Prostate cancer: symptoms, causes and treatment

In Portugal, there are around 7.500 new cases of prostate cancer every year, with a mortality rate of around 2.000 men per year. This is the most prevalent cancer among the male population, given that at birth a male newborn has a 15% likelihood of developing prostate cancer. These troubling figures can be controlled through prevention and early diagnosis. 

What is prostate cancer?  

Prostate cancer is a malignant tumour in the prostate, an exclusively male organ located below the bladder and which surrounds the urethra. In a normal cell renewal process, some prostate cells die and others multiply to replace them. Prostate cancer alters this mechanism, i.e. cells start to multiply more rapidly, in an uncontrolled and autonomous manner, potentially causing a malignant tumour. 
Prostate cancer develops silently, in most cases without exhibiting any symptom as it progresses. Warning signs appear when the disease is already in an advanced stage, therefore prevention and early diagnosis are essential to save lives. 

What are the types of prostate cancer? 

Prostate cancer is not a unique disease. There are different types, which vary depending on their source, behaviour and aggressiveness, and some are very common while others are quite rare. 

Prostatic adenocarcinoma

This is the most common type of prostate cancer and it accounts for most cases. This cancer develops in the prostate’s glandular cells and usually progresses slowly, enabling a timely diagnosis and treatment.

Ductal adenocarcinoma  

This is a rare subtype of prostatic adenocarcinoma that tends to be more aggressive and can grow quickly; therefore, it is often diagnosed at an advanced stage.

Neuroendocrine tumours 

These tumours are rare and usually present a more aggressive behaviour. They may not cause a high PSA (Prostate Specific Antigen) level, a protein produced by the prostate, which makes early diagnosis difficult.

Prostate sarcomas  

These are extremely rare and originate from the supporting tissues of the prostate, such as muscles or blood vessels. They tend to grow rapidly and require a different therapeutic approach.

What are the causes of prostate cancer? 

The exact causes of prostate cancer are still unknown. However, there are factors that can increase the risk of developing this disease, relating especially to age, genetics and lifestyle. 

Advanced age

The risk of prostate cancer increases significantly with age. This disease is more prevalent in men over the age of 50, and ageing is one of the leading factors associated with its development.

Family history

Men with close relatives (father or brothers) who suffered from prostate cancer are more likely to develop the disease. This suggests the existence of genetic factors that can be inherited.

Genetic changes 

Some changes in the genes that control cell growth and division can increase the risk of prostate cancer. These changes may be inherited or appear over time.

Hormone changes

The prostate is influenced by male hormones like testosterone. Changes in hormone levels or how the prostate responds to these hormones may lead to the development of cancer.

Diet and lifestyle 

A diet rich in fats and low in fruit and vegetables, along with a sedentary lifestyle and being overweight or obese, can increase the risk of prostate cancer. 

How is prostate cancer diagnosed?  

If there are any suspicious symptoms or changes in routine tests, it’s crucial to consult a urologist to obtain a prompt diagnosis and the right treatment. A prostate cancer diagnosis is based on the combination of several exams and clinical tests that allow an assessment of the prostate and confirm the presence of this disease.

Digital rectal exam

A digital rectal exam is a simple test in which the physician assesses the prostate through the rectum, to detect changes in size, consistency or the presence of hard nodules. If suspicious changes are found, additional diagnostic exams may be prescribed, such as PSA testing or magnetic resonance imaging.

PSA testing  

PSA (Prostate Specific Antigen) is a protein naturally produced by the prostate and measured through a blood test. High PSA levels do not necessarily mean cancer, as they can also occur in other benign scenarios, such as benign enlargement of the prostate (BPH), inflammations, or after certain medical procedures. Measuring the total PSA and free PSA helps the physician better differentiate between benign changes and those suspected of being malignant.

Prostate MRI

Magnetic resonance imaging is currently the standard exam for prostate assessment. MRI allows a more accurate identification of suspicious areas, inflammations or benign changes, and is especially useful if alterations are detected in the PSA tests or digital rectal exam. MRI also helps guide future decisions, such as the need for a biopsy.

Prostate biopsy

When prior exams indicate possible prostate cancer, this is confirmed through a biopsy. In this procedure, small prostate tissue samples are collected for laboratory analysis. Prostate fusion biopsy combines magnetic resonance and ultrasound images to provide greater precision in identifying suspicious areas.

How is prostate cancer treated?

The treatment for prostate cancer should begin immediately after the diagnosis is confirmed and depends on the stage of the tumour’s development. The urologist will determine the best therapy for each case, which may involve other medical specialties. At this time, it’s important to clarify all doubts by discussing your treatment options and principal side effects with your physician. 

When prostate cancer is detected early, the goal of treatment is to cure the disease. In advanced cases, the objective is to slow the progression of the cancer and give the patient the best quality of life possible. 

The therapeutic approaches include:

Active surveillance

In situations of slow growing and low risk prostate cancer, active surveillance can be applied. This approach involves regular check-ups, with tests, exams and sometimes biopsies, without beginning immediate treatment, to avoid unnecessary side effects.

Surgery

Surgery, called a radical prostatectomy, involves removing the entire prostate and, in some cases, nearby lymph nodes. This is a common option in patients with localised cancer who are otherwise in good general health.

Radiation therapy

Radiation therapy uses controlled doses of radiation to destroy cancer cells. It can be applied externally or, in some cases, directly to the prostate by implanting small radioactive sources. In certain situations, this is an effective alternative to surgery.

Hormone therapy

The goal of hormone therapy is to reduce the levels of male hormones that stimulate the growth of prostate cancer, such as testosterone. This method can be used alone or combined with other treatments, especially in advanced stages of the disease.

Chemotherapy

Chemotherapy involves administering drugs that destroy cancer cells or prevent their growth. This treatment is usually applied when prostate cancer is in an advanced stage or is resistant to hormone therapy.

Targeted treatments and immunotherapy

In some cases, emerging therapies can be used that act specifically on tumour cells or stimulate the immune system to destroy them. These options depend on the tumour’s specific characteristics.

Prostate cancer: frequently asked questions

We answer below some frequently asked questions about prostate cancer.

Is there a cure for prostate cancer? 

Yes, there is a cure for prostate cancer, especially when it’s diagnosed in the early stages and is treated correctly. Many cases progress slowly and have a good prognosis; therefore, medical supervision is essential to detect any changes early. 

What are the first symptoms of prostate cancer? 

In the early stages, prostate cancer may not cause symptoms. When these appear, the most common include difficulty urinating, a frequent need to urinate and difficulty emptying the bladder.

Do high PSA levels always mean prostate cancer? 

No. PSA levels can be high for various benign reasons, such as inflammations or benign enlargement of the prostate. High levels indicate a need for further investigation, but do not on their own confirm prostate cancer.

At what age should prostate cancer screening begin? 

In general, prostate cancer screening is recommended as of the age of 50. Men with a family history or higher risk may be advised to begin earlier, according to medical advice.

Does prostate cancer affect sex life? 

Some treatments for prostate cancer may affect sexual function, such as erection or ejaculation. However, there are therapeutic options and rehabilitation strategies that help minimize this impact.

Joaquim Chaves Saúde, by your side against prostate cancer 

Today, most cancers that are diagnosed early are likely to respond to treatment. This is why screening is crucial throughout the entire process, as this allows prostate cancer to be diagnosed and treated at an early stage, with a high cure rate. 

As of the age of 50, all males should undergo an annual routine check-up, and in the case of family history of this disease, screening should start at the age of 40. People of African descent should begin screening at the age of 45.

At Joaquim Chaves Saúde, you will find a team of experienced specialists to support you during this decisive time of life, providing the most advanced care and treatments in the world. Schedule your consultation now.