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Urgent
PROSTATE CANCER: WHAT MEN NEED TO KNOW FOR EARLY DETECTION
Prostate cancer is the malignant proliferation of cells within the prostate gland, an endocrine/genital gland located in the male lower pelvic region, responsible for secreting fluid that supports sperm. This is a common type of cancer in men, especially in middle-aged and elderly individuals.
Classification
1. Classification by clinical stage
T (tumor): describes the size and location of the tumor within the prostate gland, or its extension beyond the glandular capsule.
T1 (not palpable, detected by biopsy)
T2 (confined within the gland)
T3 (extends beyond, possibly to the seminal vesicles)
T4 (extends to surrounding structures such as the bladder, rectum, pelvic wall)
N (lymph nodes): presence or absence of spread to regional lymph nodes.
M (metastasis): presence or absence of distant metastasis, to bones, or other internal organs.
2. Classification by histological differentiation: Assessing the degree of differentiation of cancer cells compared to normal cells, determining the level of malignancy; the higher the grade, the higher the risk of invasion, metastasis, and recurrence.
3. Risk group classification
Based on factors such as stage (TNM), Gleason Score, PSA level, and the patient's overall clinical condition to classify into low, intermediate, and high risk.
Patient age, overall health, life expectancy, and treatment preferences are also considered when selecting an appropriate treatment method tailored to the personal risk group.
Causes and risk factors
1. Unchangeable factor
Age: men ≥ 50 years old have a high risk; many cases are detected at 65 years old or older.
Family history: if a father or brother has had prostate cancer, the risk is higher.
Race: African American have a higher incidence rate, and it may start earlier; Asian and Hispanic people have a lower incidence rate compared to non-Hispanic white people.
2. Changeable/affectable factor
Diet: High consumption of fats and animal protein may increase risk. Eating plenty of green vegetables, fruits, lycopene-rich foods (e.g., tomatoes), and cruciferous vegetables is considered beneficial.
Weight, obesity: Obesity may be linked to more aggressive forms of prostate cancer.
Physical activity: Regular exercise is suggested to reduce risk.
Symptoms
Early stages often have no clear symptoms; many cases are diagnosed through PSA screening or digital rectal examination before symptoms appear.
When symptoms are present, they may include:
Urinary symptoms: frequent urination, especially at night; difficulty starting urination; weak or interrupted urine stream; feeling of incomplete bladder emptying; pain or burning during urination.
Sexual function-related symptoms: difficulty achieving or maintaining an erection; pain during ejaculation; blood in semen may be present.
Symptoms spreading to bone or lower limbs if metastasis occurs back, hip, thigh pain; swelling of the lower limbs.
Diagnosis
1. Screening and initial detection
PSA test: measures the amount of prostate-specific antigen in the blood; if it is high or increasing over time, it may suggest suspicion.
Digital Rectal Exam (DRE): palpates the prostate gland through the rectum, detecting abnormal masses.
2. Biopsy: If PSA or DRE results are abnormal, a prostate tissue biopsy is performed for histological examination. The Gleason Score is established from the biopsy sample.
3. Imaging
Prostate MRI (especially multiparametric MRI) helps to identify tumor regions, assess extracapsular extension, and seminal vesicle invasion.
Other diagnostic tests if metastasis is suspected include CT scan, bone scan, joint imaging, and abdominopelvic imaging.
4. Stage classification & risk assessment
Based on result of TNM, Gleason Score, PSA, age, and overall health.
Treatment
Active Surveillance: Intended for low-risk, slow-growing cancers that are asymptomatic or non-metastatic; avoids overtreatment and reduces side effects. Allow monitoring including regular PSA, DRE, MRI, and repeat biopsy if necessary.
Radical Prostatectomy: Removal of the entire prostate gland, often accompanied by lymph node dissection if there is a risk. There are many surgical approaches, among which robot-assisted surgery is one of the optimal methods in specialized centers.
Radiation Therapy: External radiotherapy, brachytherapy; Johns Hopkins refers to new radiation therapy technologies that help shorten treatment time, increase effectiveness, and reduce side effects.
Hormone Therapy (Androgen Deprivation Therapy – ADT): Reduces the effects of androgens like testosterone, because androgens stimulate prostate cell growth. Applied when the disease is advanced or metastatic, or in combination with other methods.
Adjuvant therapy: Chemotherapy, immunotherapy in cases of advanced, metastatic disease, or after failure of initial methods.
Newer / less invasive methods such as Focal Therapy: selective treatment of cancerous areas within the prostate, with the goal of destroying only cancerous tissue, minimizing damage to healthy tissue, and reducing side effects related to urination and sexual function.
Reference:
Hopkins Medicine
Hopkins Medicine
Hopkins Medicine
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