Prostate Cancer Overview

Prostate cancer originates in the prostate gland, a small walnut-sized organ located below the bladder in men. This gland plays a crucial role in producing seminal fluid. Prostate cancer is one of the most prevalent cancers among men, particularly affecting those over 50 years of age. While many cases are slow-growing and manageable, early detection is vital for effective treatment.

Prostate cancer is a serious disease. And it’s common. For every 100 males, 13 will develop prostate cancer at some point in their lives. Fortunately, most people get diagnosed before it spreads beyond their prostate glands. Treatment at this stage often eliminates the cancer. Still, approximately 35,770 people in the United States die from prostate cancer each year.

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Key Risk Factors

Age: The chance of developing prostate cancer rises significantly after age 50. Around 60% of cases are diagnosed in people over 65 
Race/Ethnicity: Those of Black or African ancestry face higher risk—often earlier onset and more aggressive disease—while Asian-American and Hispanic men generally have lower incidence rates.
Family History: Having a first-degree relative (father, brother, or son) with prostate cancer doubles to triples your risk; the risk grows if multiple relatives or earlier-age diagnoses are involved 
Inherited Genes: Mutations in genes like BRCA1, BRCA2, HOXB13, Lynch syndrome genes, and others involved in DNA repair (e.g., ATM) increase risk, particularly for early-onset or aggressive disease.

Possible Risk Amplifiers (evidence mixed or emergent)

Obesity: A BMI over 30 is linked to higher rates of aggressive prostate cancer and later-stage diagnosis 
Smoking: Though not conclusively tied to incidence, smoking may contribute to more aggressive cancer and increased mortality.
Prostatitis: Chronic prostate inflammation has been associated with elevated prostate cancer risk 
Sexually Transmitted Infections (STIs): Some studies suggest a possible link between STIs and higher cancer risk, but evidence remains inconclusive.
Agent Orange Exposure: Vietnam veterans exposed to Agent Orange face higher prostate cancer rates, including aggressive forms

Additional Factors Under Investigation

Dietary influences: High consumption of red/processed meats, saturated fats, dairy, or calcium may raise risk—but evidence is inconsistent 
Geography/Occupation: Living in North America, Europe, or Australia, or working in high-exposure fields (e.g., firefighting, farming), may elevate risk due to environmental exposures such as pesticides, cadmium, or other carcinogens
Height: Taller adult stature has been linked to slightly higher prostate cancer risk 
High androgen levels: Though not definitively proven, elevated testosterone may potentially influence prostate cancer development

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Signs & Symptoms

Early stages: Usually no symptoms; detected via screening.
Potential early signs include urinary changes:
- Increased nighttime urination, weak or slow urine flow, difficulty starting/stopping
- Blood in urine or semen
Advanced disease symptoms:
- Erectile dysfunction, pelvic or bone pain (spine, hips, ribs), unexplained weight loss, fatigue, and neurological symptoms from spinal compression

Sources:

https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/signs-symptoms.html

Diagnosis & Staging

Screening tools:
- PSA blood test (Prostate-Specific Antigen)
- Digital rectal exam (DRE) to feel for hard or irregular tissue
Once suspicion arises:
- MRI (mp-MRI) and MRI/ultrasound fusion-guidance improve biopsy targeting accuracy
- Biopsy: often via transrectal or transperineal needle sampling, guided by ultrasound or MRI; diagnosis confirmed by pathologist and graded using Gleason score (6 to 10)
Emerging tools:
- Prostate Health Index (PHI) – a blood test combining PSA variants for better risk stratification
- AI-enhanced imaging (mp-MRI + ultrasound or micro-US) is improving detection of clinically significant disease and may reduce unnecessary biopsies

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Confirmatory Biopsy

Transrectal or Transperineal Biopsy – Under ultrasound guidance, multiple core samples are taken to confirm cancer and determine the Gleason score
MRI-Fusion Biopsy – Combines MRI and ultrasound to target suspicious regions, improving detection of clinically significant tumors and reducing over diagnosis.

Imaging for Diagnosis & Staging

Multiparametric MRI (mp-MRI)
- Gives detailed views of the prostate and adjacent tissue.
- Guides biopsy decisions and informs extent of local disease
Transrectal Ultrasound (TRUS)
- Often used alongside biopsy; less helpful for staging
CT Scan
- Helps evaluate lymph node involvement and detect extension beyond the prostate
Bone Scan
- Nuclear imaging to detect bone metastases; useful when PSA is elevated or in higher-stage cases
PSMA PET Scan
- Advanced imaging that targets PSMA to reveal micrometastatic disease with greater sensitivity and specificity than traditional bone or CT scans
- Studies show PSMA PET-CT improves metastatic detection rates (92% vs 65%) and influences treatment decisions
Other PET Tracers – Including fluciclovine F-18, choline C-11, and sodium fluoride F-18 for supplemental information

Staging & Grading

Gleason / Grade Group – Pathological assessment from biopsy gauges’ aggressiveness (Grade Group 1–5)
TNM Staging System
- T (tumor size/spread), N (lymph nodes), M (metastasis), plus PSA level and Grade Group per AJCC guidelines
Clinical vs. Pathological Staging
- Clinical staging uses exam, PSA, biopsy, and imaging.
- Pathological staging follows prostatectomy, offering definitive insight

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Treatment Options

Treatment strategies for prostate cancer vary based on the cancer’s stage, aggressiveness, and the patient’s overall health. For localized, slow-growing cancers, active surveillance may be recommended, involving regular monitoring without immediate treatment.

For more aggressive or advanced cases, treatment options include:

Surgery: Radical prostatectomy involves the removal of the prostate gland and is often performed using minimally invasive robotic techniques, leading to quicker recovery and fewer complications.
Radiation Therapy: External beam radiation or brachytherapy (internal radiation) targets cancer cells while sparing surrounding healthy tissue.
Hormone Therapy: Since prostate cancer cells often rely on testosterone for growth, reducing hormone levels can help control the disease.
Chemotherapy: Utilizes drugs to kill rapidly dividing cancer cells, typically used when cancer has spread beyond the prostate.
Immunotherapy and Targeted Therapy: These newer treatments aim to enhance the body’s immune response or target specific genetic mutations in cancer cells.

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