What is Prostate Cancer? Symptoms and Causes

Prostate cancer develops when cancerous cells begin to grow in the prostate gland. This gland, found only in men, is about the size of a walnut & sits just beneath the bladder & in front of the rectum.

The prostate gland encircles the urethra, the passage through which urine leaves the body. It's vital to the male reproductive system, as it creates seminal fluid that aids in sperm transport during ejaculation.

Cancer in the prostate usually begins in the gland cells (called adenocarcinoma) and may grow at different rates. Some prostate cancers grow so slowly that they never cause any harm during a person’s lifetime, while others are more aggressive and can spread (metastasize) to nearby tissues, lymph nodes, or distant organs such as the bones. 

The behavior of prostate cancer varies widely from person to person, making accurate diagnosis and risk assessment crucial for appropriate management. Let’s explore the topic.

Types of Prostate Cancer

Prostate cancer is classified based on the type of cells in which it begins. The majority of cases fall under one category, but several less common forms exhibit different behaviors and may require distinct treatment approaches.

1. Adenocarcinoma of the Prostate (Acinar and Ductal)

This is the most common type, accounting for over 95% of prostate cancers. It begins in the glandular cells that line the prostate and produce prostate fluid.

• Acinar adenocarcinoma is the most frequently diagnosed subtype. It typically develops in the outer part of the prostate and tends to grow slowly.
• Ductal adenocarcinoma is rarer and tends to grow and spread more quickly. It arises in the ducts of the prostate and may present with urinary symptoms earlier.

2. Small Cell Carcinoma

A type of neuroendocrine cancer made up of small round cells. It is aggressive, grows rapidly, and often spreads beyond the prostate at the time of diagnosis. It does not usually raise PSA (prostate-specific antigen) levels significantly, making early detection more difficult.

3. Large Cell Neuroendocrine Carcinoma

Another rare and aggressive neuroendocrine tumor. It behaves similarly to small cell carcinoma but consists of larger cancer cells. Like other neuroendocrine types, it may not respond well to hormone therapy.

4. Transitional Cell (Urothelial) Carcinoma

This cancer usually starts in the bladder and can spread into the prostate. In rare cases, it begins in the prostate itself. It tends to grow along the urethra and requires treatment similar to bladder cancer, not standard prostate cancer therapies.

5. Squamous Cell Carcinoma

This form develops from the flat cells covering the prostate and does not produce prostate-specific antigen (PSA). It tends to be aggressive and unresponsive to hormone therapy or chemotherapy commonly used for adenocarcinoma.

6. Basal Cell Carcinoma

A scarce type that originates in the basal cells of the prostate. It may be locally aggressive and requires specialized management due to the limited research and case data available.

Symptoms of prostate cancer

• Frequent urination
• Weak or interrupted urine flow
• Difficulty starting or stopping urination
• Pain or burning during urination
• Blood in urine
• Blood in semen
• Painful ejaculation
• Difficulty achieving or maintaining an erection
• Pain or stiffness in the lower back, hips, pelvis, or thighs
• Unexplained weight loss
• Fatigue
• Swelling in legs or pelvic area (if cancer has spread)
• Loss of bowel control (in advanced cases with spinal spread)
• Numbness or weakness in the legs or feet

Causes of Prostate Cancer

1. Genetic Mutations in Prostate Cells

Changes in the prostate cell's DNA can cause them to grow and divide uncontrollably. These mutations may be inherited or acquired over time and affect how cells repair damage or regulate growth.

2. Age-Related Cellular Changes

As men age, the likelihood of cell mutations increases. Accumulated exposure to environmental and internal factors over time raises the risk of abnormal cell growth in the prostate.

3. Hormonal Imbalance (Androgens)

Testosterone and dihydrotestosterone (DHT), which are male hormones, influence prostate growth. Elevated or prolonged exposure to these hormones may contribute to the development of cancerous cells.

4. Inherited Genetic Conditions

Specific inherited mutations significantly increase the risk, such as those in the BRCA1, BRCA2, and HOXB13 genes. Men with these mutations are more likely to develop aggressive prostate cancer at a younger age.

5. Inflammation of the Prostate (Prostatitis)

Chronic inflammation in the prostate may create a microenvironment that encourages cancerous changes, though the direct link remains under study.

