Prostate cancer: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Jun 20, 2023

Adenocarcinoma, a particular type of prostate cancer, is a malignant growth that develops in the gland of the same name, an integral part of the male reproductive system

The prostate is a gland, the size of a walnut, which is located between the rectum and the bladder, directly including the first part of the male urethra, that thin “tube” that carries urine towards the outside of the body.

The prostate, in addition to being an active part in the production of seminal fluid, also constantly secretes a particular type of protein called prostate specific antigen (PSA) into the blood.

When the prostate becomes enlarged and the blood levels of this protein are too high, cancer can be suspected.

Fortunately, prostate growths are not always malignant.

In fact, there are many cases of benign formations that do not require special care.

The prostate is a gland found only in men and prostate cancer is one of the most common among these individuals.

Data in hand, it is estimated that in Italy there are about 40,000 cases a year: among the most affected ethnic groups we find those of North America, north-western Europe (of which our country is part), the Caribbean islands and of Australia.

Seniority is also a risk factor that should not be underestimated.

Prostate cancer remains the most common type of cancer among patients over the age of 80

The course of prostate cancer is usually slow and rarely affects areas outside the gland with metastases.

For this reason the person, assuming the appropriate therapies in any case, can live with it for a long time.

Cases in which the carcinoma is aggressive, particularly malignant and with a rapid course are rarer, but still exist, because the tumor cells, transported by the blood and the lymphatic system, extend beyond the prostate gland, creating metastases in the body.

Prostate cancer: the causes

Modern medicine is still engaged in identifying the causes that lead to the development of this particular type of tumor.

To date, unfortunately, a precise reason has not yet been identified.

It is assumed that it may derive from mutations in the DNA of cells that induce disordered and uncontrolled replication, eventually forming tumor masses, but the causes of these mutations are still not completely clarified.

By carefully studying the affected patients, it has been possible to define a series of risk factors that contribute to increasing the probability of developing the disease:

Age of the individual. This type of cancer is very rare in people under the age of 45. The number of patients increases proportionally with advancing age. At present, the most affected group is the one between 60 and 70 years old.
Genetics. Hereditary factors, including ethnicity, increase the likelihood of having the disease. Having a father or a sibling who developed this cancer increases people’s risk. Similarly, African American groups are statistically the most affected for some genetic reason, still unclear.
Diet. Some studies show that diets too rich in protein and saturated fat can increase the risk of developing prostate cancer.
Obesity and overweight.

Then there are some diseases and inflammations of the prostate that act on the state of health of the gland, increasing the risk of malignant transformation.

Intraepithelial prostatic neoplasia is a dysplasia, most of the time mild but to be checked periodically, as it could evolve into prostate cancer.

The same happens in patients with proliferative inflammatory atrophy, a condition in which cells in the prostate are smaller than normal.

Prostate cells can also be weakened when prostatitis is present, a bacterial inflammation that can be very intense.

Finally, all subjects with atypical microacinar proliferation are at risk of prostate cancer.

That is, when the result of the biopsy is uncertain and it is not clear whether the tumor is benign or malignant, it must be kept under control.

It should be remembered that an enlarged prostate is not necessarily a symptom of malignancy.

There are many cases in which prostatic hyperplasia is benign, and the neoformation is practically harmless.

Prostate cancer: symptoms

When prostate cancer is in its early stages, the disease is almost totally asymptomatic, both because it affects a limited anatomical area and because, in most cases, its course is very slow.

However, it can happen (fortunately in very rare cases) that this type of tumor presents itself immediately as aggressive, affecting not only the prostate area, but also spreading to other areas of the body with the development of metastases.

It usually happens when the blood and lymph vessels that carry the cancer cells are also affected.

Typical symptoms are classified into two large macro-categories.

Disorders of urination and ejaculation include:

frequent urination even during the night;
urinary incontinence;
painful urination. The difficulty and pain in urination are given by the fact that, by enlarging, the prostate gland occludes a part of the urethra;
difficulty maintaining a steady stream of urine (feeling like you are not emptying your bladder completely);
blood in the urine;
painful ejaculation;
erectile dysfunction;
constant pressure and discomfort in the pelvic area and lower abdomen;

In the most serious stages, the disease evolves affecting the skeleton and lymph nodes:

bone pain, especially in the trunk and pelvis (spine, femur, ribs, hipbones). In most cases, the pain felt is directly related to the presence of localized metastases;
when the tumor compresses the bone marrow, there may be numbness in the lower limbs, urinary and fecal incontinence;
frequent bone fractures even without having suffered major trauma.

Some of these symptoms are also associated with benign tumors, which is why it is always necessary to consult a specialist from the first signs.

