The prostate is a walnut-sized exocrine gland. This means that its fluids and secretions are intended for use outside of the body.
The prostate produces the fluid that nourishes and transports sperm on their journey to fuse with a female ovum, or egg, and produce human life. The prostate contracts and forces these fluids out during orgasm.
The protein excreted by the prostate, prostate-specific antigen (PSA), helps semen retain its liquid state. An excess of this protein in the blood is one of the first signs of prostate cancer.
The urethra is tube through which sperm and urine exit the body. It also passes through the prostate.
As such, the prostate is also responsible for urine control. It can
tighten and restrict the flow of urine through the urethra using thousands of
tiny muscle fibers.
The exact cause of prostate cancer is unclear, but there are many possible risk factors.
Prostate cancer is rare among men under the age of 45 years, but more common after the age of 50 years.
Prostate cancer occurs most frequently in North America, northwestern Europe, on the Caribbean islands, and in Australia. The reasons remain unclear.
Certain genetic and ethnic groups have an increased risk of prostate cancer.
In the U.S., prostate cancer is at least 60 percent more common and 2 to 3 times more deadly among black men than non-Hispanic white men.
A man also has a much higher risk of developing cancer if his identical twin has it, and a man whose brother or father had prostate cancer has twice the risk of developing it compared to other men. Having a brother who has or has had prostate cancer is more of a genetic risk than having a father with the disease.
Studies have suggested that a diet high in red meat or high-fat dairy products may increase a person's chances of developing prostate cancer, but the link is neither confirmed nor clear.
Some research has suggested that non-steroidal anti-inflammatory drug (NSAID) use may reduce the risk of prostate cancer. Others have linked NSAID use with a higher risk of death from the disease. This is a controversial area, and results have not been confirmed.
There has also been some investigation into whether statins might slow the progression of prostate cancer. One 2016 study concluded that results were "weak and inconsistent."
It is often believed that obesity is linked to the development of prostate cancer, but the American Cancer Society maintains that there is no clear link.
Some studies have found that obesity increases the risk of death in advanced cancers. Studies have also concluded that obesity decreases the risk that a cancer will be low-grade if it does occur.
Exposure to Agent Orange, a chemical weapon used in the Vietnam war, may
possibly be linked to the development of more aggressive types of cancer,
but the extent of this has not been confirmed.
There are usually no symptoms during the early stages of prostate cancer. However, if symptoms do appear, they usually involve one or more of the following:
Advanced prostate cancer can involve the following symptoms:
If the cancer spreads to the spine and compresses the spinal cord, there may be:
A doctor will carry out a physical examination and enquire about any ongoing medical history. If the patient has symptoms, or if a routine blood test shows abnormally high PSA levels, further examinations may be requested.
Imaging scans can show and track the presence of prostate cancer.
Tests may include:
If these tests show abnormal results, further tests will include:
These will help confirm the stage of the cancer, whether it has spread, and what treatment is appropriate.
To track any spread, or metastasis, doctors may use a bone, CT scan,
or MRI scan.
Early stage prostate cancer
If the cancer is small and localized, it is usually managed by one of the following treatments:
Watchful waiting or monitoring: PSA blood levels are regularly checked, but there is no immediate action. The risk of side-effects sometimes outweighs the need for immediate treatment for this slow-developing cancer.
Radical prostatectomy: The prostate is surgically removed. Traditional surgery requires a hospital stay of up to 10 days, with a recovery time of up to 3 months. Robotic keyhole surgery involves a shorter hospitalization and recovery period, but it can be more expensive. Patients should speak to their insurer about coverage.
Brachytherapy: Radioactive seeds are implanted into the prostate to deliver targeted radiation treatment.
Conformal radiation therapy: Radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment. This minimizes healthy tissue exposure to radiation.
Intensity modulated radiation therapy: Beams with variable intensity are used. This is an advanced form of conformal radiation therapy.
