Few cases show a rapid and aggressive development of the disease, as most of the time, the tumor grows slowly and asymptomatically. Often, patients – including young people – die from different causes and cancer is only discovered after death.
Data from the National Cancer Institute (INCA) report that prostate cancer is the 2nd most common among Brazilian men, second only to non- melanoma skin cancer , and the 4th most frequent considering the general population (men and women ).
Predominant in the age group above 65, INCA still estimates that, for 2018 and 2019, more than 68 thousand cases are diagnosed per year. On average, for every 6 men, 1 will have prostate cancer.
The type is the 2nd leading cause of death, second only to lung cancer . On average, there are more than 13,700 victims per year.
In Brazil, approximately 9 out of 10 patients are over 55 years of age, but when it affects patients below that age, it may indicate hereditary genetic alterations. Therefore, cases in the family are a warning sign.
The Brazilian Society of Urology indicates that screening tests for the disease should be done from the age of 50 or from 45 in risk groups (blacks and people with a family history of the disease). When diagnosed in the initial phase, the chances of cure are high – on average, 90% – and the impacts on the patient’s life are much less.
Causes of Prostate Cancer
Prostate cancer is the result of abnormal and disorderly proliferation of cells in the prostate.
Although the exact causes are still unknown, some factors can favor the development of the disease, such as mutations in the DNA of cells. This is because the organism has a series of functions determined by DNA genes, such as cell multiplication and division. When any change affects or deactivates the action of these genes, there is a possibility that cancers will develop.
Mutations can be inherited or acquired, that is, they may or may not be transmitted to children, respectively.
In general, the hereditary ones, are responsible for 5% to 10% of the cases of prostate cancer and involve mutations in the genes:
- RNASEL (formerly HPC1) : mutations in this gene do affect the suppression of abnormal cells, causing them to live longer than they should;
- BRCA1 and BRCA2 : the mutation in these genes is related to breast cancer in women and a small amount of prostate cancers;
- DNA incompatibility repair genes (such as MSH2 and MLH1) : mutations in this gene cause a condition called Lynch syndrome, which increases the risk of prostate cancer;
- HOXB13 : young men usually have an alteration in the HOXB13 gene.
The acquired changes are those that occur during the patient’s life, usually occurring in the cell division. The division process is natural, causing the cell to turn into 2 and copy its DNA to each one. However, if there are errors during this duplication, the DNA remains defective, facilitating the development of prostate cancer.
Although there is no consensus in the acquired case, the factors that may be related are:
- Increase in male hormones (testosterone);
- Increased hormone IGF-1 (insulin growth factor);
- Inflammation of the prostate;
- Exposure to radiation or carcinogenic substances.
Some risk factors are believed to facilitate or promote the development of prostate cancer. Check out what they are:
The patient’s age is considered to be a major risk factor, that is, the older, the greater the risk. Prostate cancer is rare in men under 45 and more common in those over 50.
In addition to the higher incidence in this age group, the patient’s health is more fragile, and the risks to life are higher.
Statistics prove that genetics is a risk factor for prostate cancer. The disease is more common in black men and those who have a family history of the disease.
If the patient meets any of the criteria below, it is considered a hereditary disease and there is approximately a 50% chance of manifesting:
- 3 or more first degree relatives are affected;
- 2 first-degree relatives diagnosed before age 55;
- Happening in 3 consecutive generations (grandfather, father and son).
Several studies indicate that certain diets and foods may have a preventive effect for prostate cancer, while others may be associated with higher rates of manifestation of the disease.
Among the foods that can help protect the body against prostate cancer from several other diseases are vitamins A, D and E, in addition to the mineral selenium, found mainly in:
- Vegetables, fruits and vegetables;
- Whole grains;
- Whole grains.
Among the substances that can favor the development of prostate cancer are polycyclic aromatic hydrocarbons and heterocyclic amines, generated mainly in the preparation of red meat, and the calcium consumed in excess.
Another study showed clear evidence that men with obesity tend to be more likely to develop prostate cancer. In addition, the risk of metastasis (cancer spread beyond the affected organ) and death are also greater among patients with obesity.
Sexually Transmitted Diseases (STDs)
Men who have already had gonorrhea and trichomoniasis may have a greater chance of developing prostate cancer, according to research by the University of Michigan (USA). It is estimated that STDs can promote or influence the development of the disease.
Agent Orange is a mixture of two herbicides used as a defoliant by the United States Army in the Vietnam War. Veterans exposed to this agent had a higher risk of developing prostate cancer, about 48%, in addition to larynx, pharynx and Hodgkin’s disease.
Abuse of alcohol and other drugs
The smoking , excessive consumption of alcohol and other drug use are related to increased risk of several cancers, including prostate.
Most cases of prostate cancer are originally developed in the semen-producing glands. This type of cancer is called adenocarcinoma, which is responsible for the vast majority of diagnosed cases.
The type can manifest itself in varying degrees – low, medium or high degree. The greater the speed of proliferation and the more different from normal tissue the mutant cells are, the higher the degree of the disease.
There are other types, still, but much less common. Are they:
- Sarcoma : rarer type of prostate cancer, being more common in young men;
- Small cell carcinoma : type of cancer that appears in the layer that lines the organ called epithelial tissue;
- Neuroendocrine tumors : the occurrence is rare, but the type is quite aggressive and originates in the endocrine and neural cells.
Determining the stage of the cancer is essential to lead the patient to the most appropriate treatment, which can be, for example, radiotherapy or surgery. Called staging, the investigation considers the size, extent and location of the cancer in the body.
- The clinical stage: based on the results of physical examinations, laboratory tests, prostate biopsy, imaging tests and blood tests;
- The pathological staging: performed when the patient is undergoing surgery and uses the examination of the pathological staging along to what is observed during the surgical procedure.
There are different ways of measuring, or staging, cancer. The most common follows the TMN system:
Called the TNM system, the classification is used by the American Joint Committee on Cancer (AJCC) and the International Union for Cancer Control (UICC) to understand and measure the progress of different types of cancer.
The system initially classifies cancer according to:
- T : primary tumor;
- N : when the cancer has spread to nearby lymph nodes;
- M : when the cancer has spread through the body (metastasis).
Each of these stages uses the same categories for the classification of cancer:
Category T comprises 4 types of subcategories that describe the extent of the tumor in the prostate:
When the doctor can feel the tumor or see it through a transrectal ultrasound.
- T1a: cancer is discovered accidentally during transrectal resection of the prostate done for Benign Prostatic Hyperplasia (an enlargement of the non-cancerous prostate) and is not present in more than 5% of analyzed tissue;
- T1b: cancer is also discovered through transectal resection of the prostate, but it is present in more than 5% of the collected tissue;
- T1c: cancer is found in a needle biopsy done due to the increase in PSA.
When the doctor is able to feel the cancer with a digital rectal exam or see it through a trans-rectal ultrasound, but noting that it is still close to the prostate.
- T2a: the cancer is located in half or less than half of the prostate;
- T2b: cancer is on more than half of one side of the prostate;
- T2c: cancer is in both parts of the prostate.
When the cancer has already spread outside the prostate, probably reaching the seminal vesicles
- T3a: the cancer extended outside the prostate, but did not reach the seminal vesicles;
- T3b: cancer reached the seminal vesicles.
When the cancer has reached tissues of other organs, such as the urethral sphincter, the rectum, the bladder and / or the pelvis wall, the acronym T4 is used .
Categories N describe whether the cancer has already reached regions close to the lymph nodes.
- NX : The region close to the lymph nodes has not been evaluated;
- N0 : The cancer has not spread to the region close to the lymph nodes;
- N1 : The cancer has spread to one or more nearby lymph nodes.
These categories describe whether the cancer has already reached more distant parts of the patient’s body.
- M0 : The cancer has not spread beyond the lymph nodes.
- M1 : The cancer has spread beyond the lymph nodes.
Category M1 can be further subdivided into:
- M1a : cancer has spread outside the pelvis;
- M1b : the cancer has spread to the bones;
- M1c : the cancer has spread to other organs, such as the lungs, liver and / or brain.
D’Amico risk categories
Although the TNM system is widely used, in some cases, D’Amico risk categories can be used to measure the risks of the localized tumor (when it has not invaded other organs or tissues) to spread beyond the prostate.
