also, normal levels of PSA do not exclude the diagnosis of cancer.
However, both tests are not specific and their results alone cannot make a definite diagnosis of prostate cancer. Diagnosis of prostate cancer requires additional confirmatory testing, like a biopsy (removal of a small amount of prostate tissue for examination under a microscope). Biopsy specimens are taken from several areas of the prostate, to ensure a good sample for microscopic examination. Most people will have 12 to 14 pieces of tissue removed, and the procedure can take 20 to 30 minutes to complete.
Management and outlook of prostate cancer
Management plan of prostate cancer depends on the patient's age, life expectancy, other medical conditions, patient’s preferences and the stage of the cancer. Some examples of management include:
Active surveillance (actively monitor for cancer symptoms through regular follow-ups, for early cancer)
Watchful waiting (for elderly men or those with life-threatening illness)
Local treatment, including surgery to remove the prostate gland (prostatectomy), radiation therapy
Systemic treatment: Antiandrogen therapy, targeted therapy, chemotherapy, immunotherapy
An important part of managing prostate cancer is monitoring its growth over time, to find out if it is growing slowly or quickly. Based on the pattern of growth, your doctor can decide the most suitable treatment option.
The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 31%.The 10-year survival rate for local, regional, and distant prostate cancer combined is 98%.²
Movember. Prostate cancer. Available on: https://ex.movember.com/about/prostate-cancer
Cancer.net. Prostate cancer. Available on: https://www.cancer.net/cancer-types/prostate-cancer
Amboss knowledge. Prostate cancer. Available on: https://www.amboss.com/us/knowledge/Prostate_cancer
Medscape. Function of prostate gland. Available on: https://www.medscape.com/answers/437359-90388/what-is-the-main-function-of-the-prostate-gland
Cancer.org. Cancer facts for men. Available on: https://www.cancer.org/healthy/find-cancer-early/mens-health/cancer-facts-for-men.html
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