In the early stages, patients may receive radiation therapy combined with hormone therapy for 4 to 6 months.
Treatment recommendations depend on individual cases. The patient should discuss all available options with their urologist or oncologist.
Advanced prostate cancer
Advanced cancer is more aggressive and will have spread further throughout the body.
Chemotherapy may be recommended, as it can kill cancer cells around the body.
Androgen deprivation therapy (ADT), or androgen suppression therapy, is a hormone treatment that reduces the effect of androgen. Androgens are male hormones that can stimulate cancer growth. ADT can slow down and even stop cancer growth by reducing androgen levels.
The patient will likely need long-term hormone therapy.
Even if the hormone therapy stops working after a while, there may be other options. Participation in clinical trials is one option that a patient may wish to discuss with the doctor.
Radical prostatectomy is not currently an option for advanced cases, as it does not treat the cancer that has spread to other parts of the body.
As the prostate is directly involved with sexual reproduction, removing it affects semen production and fertility.
Radiation therapy affects the prostate tissue and often reduces the ability to father children. The sperm can be damaged and the semen insufficient for transporting sperm.
Non-surgical options, too, can severely inhibit a man's reproductive capacity.
Options for preserving these functions can include donating to a sperm bank before surgery, or having sperm extracted directly from the testicles for artificial insemination into an egg. However, the success of these options is never guaranteed.
Patients with prostate cancer can speak to a fertility doctor if they
still intend to father children.
There's no sure way to prevent prostate cancer. Study results often conflict with each other and most studies aren't designed to definitively prove whether something prevents prostate cancer. As a result, no clear ways to prevent prostate cancer have emerged.
In general, doctors recommend that men with an average risk of prostate cancer make choices that benefit their overall health if they're interested in prostate cancer prevention.
Choose a healthy diet
There is some evidence that choosing a healthy diet that's low in fat and full of fruits and vegetables may contribute to a lower risk of prostate cancer, though this hasn't been proved concretely.
If you want to reduce your risk of prostate cancer, consider trying to:
In some studies, men who ate the highest amount of fat each day had an increased risk of prostate cancer. While this association doesn't prove that excess fat causes prostate cancer, reducing the amount of fat you eat each day has other proven benefits, such as helping you control your weight and helping your heart.
To reduce the amount of fat you eat each day, limit fatty foods or choose low-fat varieties. For instance, reduce the amount of fat you add to foods when cooking, select leaner cuts of meat, and choose low-fat or reduced-fat dairy products.
You might consider using plant-based fats instead of animal fats. For instance, cook with olive oil rather than butter. Sprinkle nuts or seeds on your salad rather than cheese.
Eating more fruits and vegetables also tends to make you have less room for other foods, such as high-fat foods.
You might consider increasing the amount of fruits and vegetables you eat each day by adding an additional serving of a fruit or vegetable to each meal. Consider eating fruits and vegetables for snacks.
Another way to add omega-3s to your diet is by eating flaxseed.
Maintain a healthy weight
Men who are obese — a body mass index (BMI) of 30 or higher — may have an increased risk of prostate cancer. If you are overweight or obese, work on losing weight. You can do this by reducing the number of calories you eat each day and increasing the amount of exercise you do.
If you have a healthy weight, work to maintain it by exercising most days of the week and choosing a healthy diet that's rich in fruits, vegetables and whole grains.
Exercise most days of the week
Studies of exercise and prostate cancer risk have mostly shown that men who exercise may have a reduced risk of prostate cancer.
Exercise has many other health benefits and may reduce your risk of heart disease and other cancers. Exercise can help you maintain your weight, or it can help you lose weight.
If you don't already exercise, make an appointment with your doctor to make sure it's OK for you to get started. When you begin exercising, go slowly. Add physical activity to your day by parking your car farther away from where you're going, and try taking the stairs instead of the elevator.
Aim for 30 minutes of exercise most days of the week.