This system uses digital rectal examination and results of other tests, such as PSA (prostate specific antigen) and Gleason score (appearance of the tumor, assessed by microscopic examination) to determine which of the 3 risk groups the patient is in. : low, intermediate and high.
In most cases, the early stage of prostate cancer has no symptoms. This asymptomatic characteristic makes most men discover the disease after routine exams or when the disease is in an advanced stage.
If the patient is symptomatic in the early stages or when he is in the advanced stage of the disease, the following may manifest:
- More frequent urination;
- Get up more often at night to urinate;
- Difficulty starting to urinate;
- Drip or successive spurts of urine;
- Difficulty continuing to urinate once it has started;
- Blood in the urine or sperm;
- Painful urination;
- Painful ejaculation (less common);
- Pain in the testicles;
- Pain when ejaculating;
- Difficulties in achieving or maintaining an erection.
In advanced cases of cancer, the following symptoms are possible:
- Pain in the bones, especially in the spine, pelvis or ribs;
- Generalized infection;
- Renal insufficiency.
But it is important to note that the symptoms can often be caused by other clinical conditions than the cancer itself. That is, sometimes the patient has an increase in urinary frequency due to the benign growth of the prostate (benign prostatic hyperplasia).
Prostate cancer can be diagnosed through a variety of tests, including those for early detection (digital rectal examination and PSA measurement). Check out the diagnostic tests in the list below:
Digital rectal examination
The exam is painless and quite quick, being performed in the doctor’s office. In it, the doctor inserts his finger into the patient’s anus, using gloves and lubricant, in search of changes, abnormalities or signs of cancer.
Specific protein antigen (PSA)
prostate specific antigen (PSA) is one of the first and main tests to detect prostate cancer. In general, healthy men have PSA levels below 4ng / mL (nanograms per milliliter). When the values are above this average, the patient is referred to other confirmatory exams.
In general, patients who do not have confirmation of the disease but have results between 4ng / mL and 10ng / mL have a 25% chance of developing cancer, while values above 10ng / mL indicate more than 50% of risks for the disease.
TRIMprob (Interferometer Tissue Resonance Probe)
Non-invasive examination, TRIMprob is performed in an office and lasts around 10 minutes. In it, electromagnetic waves are emitted, capable of indicating some alteration in the prostate. Normally, this test is indicated for those who have done rectal examination and PSA measurement.
The biopsy removes a small sample of tissue from the prostate to be sent for analysis. Through the wall of the rectum, the professional inserts a needle towards the prostate. In most cases, it is assisted by a transrectal ultrasound, which is an image exam without the use of ionizing radiation.
In this case, the high frequency sound wave technique (above the audible limit to humans) is used. Ultrasound is used to assist in positioning the needles during the biopsy, in addition to measuring the size of the prostate gland.
This test is done only when the cancer is suspected to have spread to the bones and consists of applying a small amount of radioactive compound to the patient. This substance accumulates in areas of the bones that may have abnormalities caused by metastasis, arthritis or other bone diseases.
The examination is quick and in a short time the substance is eliminated through the urine.
As the machine rotates around the patient, several x-ray images are taken, producing detailed images of a part of the organism on a computer screen.
After the first images, a radioactive contrast is injected into the patient so that new images can be taken, this time with a greater contrast of the body’s structures.
Magnetic resonance imaging uses radio waves and strong magnets instead of x-rays and can verify whether the cancer has already reached the seminal vesicles and the bladder. The exam is, in general, used as a complementary diagnosis and must be performed together with the other exams.
Like bone scintigraphy, radioimmunoscintigraphy uses small amounts of radioactive material to check whether or not the cancer is limited to the prostate.
Lymph node biopsy
Examination carried out to check if the cancer reached the lymph nodes. The test is generally used when the patient needs to undergo radiotherapy and it is not yet known exactly which lymph nodes are affected by the cancer.
The biopsy is performed through the insertion of fine needles or a small incision in the abdomen (laparoscopy), so that a small sample of tissue is removed.
During prostate removal surgery, the doctor removes one of the nodes and analyzes it under a microscope. Depending on what is found, it decides whether more tissue needs to be removed or not.
Can Prostate Cancer be cured?
Yes, but the cure is directly related to the stage of diagnosis. Therefore, the sooner the disease is detected and treatment begins, the higher the cure rates.
In the early stages, prostate cancer has up to a 90% chance of being completely eliminated. It is worth noting that, even if cancer is diagnosed early, it is important to keep monitoring it with your doctor.
The most appropriate treatment must be evaluated by the doctor, considering the patient’s particularities and the manifestation of the disease. For the localized type, surgery, radiotherapy and, sometimes, just watchful observation (constant monitoring of the condition) can be considered.
When the disease is advanced, but still localized (it has not spread through the body), radiotherapy and surgery with hormonal treatment can be considered. In cases of metastatic disease (cancer has affected other parts of the body), hormone therapy is the main choice.
To begin with, it is important to know what the classification of cancer is within the Gleason Score score given to a prostate cancer according to its microscopic appearance. The lower the score, the better the patient’s prognosis:
- Score between 2 and 4: it means that there is about a 25% chance of cancer spreading outside the prostate in a period of 10 years.
- Score between 5 and 7: means that there is about a 50% chance of cancer spreading outside the prostate in a period of 10 years.
- Score between 8 and 10: means that there is about a 75% chance of cancer spreading outside the prostate in a period of 10 years.
Having established the Gleason Score of the patient in question, it is time to choose the treatment. Check out what the options are (remembering that each patient may need a specific type of treatment):
Non-immediate treatment (watchful observation)
When the tumor does not compromise the quality of the routine or is not able to affect the patient’s life span, one can choose the treatment of continued observation. On average, between 15% and 56% of diagnosed cases fall into this category, in which less than 1% of patients are at risk of death.
The patient must maintain the routine of consultations and exams, so that the condition is properly monitored. Frequent PSA exams, digital rectal examination and ultrasound are requested every 3 or 6 months. If the doctor evaluates changes or worsening of the disease, treatment is started immediately.
Radiotherapy uses several highly potent radiation beams, which have the function of causing cancer cells to be killed during the treatment process. Two approaches can be employed:
- External radiation: in this type of radiation therapy, the patient directly receives powerful rays of radiation and lasts only a few minutes. However, it is necessary to do it several times a week;
- Internal radiation or brachytherapy: brachytherapy consists of introducing radioactive seeds directly into the prostate, which can be temporary (with high doses of radiation) or permanent (with low radiation doses). In general, they have fewer side effects than external radiation.
Increasingly, therapeutic techniques have provided better results and fewer side effects, but it is still important to highlight the risks of inflammation in the rectum and bladder, which can affect up to 15% of patients. They can still manifest themselves:
- Pain when urinating;
- Frequent and / or urgent urination;
- Pain when passing stools;
- Erectile dysfunction;
- Loss of pubic hair;
Hormone therapy (hormone therapy)
Hormone therapy, also called androgen deprivation therapy or androgen suppression therapy, consists of the injection of hormones that stop the production of androgens, mainly testosterone and dihydrotestosterone (DHT).
As androgens stimulate the growth of cancer cells, when therapy inhibits hormonal action, tumors may shrink or grow more slowly. But it is important to note that hormone therapy alone is not able to cure cancer.
In general, therapy can be indicated for patients who cannot undergo surgery or radiotherapy, if the disease has returned even after treatment, before radiotherapy (reducing cancer so that the treatment is less aggressive) and also as a complement to radiotherapy in progress.
Hormone therapy options include drug and surgical interventions, such as:
Androgen level reducers
Medications called luteinizing hormone releasing hormone receptor agonists can be used. They are injected or implanted under the patient’s skin, usually in monthly or annual periods. The most common are Leuprorrelin , Gosserrelin , Triptorelin and Histrelin.
There are also surgical modes, called Bilateral Orchiectomy (Surgical Castration), which consists of removing the testicles, as they are responsible for the production and secretion of most androgen hormones.
LHRH antagonist medications are administered through monthly or annual injections and work by rapidly lowering testosterone levels in the body; There are also oral medications (tablets) that work by blocking hormone production only in the testicles by inhibiting an enzyme called CYP-17.
