June 11th is the day set aside to celebrate World Prostate Cancer Day in order to create awareness of the most common type of cancer in men. Prostate cancer is often called a “silent threat” due to its subtle early symptoms. Follow me as we shed more light on the silent killer.
WHAT IS PROSTATE CANCER?
Prostate cancer is a growth of cells that starts in the prostate gland, a walnut-sized organ in men that produces seminal fluid. According to the World Health Organisation (WHO), it is the 4th most common cancer in the world, just behind. In Nigeria, the National Institute of Health (NIH) notes it as the most common cancer among men, with rising incidence due to limited screening. In 2022, the WCRF reported approximately 1.4 million new cases of prostate cancer worldwide.
SIGNS AND SYMPTOMS OF PROSTATE CANCER
Prostate cancer’s early symptoms are vague and can easily be dismissed by the affected; that is why calling it a silent killer isn't far-fetched. Many men who dismiss the signs delay diagnosis, and a cancer's lethality increases with delayed diagnosis. Common symptoms include difficulty starting or stopping urination, weak urine flow, or frequent urination (especially at night). Blood in urine or semen, pelvic discomfort or pain, erectile dysfunction, bone pain (in advanced stages, if cancer spreads to bones), and fatigue or unexplained weight loss. For early detection, it is important to recognise persistent symptoms. When any of these symptoms last more than 2–3 weeks, it may be a pointer.
TYPES OF PROSTATE CANCER
Prostate cancer primarily arises from specific cell types in the prostate:
ADENOCARCINOMA: The most common type, originating in gland cells that produce prostate fluid. Subtypes include acinar and ductal adenocarcinoma, with acinar being the most prevalent.
SMALL CELL CARCINOMA: A rare, aggressive form that grows quickly and is harder to treat.
TRANSITIONAL CELL CARCINOMA: Arises from the urethra’s lining and is less common.
NEUROENDOCRINE TUMOURS: Rare tumours from hormone-producing cells, often aggressive. Most prostate cancers grow slowly, but aggressive forms require urgent intervention. Early detection through PSA testing often catches adenocarcinomas before they spread.
CAUSES AND RISK FACTORS
While the exact cause of prostate cancer is unknown, several risk factors increase a man’s likelihood of developing it.
AGE: Age is one risk factor that rises significantly after age 50, with most cases diagnosed in men over 65.
FAMILY HISTORY: Like many other diseases, family history and genetics are also risk factors. About 5–10% of cases are hereditary. Men with a family history of prostate, breast, or ovarian cancer face higher risks.
RACE/ETHNICITY: African and African-American men have a 60% higher risk than Caucasian men and worse outcomes, partly due to socioeconomic factors.
DIET/HORMONES: Diets high in red meat or dairy and low in vegetables may increase risk. Obesity and smoking are also linked. High levels of testosterone or other androgens may fuel cancer growth.
STAGES OF PROSTATE CANCER
Staging helps determine the cancer’s spread and guides treatment:
Localised: Cancer is confined to the prostate (Stage I–II). Most treatable, with excellent outcomes.
Regional: Cancer spreads to nearby tissues, like seminal vesicles (Stage III).
Distant: Cancer reaches distant organs, such as bones, lungs, or liver (Stage IV), requiring aggressive treatment.
TREATMENT OPTIONS
Treatment depends on the cancer’s stage, grade, and patient health. Options include
ACTIVE SURVEILLANCE: Monitoring slow-growing cancers with regular PSA tests and biopsies, suitable for low-risk cases.
SURGERY: Radical prostatectomy removes the prostate and surrounding tissues, often for localised cancer.
RADIATION THERAPY: External beam or brachytherapy targets cancer cells and is used for localised or regional stages.
HORMONE THERAPY: Reduces testosterone levels to slow cancer growth, common in advanced cases.
CHEMOTHERAPY: Used for metastatic cancer, often combined with hormone therapy.
IMMUNOTHERAPY AND TARGETED THERAPY: Emerging treatments, like sipuleucel-T, boost the immune system or target specific cancer cells.
BIOTHERAPY: Drugs like checkpoint inhibitors enhance immune response, showing promise in clinical trials. According to the National Cancer Institute, the 5-year survival rate for prostate cancer is 97.5% overall but drops to 32% for metastatic cases, underscoring the need for early detection.
Prevention: No guaranteed way exists to prevent prostate cancer, but risk can be reduced through a healthy diet (emphasis on fruits, vegetables, and whole grains while limiting red meat and processed foods), regular exercise, and quitting smoking. Prostate cancer may be a “silent threat”, but its impact on men’s lives is very loud. The vague symptoms demand vigilance, and men must know their bodies and seek screenings at the slightest change.
