Prostate Cancer

04 April 2019

Prostate Cancer and Prostatic Enlargement

Prostate cancer (PCa) happens when normal cells in the prostate gland change into abnormal cells and grow out of control. The prostate gland makes fluid that is part of semen. This gland sits below the bladder and in front of the rectum, and forms a ring around the urethra, the tube that carries urine out of the body.

PCa occurs most often in men older than 50. Although PCa is very common, most men do not die from it. This is because PCa usually grows very slowly.

Most men may hear about the condition of enlarged prostate called benign prostatic enlargement (BPE) or benign prostatic hyperplasia (BPH). Having an enlarged prostate does not mean that a person has a likelihood of having prostate cancer. The word “benign” means “not cancer.”

PCa and BPH are therefore two different diseases. PCa begins in the outer peripheral zone of the prostate, and grows outward, invading surrounding tissue. BPH begins in an area of the inner prostate called the transition zone, a ring of tissue that makes a natural circle around the urethra. In BPH, the growth is inward toward the prostate’s core, constantly tightening around the urethra (the tube that carries urine from the bladder through the prostate to the penis) and interfering with urination.

This is why BPH produces such annoying, difficult-to-ignore symptoms, such as needing to urinate more often than usual and a urine stream that is slower than usual. These symptoms can also present in cases of infection and bladder stones. On the other hand, PCa is often “silent,” producing no symptoms for months or even years. Thus, symptoms alone are not the most reliable indicators of cancer.

BPH is the fourth most common diagnosis in older men. More than 50% of men over age 50 years are affected; by the age of 80 years, 90% of men will have an enlarged prostate. The statistics are similar across the whole world. PCa is much more common in the Caucasian population, affecting 1 in 7 men in countries such as America and Australia. Among Malaysian men, it is the fourth most common cancer and the second leading cause of cancer after colorectal cancer for Indian men.

Typically, most Malaysian men will seek urological attention due to several reasons:

1. When they have bothersome urinary symptoms
2. Regular medical screening or health checkup which incidentally detected an enlarged prostate by ultrasound examination or abnormal blood test (PSA)
3. Request for prostate screening due to personal concern or prior family history of PCa

During assessment, urologists use a blood test called a PSA test and an examination called a digital rectal exam (DRE) to check for prostate cancer. In a DRE, the urologist puts a finger in the anus and up into the rectum to feel for abnormal areas on the prostate, since PCa commonly begins in the peripheral zone of the prostate gland.

Only when PCa is suspected, a confirmation of diagnosis by tissue biopsy is required in which the urologist will take a small sample of tissue from the prostate using an ultrasound probe inserted into the rectum for guidance. Occasionally, an MRI scan is also requested to locate the abnormal growths.

If PCa is detected by the biopsy, the next step is to stage the cancer in order to find out how far the cancer has spread. Treatment of PCa will be discussed and individualized for the patient after considering factors such as:

1. Stage of cancer
2. Age at diagnosis
3. Other health problems
4. Patient's wishes and preferences

In summary, BPH and PCa are diseases with increasing prevalence as the population ages. Most men will be diagnosed with BPH and only a small proportion with PCa. Getting checked and being diagnosed with PCa can be a life-altering experience. In general, the earlier the problem is caught and treated, the treatment outcome is expected to be better.

 

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