What is Prostate Cancer?
Prostate cancer is a type of cancer that develops in the prostate gland, a small organ in men that produces seminal fluid.
If you’re a man, your prostate is located just below the bladder and in front of the rectum. Prostate cancer happens when cells in this gland grow abnormally and form a tumor. In many cases, prostate cancer grows slowly and may not cause serious harm at first. However, some types can be aggressive and spread quickly to other parts of your body, especially the bones and lymph nodes.
What are the Stages of Prostate Cancer?
Prostate cancer is categorized into four main stages: Stage I, Stage II, Stage III, and Stage IV, based on how far the cancer has spread and how aggressive it appears under a microscope.
Stage I – Localized and Low Risk
At this early stage, the cancer is confined to the prostate and is often too small to be felt during a physical exam or seen on imaging. It’s usually found by chance during a biopsy or surgery for another prostate issue.
If you’re diagnosed at Stage I, your cancer cells are slow-growing, and the PSA (Prostate-Specific Antigen) level is typically under 10. This stage usually carries a very high survival rate and may not need immediate treatment, depending on your age and overall health.
Stage II – Still Localized, But More Noticeable
In Stage II, the cancer is still limited to the prostate but is more easily detected. It’s often divided into Stage IIA and IIB:
Stage IIA: Cancer may still be on one side of the prostate but has a slightly higher PSA level or a Gleason score (grading scale) that suggests a more aggressive tumor.
Stage IIB: Cancer may be found in both sides of the prostate, and PSA or Gleason scores are higher, indicating faster-growing cells.
At this point, you might still not feel symptoms, but active treatment is often recommended to prevent spread.
Stage III – Locally Advanced
At Stage III, the cancer has spread beyond the outer layer of the prostate into nearby tissues, such as the seminal vesicles. However, it hasn’t reached distant organs or lymph nodes.
You may start to notice urinary problems or pelvic discomfort. This stage typically requires more aggressive treatment, such as radiation combined with hormone therapy.
Stage IV – Metastatic or Advanced Stage
Stage IV is when the cancer has spread (metastasized) to distant parts of the body commonly the lymph nodes, bones, bladder, or rectum. It may be further classified as:
Stage IVA: Spread to nearby lymph nodes.
Stage IVB: Spread to distant organs like bones or lungs.
At this stage, you might experience more noticeable symptoms like bone pain, fatigue, or difficulty urinating. Treatment focuses on slowing the cancer’s progression and managing symptoms often involving hormone therapy, chemotherapy, or targeted therapies.
What are the Causes of Prostate Cancer?
The exact cause of prostate cancer isn’t fully understood, but several known factors can increase your risk, including age, family history, genetic mutations, race, diet, and hormone levels.
1. Age
As you get older, your risk of developing prostate cancer increases significantly. Most cases are diagnosed in men over 50, and the likelihood continues to rise with age. According to the American Cancer Society, about 60% of prostate cancer cases are found in men aged 65 or older.
2. Family History
If someone in your immediate family like your father or brother has had prostate cancer, your risk doubles. This suggests a hereditary link, meaning you may carry genetic traits that make you more vulnerable to abnormal prostate cell growth.
3. Genetic Mutations
Certain inherited gene changes, such as BRCA1, BRCA2, or HOXB13, can raise your risk. These genes are typically involved in repairing DNA damage, and mutations can lead to uncontrolled cell growth in the prostate.
4. Race and Ethnicity
If you’re African American, you are more likely to develop prostate cancer and at a younger age. This group also tends to have more aggressive forms of the disease. The reason may be a combination of genetic, environmental, and access-to-care factors
5. Diet and Lifestyle
A diet high in red meat, saturated fats, and low in fruits and vegetables may increase your risk. Obesity and lack of physical activity can also play a role, possibly due to their effects on hormone levels and inflammation.
6. Hormone Levels (Testosterone)
Prostate cells grow in response to androgens, primarily testosterone. Higher levels of testosterone or increased activity of the hormone in your body may fuel prostate cell growth, raising your cancer risk.
