The prostate is a walnut-sized gland located behind the base of a man’s penis, in front of the rectum and below the bladder. It surrounds the urethra, the tubular canal that carries urine and sperm through the penis. The main function of the prostate is to produce the spermatic fluid, the fluid in the sperm that protects, supports and aids the transport of sperm.

As men grow older, the prostate continues to grow over time. This can lead to a condition called benign prostatic hypertrophy (BPH). BPH is a common age-related condition and can cause symptoms similar to those of a prostate cancer. The BPH has not been associated with a higher risk of prostate cancer.

For Prostate
Cancer begins when healthy prostate cells get out of control, multiply, forming a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, which means that it can grow and spread to other parts of the body (metastasis). A benign tumor means that the tumor can grow but will not spread.

Prostate cancer is kind of uncommon compared to other types of cancer. This is because some prostate cancers do not spread quickly to other parts of the body. Some prostate cancers develop very slowly and cannot cause symptoms or problems for years. Even when prostate cancer has spread to other parts of the body, it can often be treated for a long time, allowing men even with advanced prostate cancer to live with good health and good quality of life for many years. However, if the cancer cannot be controlled well with existing treatments, it can cause symptoms such as pain and fatigue and can sometimes lead to death. An important part of treating prostate cancer is monitoring it closely to determine if it is growing slowly or rapidly. Based on the growth rate of the tumor, your doctor may decide the best treatment options available.

About the prostate specific antigen (PSA)
The prostate specific antigen (PSA) is a protein produced by cells of the glands of the prostate and is released into the bloodstream. PSA levels are measured using a blood test. Although there is no “normal PSA” for anyone at any age, a higher than normal level of PSA can be found in men with prostate cancer. Other non-cancerous prostate conditions, such as BPH (see above) or prostatitis, can also lead to elevated levels of PSA. Prostatitis is the inflammation of the prostate. In addition, certain activities such as ejaculation may temporarily increase PSA levels. This should be avoided before a PSA test to avoid falsely increased examinations.

The most common histological type of prostate cancer is called adenocarcinoma. Other, less common histological types include neuroendocrine prostate cancer and small cell prostate cancer. These rare variants tend to be more aggressive, produce much less PSA, and spread earlier outside the prostate.

For most types of cancer, biopsy is the only sure way for the doctor to know if an area of ​​the body has cancer. In a biopsy, the doctor takes a small sample of tissue for histological examination in a pathological laboratory.

This list describes diagnostic options for this type of cancer. Not all of the tests listed below are used to each person. Your doctor will consider the following factors when choosing a diagnostic test:

The type of cancer that is suspected

Your symptoms

The age and general state of your health

Results of previous medical examinations

Preliminary examinations

PSA test. As described in General, PSA is a type of protein that is released by the prostate and is found in higher levels in the human blood. Levels may increase when there is abnormal activity in the prostate, including prostate cancer, BPH, or prostate inflammation (prostatitis). The doctor may examine the characteristics of the PSA levels, such as the absolute level, the change over time, and the level relative to the prostate size, to decide if a biopsy is required.

«Free» PSA (Free PSA). There is a type of PSA test that allows the doctor to measure a specific component, that is called “free” PSA. Free PSA is present in the bloodstream and does not bind with proteins. A standard PSA test measures the total PSA, which includes both the bound PSA and the non-protein bound PSA. With ‘free’ PSA we measure the ratio of free PSA to total PSA. Knowing this reason can sometimes help to see if an elevated level of PSA is caused by a malignant condition such as prostate cancer.

Digital Rectal Examination (DRE). The Urologist uses DRE to find unusual portions of the prostate by sensing the area with the use of a finger. It is not quite accurate and therefore, DRE usually does not detect prostate cancer early.

Biopsy

Biopsy is the removal of a small amount of tissue for examination under a microscope (histological examination). Only a biopsy can make a clear diagnosis. To obtain a tissue sample, the surgeon more frequently uses the TRUS technique and a biopsy tool to obtain very small pieces of prostate tissue. Biopsy specimens will be taken from different areas of the prostate. This is to ensure that a good sample is taken for examination.

The pathologist then analyzes the sample under the microscope. The pathologist (and cytologist) is the doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs for the diagnosis of diseases (histological and cytological examination).

MRI fusion biopsy. An MRI fusion biopsy combines magnetic resonance imaging with the TRUS technique. The patient first receives an MRI scan to detect suspected prostate areas that require further evaluation. Then a prostate ultrasound is performed. Computer software combines these images to produce a three-dimensional image that helps targeting the exact area from which the biopsy will be performed. While it may not eliminate the need for repeat biopsies, an MRI fusion biopsy can identify better areas that are more likely to be cancerous than other methods.

In histological examination, prostate cancer receives a score called Gleason score. This score is based on how much the cancer looks like healthy tissue when the pathologist examines it under the microscope. Less aggressive tumors generally look more like healthy tissues. Tumors that are more aggressive are likely to grow and spread to other parts of the body and look less like healthy tissues.

The Gleason grading system is the most common grading system for prostate cancer. The pathologist examines and evaluates how the cancer cells are arranged in the prostate and assigns a score on a scale from 3 to 5 from 2 different sites. Cancer cells that look like healthy cells receive a low rating. Cancer cells that look less like healthy cells or look more aggressive receive a higher rating. The pathologist then gives each region a score from 3 to 5. The results are added together to give a total score of between 6 and 10.

