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Prostate Cancer

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Overview of prostate cancer

Prostate gland is a part of the male reproductive system, which produces a part of the ejaculatory fluids. The cells of this gland can display abnormal growth in certain instances wherein the affected individual is said to suffer from cancer of the prostate. Prostate cancer is the most commonly diagnosed cancer (after lung cancer) in men. It is noted to affect men over the age of 50 years.

The highest incidence of prostate cancer in the world is observed in American men (especially African-American men) while the lowest incidence has been noted in Asia and North Africa.1

Signs and Symptoms of prostate cancer

The signs and symptoms noted in individuals with prostate cancer are related to the urinary and reproductive systems in general.

These symptoms include the following:

  • Difficulty in urination (delayed start of the urine)
  • Dribbling of urine (immediately after urination)
  • Urine mixed with blood (hematuria)
  • Pain during urination and ejaculation
  • Inability to control urination (incontinence)

Other associated symptoms such as long-standing back pain, impairment of the legs, tenderness or pain in the bones and weight loss may indicate extensive spread of the cancer.2

Signs and symptoms of prostate cancer

Causes of prostate cancer

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Although the exact cause of prostate cancer has not been identified, several risk factors have been noted to have a role in its occurrence.

These include the following:

  • Family history of prostate cancer
  • Elevated levels of testosterone over many years
  • Belonging to the African-American race
  • Age above 50 years
  • Diet high in fat (especially polyunsaturated fatty acid or PUFA) and deficient in vitamin D
  • Chronic exposure to cadmium and other environmental pollutants such as pesticides
  • Men working in rubber industries may have an increased risk

These factors may act together or as a single agent resulting in modification of the genes that are responsible for the normal cell production in the prostate gland. The cells in the prostate gland begin to form at an abnormal rate (referred as a tumor) either due to such gene modifications or due to the increased stimulation from the testosterone hormone resulting in cancer.1

Diagnosis of prostate cancer

The diagnosis of prostate cancer is based on

  • A careful evaluation of the signs and symptoms noted
  • Family, personal and occupational history
  • Physical examination
  • Specific investigations and laboratory tests

The presence of risk factors is evaluated, which is followed by rectal examination in order to note for any changes in the structure of the prostate gland, which can be felt through the rectum.

Prostate specific antigen

A specific blood test which detects the levels of an antigen known as prostate-specific antigen or (PSA) is considered helpful in diagnosing prostate cancer and is frequently used as a screening test for men over the age of 50 years. Further confirmation is required because PSA levels are increased even in the presence of infection or trauma.

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Urine test

Urine test may be advised to detect the presence of blood cells and other cells.


Biopsy of the prostate gland helps to confirm the diagnosis.

Additionally, imaging tests such as plain chest X-ray, CT scanning and bone scans may be advised to evaluate the extent of spread of the cancer.

Based on the biopsy and other findings of physical examination, and imaging tests, the prostate cancer is graded. Prostate cancer is graded from grade I through grade IV from mild to severe. The treatment option is advised based on the grade of the cancer.2–4

Treatment of prostate cancer

The treatment option selected is based on the age of the individual, size of the tumor and extent of the prostate cancer.

The various methods of treatment include:

  • Surgery (radical prostatectomy)
  • Radiotherapy
  • Watchful waiting
  • Chemotherapy

The salient features of these treatment options are given below. The affected individuals are required to be monitored for the progress of the condition at regular intervals for the rest of their life.

Surgery (Radical Prostatectomy)

  • It is advised in elderly patients who are below 70 years of age with the tumor restricted to the prostate gland.
  • It involves complete removal of the prostate gland.
  • It requires a hospital stay of 2–3 days and full activity can be resumed after a month of the surgery.
  • It offers a long-term cure rate.
  • Side-effects are rare and can include incontinence and impotence.


  • It is advised in patients above 70 years of age with the tumor restricted to the prostate gland.
  • If the tumor is exposed to radiation at controlled doses daily for 4–6 weeks or pellets that emit radiation at a controlled rate at surgically implanted near the prostate gland.
  • It does not require hospital stay; no risks related to surgery and anesthesia; no risk of incontinence.
  • Cure rate similar to that of surgery
  • Disadvantages include higher risk of recurrence; risk of impotence

Radiation therapy for prostate cancer

Watchful Waiting

  • This is advised in elderly patients with concomitant significant medical conditions that negates the possibility of surgery or radiotherapy; and if the tumor size is small.
  • It involves administration of medications to control the production of testosterone.
  • The side–effects, risks of surgery and radiotherapy are eliminated.
  • The major disadvantage is curative treatment cannot be carried out if the cancer progresses.


  • This has been studied extensively
  • This is advised in cases that do not respond to watchful waiting protocol.
  • It involves of administration of drugs such as estramustine that restrict the abnormal growth of cells
  • This is associated with various side-effects such as hair loss, nausea, mouth sores and stomach upsets.2,4

Chemotherapy of prostate cancer

Complications of prostate cancer

The complications of prostate cancer are associated with either the treatment procedures or with the severity of the disorder. Constant back pain and sciatica are the common complications of severe prostate cancer, while impotence and urinary incontinence are the complications associated with treatment.

Prevention of prostate cancer

Although there are no specific steps that could prevent the occurrence of prostate cancer, a few factors such as the diet and lifestyle practices may have a role in preventing prostate cancer. Maintenance of weight within 10% of one’s ideal body mass index (BMI), avoiding consumption of red meat and fatty fish and consuming a diet, which ensures appropriate amounts of vitamins and minerals to the body have been found to be helpful to a certain extent.5

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Stages of prostate cancer


1.Bostwick DG, Burke HB, Djakiew D, Euling S, Ho S, Landolph J, et al. Human prostate cancer risk factors. Cancer. 2004; 101(10 Suppl): 2371–2490.

2.Naitoh J, Zeiner RL, Dekernion JB. Diagnosis and treatment of prostate cancer. Am Fam Physician. 1998; 57(7).

3.Roscigno M, Scattoni V, Bertini R, Pasta A, Montorsi F, Rigatti P. Diagnosis of prostate cancer. Minerva Url Nefrol. 2004; 56(2):123–143.

4.Horwich A. Prostate cancer management. Ann Oncol. 2004; 15(Suppl 4): iv307–iv312.

5.Santillo VM, Lowe FC. Role of vitamins, minerals and supplements in the prevention and management of prostate cancer. Int Braz J Urol. 2006; 32: 3–14.

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