6. Exposure to Carcinogenic Substances

Long-term exposure to certain chemicals, such as those found in firefighting foam, industrial settings, or Agent Orange (a defoliant used in war), may elevate prostate cancer risk.

7. Obesity-Associated Cellular Stress

Obesity can alter hormone levels and increase inflammation, both of which may contribute to DNA damage and abnormal cell signaling in the prostate.

8. High-Fat Animal-Based Diets

Diets rich in saturated fats & low in vegetables and fruits may be linked to higher prostate cancer incidence, possibly due to changes in hormone levels and inflammation pathways.

9. Racial and Ethnic Background-Linked Factors

While not a cause in itself, African-American men are more likely to have aggressive forms of prostate cancer, suggesting possible genetic or environmental triggers that are still being studied.

Who Is at Higher Risk for Prostate Cancer?

Certain men have a significantly higher likelihood of developing prostate cancer due to a combination of biological, genetic, and lifestyle-related factors. Age remains the strongest predictor — the risk increases sharply after age 50, and most cases are diagnosed in men over 65 years old. 

Family history is another key risk factor. Men with a father, brother, or son who has had prostate cancer are more likely to develop it themselves, especially if the relative was diagnosed at a younger age. Inherited gene mutations, particularly in BRCA1, BRCA2, and HOXB13, further increase this risk and may be associated with more aggressive forms of the disease.

Race and ethnicity also influence risk patterns. African-American men face the highest rates of prostate cancer in the world, are more likely to be diagnosed at advanced stages, and tend to have more aggressive tumors. In contrast, Asian-American and Hispanic men have lower overall incidence rates. 

Men with occupational exposure to harmful chemicals or those with a history of prostate inflammation may also face increased risk. 

How Prostate Cancer Is Diagnosed

• Digital Rectal Exam (DRE)

A doctor manually examines the prostate through the rectum to check for lumps, hard areas, or abnormal texture.

• Prostate-Specific Antigen (PSA) Blood Test

Measures the level of PSA, a protein produced by prostate tissue. Elevated levels can indicate cancer but may also result from benign conditions like prostatitis or enlargement.

• PSA Velocity and PSA Density Analysis

Examines how rapidly PSA levels are increasing over time or the concentration of PSA about prostate size, enabling a more accurate assessment of cancer risk.

• Free vs. Total PSA Ratio Test

Evaluates the percentage of PSA in the blood that is not bound to proteins. A lower free PSA ratio may suggest a higher chance of cancer.

• MRI (Magnetic Resonance Imaging)

A multiparametric MRI provides detailed images of the prostate and surrounding tissues, enabling the detection of suspicious areas and guiding biopsies.

• Prostate Biopsy (TRUS-Guided or MRI Fusion)

Involves collecting tissue samples using a needle guided by transrectal ultrasound (TRUS) or MRI-TRUS fusion. These samples are examined under a microscope to confirm the presence of cancer.

• Gleason Score Assessment

Once a biopsy confirms cancer, the Gleason score is used to grade its aggressiveness based on cellular patterns. It helps in staging and treatment decisions.

• Genomic Testing of Tumor Tissue

Tests like Decipher or Oncotype DX analyze gene activity in the tumor to predict the likelihood of the cancer growing or spreading.

• Bone Scan

Performed if there’s concern that cancer has spread to the bones, especially in patients with high PSA or symptoms like bone pain.

• CT Scan or PET Scan

Used in advanced cases to check for cancer spread to lymph nodes, pelvis, or distant organs.

Treatment Options for Prostate Cancer

• Active Surveillance

This involves regular monitoring through PSA tests, digital rectal exams, and biopsies to track slow-growing cancers that may not require immediate intervention.

• Watchful Waiting

A less intensive monitoring approach is usually chosen for older patients or for the ones with other severe health conditions. The focus is on managing symptoms if and when they appear.

• Surgery (Radical Prostatectomy)

Complete removal of the prostate gland & some surrounding tissue. This may involve traditional open surgery or minimally invasive techniques such as laparoscopy or robotic-assisted surgery.

• Radiation Therapy

This technique uses high-energy beams to target and destroy cancer cells. It can be delivered externally (external beam radiation) or internally via implanted radioactive seeds (brachytherapy).

• Hormone Therapy (Androgen Deprivation Therapy)

This therapy aims to reduce or block the body's production or use of male hormones that fuel cancer growth. This may involve injections, implants, or surgical removal of the testicles.

• Cryotherapy (Cryoablation)

This process involves freezing prostate tissue to kill cancer cells. It’s typically used for early-stage cancer or recurrence after radiation.

• High-Intensity Focused Ultrasound (HIFU)

Delivers focused sound waves to heat and destroy targeted areas of prostate tissue, often used in localized cases.

• Chemotherapy

This therapy uses anti-cancer drugs to destroy rapidly growing cancer cells. Often used for advanced or hormone-resistant prostate cancer.

• Immunotherapy

Stimulates the body’s immune system to recognize and attack prostate cancer cells, typically used in advanced stages or when other treatments are no longer effective.

• Targeted Therapy

Focuses on specific genetic or molecular features of the cancer cells to inhibit growth or survival. It is used in select patients who have undergone genetic testing.

• Bone-Directed Therapy

Given when cancer spreads to the bones, these treatments help strengthen bones and reduce pain or fracture risk.

• Palliative Care

Focuses on relieving pain & other symptoms in advanced cancer, aiming to improve quality of life rather than cure the disease.

Side Effects of Treatment and Living with Prostate Cancer

• Urinary Incontinence

Loss of bladder control, ranging from occasional leakage to complete inability to control urination.

• Erectile Dysfunction

Difficulty achieving or maintaining an erection, often following surgery, radiation, or hormone therapy.

• Reduced Libido

Decreased interest in sexual activity due to hormonal changes or psychological effects.

• Infertility

Most treatments, especially surgery and radiation, can lead to permanent loss of fertility.

• Bowel Dysfunction

Radiation can lead to rectal bleeding, loose stools, or bowel urgency.

• Hot Flashes

A common side effect of hormone therapy involves sudden feelings of heat and sweating.

• Breast Changes

Hormonal treatments may cause breast tenderness or enlargement.

• Fatigue

Persistent tiredness not relieved by rest is commonly reported during and after most treatments.

• Loss of Muscle Mass and Strength

Primarily associated with long-term hormone therapy.

• Mood Changes and Depression

Emotional side effects, including anxiety, irritability, or depression, are common and often underreported.

• Cognitive Effects

Some patients on hormone therapy report memory issues or difficulty concentrating.

• Bone Thinning (Osteoporosis)

Long-term hormonal treatment can weaken bones, increasing the risk of fractures.

• Lymphedema

Swelling in the legs or genital area, especially after lymph node removal or radiation.

Managing Prostate Cancer and Reducing Future Risk

1. Regular Medical Monitoring

Patients under active surveillance or post-treatment care require scheduled PSA tests, imaging, and physical exams to detect any recurrence or progression early.

2. Healthy Weight Maintenance

Staying within a healthy weight range will help reduce the risk of aggressive prostate cancer and support better recovery outcomes.

3. Physical Activity

Regular exercise enhances energy levels, bone density, and cardiovascular health. It also helps manage treatment-related fatigue and mood disturbances.

4. Balanced, Plant-Rich Diet

A diet high in vegetables, fruits, and whole grains and low in saturated fats may support overall health & reduce the risk of recurrence or progression.

5. Limiting Dairy and Red Meat Intake

Some studies suggest that excessive consumption of high-fat dairy and red meats may be linked to higher prostate cancer risk, although more research is needed.

6. Smoking Cessation

Quitting smoking supports overall cancer recovery and reduces the risk of other cancers and cardiovascular diseases.

7. Limiting Alcohol Consumption

Reducing alcohol intake may support immune function and lower the risk of cancer progression.

8. Stress Management

Psychological counseling, support groups, or mindfulness practices can help patients cope with emotional stress during and after treatment.

9. Genetic Counseling (if needed)

Men with a strong family history or those with known gene mutations should consider genetic counseling to inform their personal risk and screening strategies.

10. Informed Screening Decisions

Men over 50 — or over 45 with a family history or high-risk background — should discuss PSA testing and other screening options with their healthcare provider to decide if and when to start screening.

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