Excerpt

Prostate cancer is the fourth most common cancer among Malaysian men but is highly treatable in the early stages. Read on to learn more about prostate cancer.

What is Prostate Cancer?

Cancers can form in any part of the body. Mutations in the abnormal cells will continue to multiply uncontrollably and more rapidly than normal cells do, depriving healthy cells of the oxygen and nutrients they need. Eventually, the abnormal cells will survive while other healthy cells die. If this spread is not controlled and prevented, the cancer cells may eventually travel to other parts of the body like the bones or other organs and start to grow there as well.

Prostate cancer begins when abnormal cells start to develop in the prostate gland. The prostate gland is a walnut-sized organ beneath the urinary bladder that is responsible for producing semen and helps regulate urine flow. While prostate cancer is a relatively slow-growing disease, prevention and detection are still crucial to intercept the spread.

Prostate cancer is the 4th most common form of cancer in Malaysia. It may be a common type of cancer among males but is highly treatable in the early stages. Hence, it’s important to learn about prostate cancer so we know how to spot the warning signs and seek treatment early.

Causes and Risk Factors of Prostate Cancer

In Malaysia and many parts of the world, prostate cancer is most common in older men.

Unfortunately, prostate cancer cannot be prevented. When a patient is diagnosed with this condition, they will be advised on the suitable treatment options, as well as how they can alter their lifestyle choices to benefit their overall health such as consuming more fruits and vegetables, exercising regularly and avoiding high-fat diets. While the causes of prostate cancer are not entirely clear, a combination of factors may play a role in its development such as:

• Age
• Family history and genetics
• Ethnicity
• Hormones
• Diet
• Obesity
• Environment
• Lifestyle
  
  

Signs and Symptoms of Prostate Cancer

• Urinary Problems

Having difficulty urinating is one of the most common symptoms and early signs of prostate cancer as the gland is located underneath the bladder, surrounding the urethra. Urinary problems typically include a frequent need to urinate, weak or interrupted urine flow, bleeding while urinating, blood in the seminal fluid, or a pain or burning sensation while urinating.

However, having urinary symptoms do not automatically equate to having prostate cancer. Other diseases such as prostatitis and Benign Prostatic Hypertrophy (BPH) can cause similar symptoms as well.

• Pain and Numbness

As prostate cancer develops, it may spread to the bones surrounding the area as well. You may begin to experience pain in your back, chest, and pelvis. In the event that cancer spreads to your spinal cord, you may lose feeling in your bladder and legs, causing numbness in the lower body.

• Sexual Problems

Erectile dysfunction is considered to be another symptom of prostate cancer. This refers to one’s inability to get or keep an erection and even reduced sexual desire. Having trouble occasionally shouldn’t be cause for concern. However, if this becomes an ongoing issue, it is advisable to consult your doctor. This condition is also known to be linked with circulation and blood pressure, which may be related to health issues such as high blood pressure. 

Other symptoms of prostate cancer include loss of appetite as well as weight loss. If you begin to experience any of these symptoms, please consult a doctor immediately.

How can prostate cancer be detected?

There are several ways in which cancer can be detected in the prostate gland. Some of these methods include a Digital Rectal Exam (DRE), a Prostate Specific Antigen (PSA), a prostate biopsy, as well as analysing your family history.

Digital Rectal Exam (DRE)

In this process, the doctor will feel the texture of the prostate gland with a finger gently placed in the back passage or rectum. The purpose of this examination is to check the lower rectum, pelvis and lower belly for cancer and other health problems. While this method is used to detect abnormal nodules that may form on the prostate, DREs can also be performed on women to spot any irregularities in the reproductive organs or the bowel.

Prostate Specific Antigen (PSA) Test

Prostate Specific Antigen tests, or PSA tests, involve taking a blood sample from a vein and testing for PSA, a protein produced by the prostate gland responsible for keeping semen in liquid form. The test will then determine the PSA levels and which category they fall under. Higher than normal PSA levels could be a possible sign of prostate cancer.

Prostate Biopsy

Like any biopsy, an ultrasound-guided biopsy can be performed to detect the presence of cancer in the prostate by taking thin sections of tissue from the prostate gland. Depending on the samples required, this procedure can be done under either local or general anaesthesia.

Family History

Knowing your family’s history and genetics can also be crucial in the development of prostate cancer. If you have family members with a history of prostate cancer, you will also have a higher risk of developing prostate cancer than those without.