Androgen function blockers
Called antiandrogens, these drugs work by blocking or inhibiting male hormone cell receptors, causing the biological hormonal effects to stop. Antiandrogens are taken orally (tablets) daily, and may include medications such as Bicalutamide , Flutamide and Nilutamide.
There is also Enzalutamide , a newer drug, capable of inhibiting the action of the androgen receptor, preventing the duplication of cancer cells. In some cases, the drug may act by decreasing PSA levels and increasing patient survival.
Other androgen suppressant drugs
Estrogen-based therapies (female hormones) can be used. However, although it is still used, this therapy generally causes intense side effects and, therefore, it has been gradually replaced.
Ketoconazole is most often used to treat yeast infections, but its action is also able to block some hormones, such as androgens. In some cases, the concomitant use of corticosteroids may be recommended, under medical prescription, as a way to reduce side effects, including:
- Erectile dysfunction;
- Heat waves;
- Loss of bone mass;
- Reduced libido;
- Swelling of the breasts;
- Weight gain.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Also called total proctectomy, the procedure consists of removing the prostate, seminal vesicles and, in some cases, also regional lymph nodes. Under general anesthesia, the procedure can be performed via an open, laparoscopic or robotic approach.
In general, the result of the 3 is quite similar and the risks in the post-operative also, being that the main difference is in the recovery time and in the better precision, less bleeding and better visualization of the professional during the surgery.
- Robotic surgery: a surgeon, through a console, performed through a robot. About 95% of prostate cancer surgeries performed in the USA are done in this way, bringing very efficient results and making the procedure less invasive.
- Incision made in the abdomen: compared to other types of surgery, this made through the incision in the abdomen generates less risk of damage to the nerves, which can cause problems in bladder control and erections.
- Incision between the anus and the scrotum: perineal surgery, as it is called, allows a shorter recovery time for the patient.
- Laparoscopic prostatectomy: with the aid of a camera, through small incisions made in the abdomen, the surgeon performs the surgery. This type of laparoscopy can cause some collateral damage, such as urinary incontinence and erectile dysfunction. In rare cases, surgery can be fatal.
Freezing of prostate tissue (cryosurgery)
Also called cryosurgery or cryoablation, freezing the prostate tissue consists of inserting small needles into the prostate to conduct a cold gas capable of freezing and destroying the prostate tissue.
Despite being less invasive than surgery, the long-term achievements of the cryosurgery procedure are not yet fully understood. In addition, patients who have already undergone radiotherapy may not benefit as much from the technique.
After the procedure, it takes about 3 weeks for the patient to recover, and it is possible for the patient to have blood in the urine, local pain and swelling in the penis, especially in the first 2 days.
Other risks involve:
- Erectile dysfunction;
- Intestinal incontinence;
- Urinary incontinence.
Chemotherapy consists of the use of drugs capable of destroying cancer cells, being administered intravenously or orally. It is a treatment option for patients who already have cancer in the metastatic stage, that is, the cancer has spread to other parts of the body besides the prostate.
Among the medications used, Docetaxel , Cabazitaxel , Mitoxantrone and Estramustine may act, in general, delaying the worsening of the disease, reducing symptoms and improving the patient’s life expectancy.
The main side effects of chemotherapy are:
- Hair loss;
- Mouth sores;
- Loss of appetite;
- Nausea and vomiting.
Although vaccines are known as forms of prevention, for cancers, they act as a treatment. In general, the therapy has fewer side effects and works by stimulating the patient’s immune system, allowing more effective combats to take place against the damaged cells.
In general, they are made individually, in which the patient’s own cells are used in the preparation of the vaccine. The therapeutic field is quite recent and studies are still evaluating its effectiveness.
When the disease is not diagnosed or treated correctly, the greatest risks involve the formation of metastases (the spread of cancer cells to other parts of the body), bone pain, weight loss and anemic conditions. Understand:
When cancer cells invade lymphatic vessels or the bloodstream, the whole organism is susceptible. It usually occurs when the diagnosis is late or the treatment is not having any effect.
In general, bones are the most threatened, with cells settling, growing and forming so-called bone metastases.
Both the cancer itself and the treatments can cause urinary incontinence in the patient, for example radiotherapy. In some cases, incontinence can be treated and resolved in a few months.
