Prostate Cancer

Risk Factors

• Age: Rarely diagnosed before age 40; risk increases significantly after 50.
• Race/Ethnicity: Black men have higher incidence and mortality; Asian men have lower risk.
• Family History: Having father or brother with prostate cancer increases risk 2-3x.
• Genetic Mutations: BRCA1, BRCA2, Lynch syndrome increase risk.
• Obesity: May increase risk of aggressive disease.

Screening and Detection

Screening Recommendations (vary by organization):

• Average risk men age 50-69: Shared decision-making about PSA screening recommended.
• High-risk men (Black men, family history) age 40-49: Earlier screening discussions recommended.
• PSA test: Blood test measuring PSA levels. Not specific for cancer; elevated may indicate benign conditions.
• Digital Rectal Exam (DRE): Doctor feels prostate for bumps or hardness.

Diagnosis involves:

• Prostate biopsy: Tissue samples examined for cancer cells. Definitive diagnosis method.
• Imaging (MRI, ultrasound): Helps guide biopsy and assess extent of disease.

Staging and Gleason Score

Gleason Score (grades aggressiveness):

• 6: Low-grade (slow-growing)
• 7: Intermediate-grade (moderate growth)
• 8-10: High-grade (aggressive, fast-growing)

TNM Staging (extent of disease):

• Stage I-II: Confined to prostate
• Stage III: Extends beyond prostate
• Stage IV: Spread to lymph nodes or distant organs

Five-year survival by stage: Stage I/II ~100%, Stage III ~95%, Stage IV ~30%.

Treatment Options

Active Surveillance

For low-risk cancers (low Gleason score, low PSA, small tumor):

• Regular PSA tests and digital rectal exams
• Periodic biopsies to monitor progression
• Treatment only if cancer shows signs of growth
• Many men never need treatment

Surgery (Radical Prostatectomy)

Surgical removal of prostate and nearby tissues:

• Open surgery, laparoscopic, or robot-assisted approaches
• Curative for localized disease
• Side effects: erectile dysfunction, urinary incontinence (often temporary)

Radiation Therapy

• External beam radiation: Targeted radiation from outside the body
• Brachytherapy: Radioactive seeds implanted in prostate
• Often combined with hormone therapy

Hormone Therapy (Androgen Deprivation)

Reduces testosterone or blocks its effects:

• Used for advanced or high-risk disease
• Can be given alone or with radiation/chemotherapy
• Side effects: hot flashes, erectile dysfunction, fatigue, bone loss

Chemotherapy

Used for castration-resistant prostate cancer (cancer that continues to progress despite hormone therapy).

Newer Targeted Therapies

For advanced disease: PARP inhibitors, novel hormonal agents for specific mutations.

Common Side Effects and Management

• Erectile dysfunction: Common after surgery/radiation. Medications, devices, counseling help.
• Urinary incontinence: Often improves over time; pelvic floor exercises help.
• Bowel changes (from radiation): Dietary modifications and medications manage diarrhea.
• Hot flashes (from hormone therapy): Managed with medications or coping strategies.
• Bone loss (from hormone therapy): Calcium, vitamin D, weight-bearing exercise, bone-protecting drugs.
• Fatigue: Activity pacing and rest help.