Overview
Prostate cancer is a condition characterized by the uncontrolled growth of cells within the prostate gland. This gland, exclusive to males, contributes to the production of seminal fluid. It is situated just below the bladder and in front of the rectum, playing a vital role in both the urinary and reproductive systems.
The majority of prostate cancers are adenocarcinomas, which originate from the glandular cells that produce the prostate fluid that mixes with semen during ejaculation. While there are other types of prostate cancer, such as small cell carcinomas, neuroendocrine tumors (excluding small cell varieties), transitional cell carcinomas, and sarcomas, these are relatively rare.
 
Type of cancer
1. Adenocarcinomas: These are the most common type of prostate cancer and originate from the cells responsible for secreting prostate fluid, a key component of semen.
2. Small Cell Carcinomas, Neuroendocrine Tumors, Transitional Cell Carcinomas, and Sarcomas: These are less common forms of prostate cancer.
 
 

Prostate Cancer TNM Staging

T — Primary Tumor

TX: Primary tumor cannot be assessed.

T0: No evidence of primary tumor.

T1: Clinically inapparent tumor, not palpable or visible by imaging.

T1a: Tumor incidental histological finding in ≤5% of tissue resected.

T1b: Tumor incidental histological finding in >5% of tissue resected.

T1c: Tumor identified by needle biopsy (e.g., because of elevated PSA), not palpable or visible by imaging.

T2: Tumor confined within the prostate, palpable or visible by imaging.

T2a: Tumor involves one-half of one lobe or less.

T2b: Tumor involves more than one-half of one lobe, but not both lobes.

T2c: Tumor involves both lobes.

T3: Tumor extends through the prostatic capsule or invades the seminal vesicle(s).

T3a: Extraprostatic extension (unilateral or bilateral), including microscopic bladder neck involvement.

T3b: Tumor invades seminal vesicle(s) (unilateral or bilateral).

T4: Tumor is fixed or invades adjacent structures other than seminal vesicles: levator muscles, rectum, bladder, external sphincter, pelvic wall, etc.

N — Regional Lymph Nodes

NX: Regional lymph nodes cannot be assessed.

N0: No regional lymph node metastasis.

N1: Regional lymph node metastasis.

M — Distant Metastasis

M0: No distant metastasis.

M1: Distant metastasis present.

M1a: Non-regional lymph node metastasis (e.g., para-aortic, mediastinal, supraclavicular).

M1b: Bone metastasis.

M1c: Metastasis to other site(s) with or without bone disease.

Incidence Rates
Prostate cancer is the second most common cancer in men worldwide, with more than 1.4 million new cases reported in 2020. The incidence of prostate cancer varies greatly across the globe. The highest rates are found in Guadeloupe and Martinique, followed by Ireland, Barbados, Saint Lucia, Estonia, Puerto Rico, Sweden, France, and the Bahamas.
In terms of mortality, the highest rates are observed in Zimbabwe, Barbados, Haiti, Zambia, Jamaica, Trinidad and Tobago, the Bahamas, the Dominican Republic, Saint Lucia, and Côte d’Ivoire.
In Asia, the incidence rates of prostate cancer vary. Eastern Asia has the highest incidence rate (50.4 per 100,000 for males), whereas South-Central Asia has the lowest incidence rate (11.9 per 100,000 for males).
These rates can vary widely due to factors such as differences in screening practices, access to healthcare, lifestyle, and genetic factors.

Symptoms
Symptoms of Prostate Cancer can include:
1.Frequent urination
2.Weak or interrupted urine flow
3.The urge to urinate frequently at night
4.Blood in the urine
5.New onset of erectile dysfunction
6.Pain or burning during urination
7.Discomfort or pain when sitting, caused by an enlarged prostate
8.More frequent urination, especially at night
9.A strong or sudden urge to urinate
10.Difficulty starting the flow of urine
11.Weak or slow urine stream
12.Interrupted urine stream (starts and stops)
13.Being unable to empty the bladder completely
14.Blood in urine or blood in semen
 
Cause
Cause of Prostate Cancer is not entirely clear, but many cases of the disease appear to be related to aberrant cell signaling that involves male androgen hormones, particularly testosterone and its metabolites. Mutations in your DNA, or genetic material, lead to the growth of cancerous cells.
 
Risk factors
Risk Factors of Prostate Cancer include:
1. Age: The risk of prostate cancer increases with age, especially after age 50.
2. Race: Prostate cancer develops more often in African American men and in Caribbean men of African ancestry than in men of other races.
3. North American or northern European location
4. Family history
5. Hereditary breast and ovarian cancer (HBOC) syndrome
6. Other genetic changes
7. Agent Orange exposure
8. Eating habits and weight
9. Obesity
10. Smoking
11. Alcohol consumption
12. Exposure to chemicals, such as the herbicide Agent Orange
13. Inflammation of the prostate

Diagnosis and Test
The diagnosis of prostate cancer involves a series of tests:
1. Digital Rectal Exam (DRE): In this procedure, a doctor manually examines the prostate through the rectum to identify any hard or lumpy areas, known as nodules.
2. Prostate-Specific Antigen (PSA) Test: This blood test measures the level of PSA, a substance produced by the prostate. An elevated PSA level may indicate prostate infection, inflammation, enlargement, or cancer.
3. Prostate Biopsy: This is the most definitive method for diagnosing prostate cancer. It typically involves inserting a thin needle into the prostate to collect tissue samples. These samples are then analyzed in a lab to determine the presence of cancer cells.
4. Imaging Test of the Prostate Gland: This could involve an MRI or a transrectal ultrasound (TRUS).
5. Complete Blood Count (CBC): This test measures the quantity and quality of white blood cells, red blood cells, and platelets.
6. Blood Chemistry Tests: These tests measure certain chemicals in the blood.
If the results of screening tests or symptoms suggest the possibility of prostate cancer, further tests will be needed to confirm the diagnosis. In such cases, you might be referred to a urologist, a doctor who specializes in treating cancers of the genital and urinary tract, including the prostate. The definitive diagnosis of prostate cancer can only be made with a prostate biopsy.

Treatment Options:
1. Surgery: A prostatectomy is an operation where doctors remove the prostate.
2. Radiation Therapy: This involves using high-energy rays (similar to X-rays) to kill the cancer.
3. Cryosurgery: This is a procedure that involves freezing tissue to kill cancer cells.
4. Hormone Therapy: This treatment aims to stop the body from producing the male hormone testosterone, which may help stop the growth and spread of the cancer cells.
5. Chemotherapy: This uses drugs to kill cancer cells or stop them from dividing.
6. Immunotherapy: This helps the body’s immune system fight cancer.
7. Targeted Drug Therapy: This uses drugs to identify and attack specific cancer cells without harming normal cells.

Prognosis
1. Early Stage Diagnosis: Prostate cancer has a 5-year survival rate of over 95% when diagnosed at stage 1–3.
2. Advanced Stage Diagnosis: For the 1 in 5 people diagnosed with stage 4 prostate cancer (metastatic), the 5-year survival rate is just 49%. The survival rate in most people with advanced prostate cancer (Stage IV) is 30 percent at the fifth year of diagnosis.

Supportive
Supportive care helps people meet the physical, practical, emotional, and spiritual challenges of prostate cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended. These might include nursing or social work services, financial aid, nutritional advice, rehab.