In addition, prostate removal surgery can cause degrees of difficulty in controlling the bladder, causing partial or total leakage of urine.
As with incontinence, treatments for prostate cancer can lead to erectile dysfunction , that is, the inability to achieve an erection or maintain one.
As with any surgical procedure, removal of the prostate can pose risks to the patient. In general, the most frequent include infarction , stroke and thrombosis in the legs, pulmonary embolism and infections at the site.
After surgery, urinary incontinence can affect up to 5% of patients, but it tends to be gradually alleviated until complete recovery.
Risks to life
In Brazil, prostate cancer is currently the 2nd biggest cause of death due to cancer among men, being the 1st place occupied by lung cancer. On average, there are 13,000 deaths annually.
Considering the world sphere, the disease is the 5th type of cancer that kills the most, making about 300 thousand deaths per year.
Living with cancer
Facing the fact of having cancer is not always easy, so some care during and after treatment is necessary.
Adequate nutrition is essential throughout life, but especially when the body is subjected to medical treatments. Among some of the symptoms, there may be reduced appetite or difficulty in eating. However, maintaining good body nutrition makes treatment responses more effective and the body is less impacted by therapies.
It is recommended that small meals are eaten several times a day, so that symptoms such as nausea and / or vomiting are avoided. In some cases, nutritional supplements may be indicated by the doctor to ensure that your nutrition is being done in the right way.
Opting for natural foods, rich in vitamins and minerals, with little industrialization and chemicals can help the functioning of the organism, avoiding aggravating the patient’s weakness.
The ideal is to always consult a nutritionist and follow the doctor’s recommendations.
Maintaining an adequate routine of physical activities assists in the functioning of the organism due to the several benefits already known from the exercises, such as:
- Improves cardiovascular conditioning;
- Helps in weight loss, when combined with an adequate diet;
- Improves musculature;
- Reduces fatigue.
In addition to physical action, maintaining an activity routine assists in the patient’s well-being, promoting relaxation, reducing stress and anxiety levels , as well as encouraging interaction.
If the practice of sports or other physically intense activities is not pleasant or possible, the patient can choose classes or practices such as:
- Art therapy;
- Dance or movement therapy;
- Physical exercises;
- Music therapy;
- Relaxation techniques;
Keep your friends and family close
Keeping loved ones close is a way of receiving support, both physical and emotional, which is critical at this time. It is very important to have affective support, capable of making the treatment a less stressful process.
The most effective way to prevent prostate cancer and several other diseases is to adopt a healthy lifestyle. Simple measures assist in the correct functioning of the organism and bring more quality of life.
Take care of the food
A fundamental part of life, an adequate and balanced diet reduces the risks of various diseases, in addition to helping the body to function properly.
The ideal is to reduce the intake of processed products , fat, sodium and sugar. Including fruits, vegetables, legumes and whole grains, always with the help and guidance of nutritionists, is essential to ensure a good food variety, maintaining adequate nutrient intake.
Maintaining a routine of regular physical activities helps in the proper functioning of the organism and acts as a preventive factor.
Exercises also assist in maintaining or reducing weight, making the risks of prostate cancer to be minimized, as soon as obesity may be related to the disease.
And you do not need to choose very intense sports, as it is estimated that maintaining a routine of light or moderate activities, for an average of 50 minutes, 3 times a week is enough to result in improvements in health.
Do not smoke and reduce alcohol consumption
Smoking is directly related to several diseases and changes in the body. Both nicotine and dozens of other substances present in cigarettes can cause serious damage to the body and favor the development of cancers.
In addition, excessive consumption of alcohol and other drugs is also related to health risks.
Make regular appointments
Going to the doctor should be a habit adopted as a form of prevention and do not comment to perform treatments. Maintaining a routine of exams, making regular appointments and taking care of your health is the best way to detect changes or illnesses early, making the treatment, when necessary, less aggressive and more promising.
Especially men with a family history or who fall into some risk factor, such as being black or having obesity, should pay special attention to preventive exams.
For this, it is necessary that every man over 50 years old undergo preventive exams on an annual basis. These tests consist of checking the PSA, through a blood test, and digital rectal examination. In cases of any suspicion, a biopsy of the prostate tissue should be performed.