Prostate cancer

What is it?

The prostate is a male sex organ. The prostate is a gland that produces the fluid of the ejaculate. Prostate cancer is a disease in which an abnormal growth or proliferation of prostate cells occurs.

Most types of prostate cancer grow very slowly: over several years.

Prostate cancer is one of the most commonly diagnosed cancers in men. Usually the diagnosis is made at an early stage. This means that, in most cases, the cancer is detected if it has not yet spread.

Factors that play a role

The causes of prostate cancer, as with other types of cancer, vary and are complex. There is no insight into the exact causes of prostate cancer. However, there are certain factors associated with an increased risk of developing prostate cancer.

Age and predisposition

Prostate cancer is rare in men under the age of 50. But the risk of developing prostate cancer increases from that age onwards.

If a close relative is diagnosed with prostate cancer, the risk of prostate cancer in that man increases. A man whose father or brother has prostate cancer is twice as likely to get the disease. The risk is even greater for men with several family members with this disease, especially if they were diagnosed at an early age. For this reason, an underlying genetic cause is suspected, but the exact genetic abnormalities are not known.

Ethnic origin also seems to play a role: men of African origin have the highest risk of prostate cancer and men of Asian origin the lowest.

Dietary and living habits

There is much uncertainty about the lifestyle causes (and prevention) of prostate cancer.

It is suspected that an unhealthy lifestyle (obesity, lack of exercise) and high blood pressure increase the risk of prostate cancer.

Soy shoots contain 'phytoestrogens’ or ‘isoflavones': these reduce the risk of prostate cancer. Perhaps the same applies to cooked tomatoes (containing 'lycopene').

Symptoms

Prostate cancer at an early stage does not cause any symptoms. In some exceptional cases, prostate cancer at an advanced stage can slow down the flow of urine and make you feel like you have to urinate frequently. Important: other benign prostate diseases are much more often the cause of these urination symptoms.

If prostate cancer is advanced, haematuria (blood in the urine) or erectile dysfunction may occur. Pain in the pelvic bone, spine, hips or ribs may also occur, as prostate cancer at an advanced stage typically spreads to the bones.

To detect prostate cancer at an early stage, the combination of a physical examination (digital rectal examination) and the result of a blood test (PSA test) is used.

A high-quality study of 150,000 patients in different European countries shows that prostate cancer screening significantly reduces the risk of prostate cancer mortality (29% risk reduction) and that the quality of the prostate cancer screening test (physical examination + PSA test) is similar to that currently in used to detect breast cancer.

On the other hand, data in the literature has also shown that this screening approach is associated with a high risk of detection of small, non-relevant prostate cancers: it is said that screening for prostate cancer is characterised by a real risk of ‘overdiagnosis’. The diagnosis of such small, irrelevant and slow-growing prostate cancers can lead to (unnecessary) aggressive treatment. Overdiagnosis therefore leads to overtreatment. When you consider that any type of prostate cancer treatment is inevitably accompanied by a risk of debilitating complications, sometimes the cure is worse than the disease.

In summary, screening for prostate cancer must be well-reasoned and offered with caution: a variety of factors must be taken into account (family history, patient age and condition...), and the pros and cons of prostate cancer screening must be discussed with the patient in advance.

Diagnosis

Prostate cancer is detected by means of:

• Digital rectal examination: the prostate is examined for the presence of hard lumps.
• PSA test (prostate-specific antigen): PSA is a substance produced mainly by the prostate and can be found in increased amounts in the blood of men with prostate cancer.
• Transrectal ultrasound imaging: to obtain an image of the prostate.
• MRI scan of the prostate
• Biopsy: a piece of tissue is removed from the tumour and examined microscopically and tested for the presence of cancer.

Treatment

When prostate cancer has not yet spread, various treatment options are available:

1. Removal of the prostate (radical prostatectomy)
2. Radition of the prostate, through external radiation or the implantation of radioactive seeds
3. Observation (watchful waiting)
   

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip