Prostate cancer is one of the most common malignancies affecting men worldwide and represents a significant public health concern. According to global cancer statistics, it is among the leading causes of cancer-related morbidity and mortality in men, particularly in developed countries (Sung et al., 2021). This article examines the causes, symptoms, and treatment options for prostate cancer, drawing on evidence from textbooks, peer-reviewed journal articles and reputable health organisations.
1.0 Overview of Prostate Cancer
The prostate gland is a small, walnut-shaped organ located below the bladder and in front of the rectum. It forms part of the male reproductive system and produces seminal fluid that nourishes and transports sperm (McAninch and Lue, 2020).
Prostate cancer develops when cells in the prostate undergo malignant transformation, leading to uncontrolled growth. Most prostate cancers are adenocarcinomas, originating from the glandular epithelial cells (Kumar et al., 2020). The disease often progresses slowly, but aggressive forms can metastasise to lymph nodes and bones.
2.0 Causes and Risk Factors
The exact cause of prostate cancer remains multifactorial and incompletely understood. However, several well-established risk factors have been identified.
2.1 Age
Increasing age is the strongest risk factor. Prostate cancer is rare in men under 40 but becomes significantly more common after the age of 50 (Rawla, 2019). Age-related genetic mutations and hormonal changes contribute to carcinogenesis.
2.2 Genetic Factors
A positive family history increases risk. Men with a first-degree relative diagnosed with prostate cancer have approximately double the risk (Carter et al., 2013). Inherited mutations in genes such as BRCA1, BRCA2, and HOXB13 are associated with increased susceptibility (Pritchard et al., 2016).
2.3 Ethnicity
Incidence rates vary by ethnicity. Men of African or Caribbean descent have higher incidence and mortality rates compared to Caucasian men (Sung et al., 2021). The reasons are likely to involve a combination of genetic predisposition and socioeconomic factors.
2.4 Hormonal Influences
Androgens, particularly testosterone and dihydrotestosterone (DHT), play a central role in prostate cell growth. The androgen receptor signalling pathway is critical in prostate cancer development and progression (Feldman and Feldman, 2001).
2.5 Lifestyle and Environmental Factors
Dietary factors such as high intake of saturated fats and red meat have been associated with increased risk, while diets rich in fruits and vegetables may offer some protective effect (World Cancer Research Fund, 2018). Obesity has also been linked to more aggressive disease (Rawla, 2019).
3.0 Pathophysiology
Prostate cancer typically begins as prostatic intraepithelial neoplasia (PIN), a precursor lesion (Kumar et al., 2020). Genetic mutations accumulate, leading to malignant transformation. Tumour progression often involves invasion through the prostatic capsule and metastasis via lymphatic and haematogenous routes, especially to bones, causing osteoblastic lesions.
4.0 Symptoms
Early-stage prostate cancer is often asymptomatic, which complicates early detection. Many cases are identified through prostate-specific antigen (PSA) testing or digital rectal examination (DRE).
When symptoms occur, they may include:
4.1 Urinary Symptoms
- Difficulty starting urination
- Weak or interrupted urine flow
- Increased frequency, particularly at night (nocturia)
- Pain or burning during urination
These symptoms resemble benign prostatic hyperplasia (BPH), making differential diagnosis essential (McAninch and Lue, 2020).
4.2 Haematuria or Haemospermia
Blood in urine or semen may occur in advanced disease.
4.3 Erectile Dysfunction
Tumour invasion or treatment effects may impair erectile function.
4.4 Bone Pain
In metastatic disease, patients commonly present with bone pain, particularly in the spine, pelvis or ribs. This reflects skeletal metastases, a hallmark of advanced prostate cancer (Kumar et al., 2020).
4.5 Systemic Symptoms
Weight loss, fatigue and anaemia may occur in advanced stages.
5.0 Diagnosis
5.1 Prostate-Specific Antigen (PSA) Testing
PSA is a glycoprotein produced by prostate cells. Elevated levels may indicate prostate cancer but can also occur in BPH or prostatitis. PSA screening remains controversial due to risks of overdiagnosis and overtreatment (Hamdy et al., 2016).
5.2 Digital Rectal Examination (DRE)
DRE may detect irregularities or nodules in the prostate.
5.3 Biopsy
Definitive diagnosis requires a transrectal ultrasound-guided biopsy.
5.4 Imaging
Magnetic resonance imaging (MRI) and bone scans assess local and distant spread.
6.0 Treatment
Management depends on stage, Gleason score, PSA level and patient health status. Treatment options include:
6.1 Active Surveillance
For low-risk, localised disease, active surveillance is often appropriate. Patients undergo regular PSA testing, imaging and repeat biopsies. This approach reduces unnecessary treatment-related morbidity (Hamdy et al., 2016).
Example: A 65-year-old man with low PSA and Gleason 6 disease may be monitored without immediate intervention.
6.2 Surgery
Radical prostatectomy involves complete removal of the prostate gland. It is typically recommended for localised disease in healthy patients (McAninch and Lue, 2020).
Potential complications include:
- Urinary incontinence
- Erectile dysfunction
6.3 Radiotherapy
Radiotherapy can be delivered externally or via brachytherapy (implanting radioactive seeds). It offers outcomes comparable to surgery in early-stage disease (Hamdy et al., 2016).
6.4 Hormone Therapy
Androgen deprivation therapy (ADT) reduces testosterone levels, slowing tumour growth. It is commonly used for advanced or metastatic disease (Feldman and Feldman, 2001).
6.5 Chemotherapy
Drugs such as docetaxel are used in castration-resistant prostate cancer (Tannock et al., 2004).
6.6 Targeted and Novel Therapies
Recent advances include PARP inhibitors for BRCA-mutated cancers and immunotherapy approaches. Precision medicine is increasingly guiding treatment decisions (Pritchard et al., 2016).
6.7 Prognosis
Prognosis depends on stage at diagnosis. Localised prostate cancer has a high five-year survival rate exceeding 95%, while metastatic disease carries a poorer prognosis (Sung et al., 2021). Early detection and risk stratification are critical to improving outcomes.
7.0 Prevention and Public Health Considerations
There is no guaranteed prevention strategy. However:
- Maintaining a healthy weight
- Engaging in regular physical activity
- Consuming a balanced diet rich in vegetables
- Discussing PSA screening with a healthcare provider
These measures may reduce risk or promote early detection (World Cancer Research Fund, 2018).
Prostate cancer is a prevalent and potentially life-threatening malignancy influenced by age, genetics, hormones and lifestyle factors. While early disease may be asymptomatic, advanced stages can cause significant morbidity, particularly through bone metastases. Modern management ranges from active surveillance to surgery, radiotherapy and systemic therapies. Continued research into genetic risk factors and targeted treatments offers promising advances in personalised care. Early diagnosis and informed treatment decisions remain central to improving survival and quality of life.
References
Carter, H.B., Helfand, B., Mamawala, M. and Wu, Y. (2013) ‘Germline mutations and prostate cancer’, Journal of Clinical Oncology, 31(15), pp. 2020–2026.
Feldman, B.J. and Feldman, D. (2001) ‘The development of androgen-independent prostate cancer’, Nature Reviews Cancer, 1(1), pp. 34–45.
Hamdy, F.C., Donovan, J.L., Lane, J.A. et al. (2016) ‘10-year outcomes after monitoring, surgery, or radiotherapy for localised prostate cancer’, New England Journal of Medicine, 375(15), pp. 1415–1424.
Kumar, V., Abbas, A.K. and Aster, J.C. (2020) Robbins and Cotran Pathologic Basis of Disease. 10th edn. Philadelphia: Elsevier.
McAninch, J.W. and Lue, T.F. (2020) Smith & Tanagho’s General Urology. 19th edn. New York: McGraw-Hill.
Pritchard, C.C., Mateo, J., Walsh, M.F. et al. (2016) ‘Inherited DNA-repair gene mutations in men with metastatic prostate cancer’, New England Journal of Medicine, 375(5), pp. 443–453.
Rawla, P. (2019) ‘Epidemiology of prostate cancer’, World Journal of Oncology, 10(2), pp. 63–89.
Sung, H., Ferlay, J., Siegel, R.L. et al. (2021) ‘Global cancer statistics 2020’, CA: A Cancer Journal for Clinicians, 71(3), pp. 209–249.
Tannock, I.F., de Wit, R., Berry, W.R. et al. (2004) ‘Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer’, New England Journal of Medicine, 351(15), pp. 1502–1512.
World Cancer Research Fund (2018) Diet, nutrition, physical activity and prostate cancer. Available at: https://www.wcrf.org.