Routine check-ups are also essential because prostate cancer is often discovered accidentally when you go to the doctor to investigate the origin of the aforementioned symptoms.

Prostate cancer: the diagnosis

Prostate cancer prevention is essential to avoid a late diagnosis and to ensure that the disease remains localized, lowering the risk of incurring more serious complications.

For this purpose, it is recommended that you periodically visit your doctor or a urologist.

Routine checks must become good practice especially for those who are part of the age group most at risk, that of the over 60s.

Blocking the disease from its onset guarantees a better prognosis.

The visit begins with the collection of the subject’s medical history and continues with an objective examination carried out by the specialist, who will take care to investigate not only the present symptoms, but also the past clinical history, in order to have a 360-degree view.

A fundamental step in the diagnostic process is the blood sample to check the PSA values which, as we have seen, if too high can be a sign of an alteration at the glandular level.

Its presence, however, is not specific for the presence of a malignant tumor, but can also highlight the presence of other prostatic pathologies such as prostatitis and prostatic hypertrophy.

The value can also rise following trauma involving the prostate (for example, if the sample is taken after riding a bicycle).

If the blood tests are not very clear or show abnormal values, the doctor may decide to continue with the investigation, using biomedical imaging techniques.

Digital transrectal ultrasound (DRE) allows to identify disorders of the prostate gland.

Similarly, an MRI helps provide a 3D image of the gland, highlighting any problems.

A prostate biopsy, although more invasive, allows a part of the diseased prostate tissue to be taken directly for its histological study.

Thanks to this technique it is possible to find out if the tumor is benign or malignant and at what stage it is in its evolution.

The surgery usually takes place in the clinic under local anesthesia and does not require hospitalization.

If the cancer is at an advanced stage and has metastasized, the specialist may decide to order tests that provide further details:

a chest x-ray can see if the cancer has already spread and metastasized to the lungs;
CT is the method of choice to investigate the health of the lymph nodes, in particular the pelvic and abdominal ones, the first to be affected by prostate cancer;
bone scintigraphy offers a precise view of the spread of the tumor to bone and soft tissue;
choline PET is a brand new test, currently the most accurate, to highlight this type of mass. A radiopharmaceutical is injected into the patient, which highlights the abnormal areas.

A thorough examination is always useful to exclude other pathologies that affect the prostate but are not cancerous.

An increase in prostate volume can, in fact, be associated with benign prostatic hyperplasia – therefore a harmless tumor of the gland – or prostatitis, a bacterial inflammation that affects this organ.

What happens if the doctor detects cancer during tests?

Whenever the results of the investigations suggest the presence of a tumor, it will be the doctor’s job to try to understand its benign or malignant nature.

The grade of the tumor is also evaluated, i.e. at what stage it is, whether it is in the initial stage or has already formed metastases.

This is vital information that directly affects the patient’s treatment and prognosis.

Treatments and cures for prostate cancer

The treatments provided for prostate cancer vary according to the intensity of the symptoms and the stage in which the disease is.

The most used for the treatment of localized and early stage cancer include, as an essential first step, a constant control of PSA levels in the blood, by sampling and studying the blood component.

To prevent the situation from getting worse by invading extra tissue, the urologist can recommend radical prostatectomy to the patient.

It is an invasive surgical therapy, which involves the removal of the prostate.

The new surgical engineering offers the patient a laparoscopic and robotic surgery, which guarantees shorter recovery times because it does not require direct access from the abdomen.

These are techniques that minimize the risk of future incontinence and erectile dysfunction.

This is because it reduces the risk of damaging surrounding structures.

It is an operation aimed only at the areas to be removed.

Normally surgery is the ideal way to treat limited cancer since it does not necessarily have to be followed by other radiological and chemotherapy treatments.

Often used instead of surgery, brachytherapy involves implanting radioactive sources in the prostate.

It is a type of radiotherapy that acts directly on the injured area, without involving the surrounding ones.

External beam radiotherapy, on the other hand, consists of direct irradiation of the prostate.

Cancer cells are more sensitive than healthy cells to X-rays and are damaged.

When the cancer is advanced and has already started to spread through the body, the following are ideal:

androgen deprivation therapy or hormone therapy. These are hormonal treatments that reduce the level of androgens in the body which are currently considered one of the main causes of the multiplication of cancer cells. In general, early use of this type of therapy causes the growth of the cancer to slow down or even stop;
chemotherapy is a last resort, prescribed only for patients who do not respond to hormone treatments.

There are many cancer centers that are experimenting with new biological therapies based on the use of engineered immunity cells that selectively attack the diseased ones.