The lowest Gleason score is 6, which is a low cancer score. A Gleason 7 rating is a medium grade cancer and an 8, 9 or 10 grade is a high grade malignancy. A low grade cancer develops more slowly and is less likely to spread than a high grade cancer.

Gleason X: Gleason rating cannot be determined.

Gleason 6: Cells are well differentiated, which means they look like healthy cells.

Gleason 7: Cells are moderately differentiated, which means they look a bit like healthy cells.

 Gleason 8, 9, or 10: Cells are slightly differentiated or undifferentiated, which means they look very different from healthy cells.

Gleason results are often grouped into simplified groups of grades:

 Group Grade 1 = Gleason 6

Group Grade 2 = Gleason 3 + 4 = 7

 Group Grade 3 = Gleason 4 + 3 = 7

Group Grade 4 = Gleason 8

Group Grade 5 = Gleason 9 or 10

The following factors may increase a man’s risk in developing prostate cancer:

Age

The risk of prostate cancer increases with age, especially after the age of 50. More than 80% of prostate cancers are diagnosed in men 65 and older.

Race / Ethnicity

Colored men have a higher risk in developing prostate cancer than white men. They are also more likely to develop prostate cancer at a younger age and have more aggressive tumors that grow rapidly. The exact reasons for these differences are not known and may include genetic, socioeconomic or other factors. Hispanic men have a lower risk in developing prostate cancer and dying of the disease than non-Hispanic white men.

Family history

Prostate cancer that has occurred in more than one member of a family is called familial prostate cancer and it accounts for about 20%. This type of prostate cancer develops because of a combination of common genes and common environmental or lifestyle factors.

The hereditary prostate cancer, which means the cancer is inherited from a relative, it is rare and represents approximately 5% of all cases. Hereditary prostate cancer occurs when changes in genes, or mutations, are transmitted within a family from one generation to the next.

Hereditary prostate cancer should be excluded if a person’s family history includes any of the following:

3 or more first-degree relatives with prostate cancer

Prostate cancer in 3 generations on the same side of the family

2 or more close relatives, such as father, brother, son, grandfather, uncle or nephew, on the same side of the family who were diagnosed with prostate cancer before the age of 55

If a person has a first-degree relative – i.e. father, brother or son – with prostate cancer, the risk of developing prostate cancer is 2 to 3 times higher than average. This risk is further increased by the number of relatives diagnosed with prostate cancer.

Hereditary Breast – Ovarian Cancer Syndrome (HBOC)

HBOC is associated with mutations in the BRCA1 and / or BRCA2 genes. BRCA stands for “BReast Cancer.” HBOC is more often associated with an increased risk of breast and ovarian cancer in women. However, men with HBOC also have an increased risk of developing breast cancer and a more aggressive form of prostate cancer. Mutations in the BRCA1 and BRCA2 genes are thought to cause only a small proportion of familial prostate cancers. Men who have BRCA1 or BRCA2 mutations should be screened for prostate cancer exclusion at an earlier age. Genetic testing may only be appropriate for families with prostate cancer that may also have HBOC. (Find out about hereditary cancer testing here)

If you are concerned about this based on your own family history, talk to a genetic counselor or a doctor to provide you more information.

Other genetic changes

Other genes that may have an increased risk of developing prostate cancer include HPC1, HPC2, HPCX, CAPB, ATM and FANCA. However, none of them have been directly shown to cause prostate cancer or constitute a specific mutant gene for this disease. Research to identify genes associated with an increased risk of prostate cancer is ongoing, and researchers are constantly learning more about how specific genetic changes may affect prostate cancer development.

Currently, no genetic tests are available to determine the likelihood of a person developing prostate cancer.

Eating Habits

No studies have shown that diet and nutrition can directly cause or prevent the development of prostate cancer. However, many studies examining the links between certain eating behaviors and cancer suggest that there may be a link. For example, obesity is associated with many cancers, including prostate cancer, and a healthy diet is recommended to avoid weight gain

Often, early prostate cancer has no symptoms. It is usually found through a PSA or DRE test (see General and Diagnosis). If a PSA or DRE test indicates prostate cancer, more monitoring and control is needed to diagnose prostate cancer. When prostate cancer causes symptoms, it is usually diagnosed at a later stage. These symptoms may include:

Frequent urination

Impaired or interrupted urine flow

The need to urinate frequently at night

Blood in the urine

Blood in the sperm

New appearance of erectile dysfunction

Pain or burning during urination

Dizziness or pain as you sit, caused by an enlarged prostate

Sometimes men with prostate cancer have none of these changes. Other non-cancerous prostate diseases, such as BPH (see General) or an enlarged prostate, can cause similar symptoms. Or, the cause of a symptom may be a different medical condition that is not cancer. Urinary symptoms (pain, etc.) can also be caused by a bladder infection or other conditions.

If the cancer has spread outside the prostate gland (metastasis), a man may develop:

Pain in the back, hips, thighs, shoulders or other bones

Swelling of the legs

Unexplained weight loss

Fatigue

Change in bowel habits