What are the Early Signs of Prostate Cancer?
The early signs of prostate cancer may include frequent urination, weak urine flow, difficulty starting or stopping urination, blood in urine or semen, and erectile dysfunction though many men may not notice symptoms in the early stages.
1. Frequent Urination
You may feel the urge to urinate more often, especially at night (a condition called nocturia). This happens when the tumor begins to press against the urethra or bladder, affecting how they function.
2. Weak or Interrupted Urine Flow
If your urine stream feels weaker than usual or stops and starts mid-flow, it could be due to pressure from the growing prostate on the urethra. This is one of the most common early urinary symptoms.
3. Difficulty Starting or Stopping Urination
You might struggle to begin urinating or find it hard to stop once you’ve started. This is usually caused by the prostate pressing against the urinary pathway, which interferes with your bladder’s ability to empty properly.
4. Blood in Urine or Semen
Seeing blood in your urine (hematuria) or semen can be alarming. While it can be caused by other conditions, it may also be an early warning sign of prostate cancer and should be checked by your doctor right away.
5. Erectile Dysfunction
Some men may notice difficulty achieving or maintaining an erection. This can occur due to the cancer itself or due to its effects on nearby nerves and tissues.
What are the Treatments of Prostate Cancer?
The main treatments for prostate cancer include active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, immunotherapy, and targeted therapy, depending on the stage and aggressiveness of the cancer.
1. Active Surveillance
If your prostate cancer is slow-growing and not causing symptoms, your doctor may suggest closely monitoring it instead of treating it right away.
You’ll undergo regular PSA blood tests, digital rectal exams, and possibly biopsies. This approach helps avoid unnecessary side effects if the cancer isn’t progressing.
2. Surgery (Prostatectomy)
Surgery involves removing the entire prostate gland, and sometimes nearby lymph nodes.
If you have localized cancer and are in good health, radical prostatectomy can be a curative option. It’s usually done through traditional open surgery or minimally invasive robotic-assisted techniques.
3. Radiation Therapy
Radiation uses high-energy rays to kill cancer cells.
You may receive it in two main forms:
External Beam Radiation Therapy (EBRT): Delivered from outside the body.
Brachytherapy: Radioactive seeds are placed directly inside your prostate.
Radiation is often used for early-stage cancer or after surgery if there’s a risk the cancer has returned.
4. Hormone Therapy (Androgen Deprivation Therapy – ADT)
Prostate cancer cells grow in response to male hormones like testosterone. Hormone therapy lowers your body’s hormone levels or blocks them to slow the cancer.
You may receive hormone shots, pills, or surgery to remove the testicles (orchiectomy) in more advanced cases.
5. Chemotherapy
Chemotherapy uses drugs to kill fast-growing cancer cells.
It’s usually given when the cancer has spread outside the prostate and isn’t responding well to hormone therapy. The most common drugs include docetaxel and cabazitaxel.
6. Immunotherapy
This treatment boosts your body’s immune system to fight cancer.
Sipuleucel-T (Provenge) is an FDA-approved option for some men with advanced prostate cancer that no longer responds to hormone therapy.
7. Targeted Therapy
Targeted therapy works by attacking specific gene changes or proteins in cancer cells.
If your cancer has genetic mutations like BRCA1 or BRCA2, you may benefit from drugs like PARP inhibitors (e.g., olaparib).
Is Prostate Cancer Curable?
Yes, prostate cancer is often curable, especially when it’s diagnosed early and confined to the prostate gland. The chances of a full recovery are highest in the early stages (Stage I and Stage II), where treatment options like surgery (prostatectomy) or radiation therapy can effectively eliminate the cancer.
What are the Available Medicines For Prostate Cancer in Pakistan?
Abiraterone Acetate including Zytiga, Yonsa)
Enzalutamide (e.g., Xtandi)
Bicalutamide (Casodex)
Goserelin including (zoladex)
Leuprolide Acetate or Mesylate (e.g., Lupron Depot)
Darolutamide (Nubeqa)
These drugs help reduce male hormones that stimulate prostate cancer growth.