How to prevent prostate cancer?

Despite efforts, effective techniques for the prevention of prostate cancer have not yet been identified.

However, it is possible to intervene on risk factors.

A good rule is to maintain a healthy lifestyle, which includes careful nutrition and constant exercise.

This also includes a control of weight and fat consumption.

For the purposes of early diagnosis, it is also recommended to undergo periodic urological visits and blood tests to observe PSA levels, the main sign of the presence of this type of tumour.

Periodic screenings are recommended after the age of 40, especially if there is a family history.

The prostate, in addition to being an active part in the production of seminal fluid, also constantly secretes a particular type of protein called prostate specific antigen (PSA) into the blood.

When the prostate becomes enlarged and the blood levels of this protein are too high, cancer can be suspected.

Fortunately, prostate growths are not always malignant.

In fact, there are many cases of benign formations that do not require special care.

The prostate is a gland found only in men and prostate cancer is one of the most common among these individuals.

Seniority is also a risk factor that should not be underestimated.

Prostate cancer remains the most common type of cancer among patients over the age of 80.

The course of prostate cancer is usually slow and rarely affects areas outside the gland with metastases.

For this reason the person, assuming the appropriate therapies in any case, can live with it for a long time.

Prostate cancer: the causes

Modern medicine is still engaged in identifying the causes that lead to the development of this particular type of tumor.

To date, unfortunately, a precise reason has not yet been identified.

By carefully studying the affected patients, it has been possible to define a series of risk factors that contribute to increasing the probability of developing the disease:

Age of the individual. This type of cancer is very rare in people under the age of 45. The number of patients increases proportionally with advancing age. At present, the most affected group is the one between 60 and 70 years old.
Genetics. Hereditary factors, including ethnicity, increase the likelihood of having the disease. Having a father or a sibling who developed this cancer increases people’s risk. Similarly, African American groups are statistically the most affected for some genetic reason, still unclear.
Diet. Some studies show that diets too rich in protein and saturated fat can increase the risk of developing prostate cancer.
Obesity and overweight.

Then there are some diseases and inflammations of the prostate that act on the state of health of the gland, increasing the risk of malignant transformation.

Intraepithelial prostatic neoplasia is a dysplasia, most of the time mild but to be checked periodically, as it could evolve into prostate cancer.

The same happens in patients with proliferative inflammatory atrophy, a condition in which cells in the prostate are smaller than normal.

Prostate cells can also be weakened when prostatitis is present, a bacterial inflammation that can be very intense.

Finally, all subjects with atypical microacinar proliferation are at risk of prostate cancer. That is, when the result of the biopsy is uncertain and it is not clear whether the tumor is benign or malignant, it must be kept under control.

It should be remembered that an enlarged prostate is not necessarily a symptom of malignancy. There are many cases in which prostatic hyperplasia is benign, and the neoformation is practically harmless.

Prostate cancer: symptoms

When prostate cancer is in its early stages, the disease is almost totally asymptomatic, both because it affects a limited anatomical area and because, in most cases, its course is very slow.

It usually happens when the blood and lymph vessels that carry the cancer cells are also affected.

Typical symptoms are classified into two large macro-categories.

Disorders of urination and ejaculation include:

frequent urination even during the night;
urinary incontinence;
painful urination. The difficulty and pain in urination are given by the fact that, by enlarging, the prostate gland occludes a part of the urethra;
difficulty maintaining a steady stream of urine (feeling like you are not emptying your bladder completely);
blood in the urine;
painful ejaculation;
erectile dysfunction;
constant pressure and discomfort in the pelvic area and lower abdomen;

In the most serious stages, the disease evolves affecting the skeleton and lymph nodes:

bone pain, especially in the trunk and pelvis (spine, femur, ribs, hipbones). In most cases, the pain felt is directly related to the presence of localized metastases;
when the tumor compresses the bone marrow, there may be numbness in the lower limbs, urinary and fecal incontinence;
frequent bone fractures even without having suffered major trauma.

Some of these symptoms are also associated with benign tumors, which is why it is always necessary to consult a specialist from the first signs.

Routine check-ups are also essential because prostate cancer is often discovered accidentally when you go to the doctor to investigate the origin of the aforementioned symptoms.

Prostate cancer: the diagnosis

Prostate cancer prevention is essential to avoid a late diagnosis and to ensure that the disease remains localized, lowering the risk of incurring more serious complications.

For this purpose, it is recommended that you periodically visit your doctor or a urologist.

Routine checks must become good practice especially for those who are part of the age group most at risk, that of the over 60s. Blocking the disease from its onset guarantees a better prognosis.