Additional tests that can be conducted to detect prostate cancer include lymph node biopsy, ultrasound, bone scan, computerised tomography (CT) scan, and a magnetic resonance imaging (MRI).

 

Common Types of Prostate Cancer

• Adenocarcinoma

Adenocarcinomas, the most common type of prostate cancer found in men around the world, refers to cancer that develops in the gland cells that line the prostate gland.

• Sarcomas

Unlike adenocarcinomas that develop from cells lining the prostate, sarcomas develop from smooth muscle cells inside the prostate called mesenchymal cells. This form of prostate cancer is commonly found in younger men between ages 35 and 60, and have also been found in children in extremely rare cases.

• Neuroendocrine Tumours (NETs)

Also known as carcinoids amongst medical professionals, Neuroendocrine Tumors (NETs) are an aggressive variant of prostate cancer that may arise in the later stages. These tumours can be found in the neuroendocrine system, which comprises the nerve and gland cells responsible for making and releasing hormones into the bloodstream. Apart from being extremely rare, it has been discovered that NETs do not affect one’s PSA levels and are completely hereditary.

• Small Cell Carcinoma

Similar to NETs, small cell carcinoma is another type of neuroendocrine cancer that is a rare malignancy that only accounts for less than 1% of all prostate cancers. Small cell prostate cancers are very different from most types of prostate cancer as they grow at a more rapid rate. With that said, it could potentially spread to other parts of the body as well.

 

Advanced Prostate Cancer

If your prostate cancer level has reached this stage, it means that the cancer cells have already begun spreading to other parts of your body. Typically, individuals with advanced or metastatic prostate cancer will need more targeted and systemic therapies along with a combination of treatments.

Different Stages of Prostate Cancer

After conducting the necessary tests and examinations, doctors will finally be able to determine one’s cancer stage.

• Stage I: Cancer in Stage I is usually slow-growing and in its early stages. Patients may not be able to detect symptoms as the tumour cannot be felt. The cancer cells are well-differentiated, which means they look like healthy cells.
• Stage II: At this point, the cancer is growing slowly and can only be found in the prostate. The tumour may be small, but there is still a risk of growing and spreading outside of the prostate gland.
• Stage III: The tumour is growing rapidly and is likely to grow, spread, and develop into advanced prostate cancer.
• Stage IV: Once it reaches Stage IV, the cancer cells have spread beyond the prostate and into other parts of the body.
  
  

Staging System

There are two types of staging in prostate cancer: clinical staging and pathologic staging.

• Clinical staging is based on the urologist’s physical examination of the patient’s prostate and other tests that will help determine the extent of your disease. Some of the other assessments include a prostate biopsy and several imaging tests. These test results will also help determine whether further examination and tests are needed.

On the other hand, pathologic staging is based on information found during surgery. This is known to be more accurate than clinical staging. More often than not, the surgery would include the removal of the entire prostate and certain lymph nodes.

Warning Signs

Prostate cancer does share some symptoms with other medical issues, such as those that cause the prostate to become enlarged. The similarities of symptoms between prostate cancer and these conditions can be rather confusing at first, but we will provide additional information to help you be informed.

Because of how benign the tumour starts out, it will take time before it grows to a size that causes pain when it pushes against whatever is in its way.

Early detection is thus the key factor in determining if it is indeed prostate cancer. However, if you do experience any of the following warning signs, be sure to take notes of how you feel and how it may have changed before you see a doctor for a diagnosis.

Frequent Urination

The prostate gland will slowly grow in size as a person ages. The gland itself is located just at the base of the bladder, surrounding the first part of the tube that carries urine from the bladder to the penis. This tube is called the urethra, which also carries semen, the fluid containing sperm.

When the cancerous tumour in the prostate gland grows in size, it may begin to press on the urethra or even the bladder. You may find yourself having to urinate more often than usual, especially at night. Urinary incontinence could be a major inconvenience to your daily activities, and it could even affect your emotional state, such as how others will perceive your constant need to use the washroom.

Difficult Urination/Ejaculation

Because of how the tumour can grow as the cancer advances, the tumour may eventually begin to compress the urethra. This may first present itself as a slow, interrupted flow of urine or semen (during sexual activity). Over time, it could eventually lead to the retention of urine or semen in the urethra, which can cause long term issues if left untreated.

In some instances, this difficulty can potentially lead to the sudden onset of erectile dysfunction, even if you have had no prior complications.

Pain During Urination/Ejaculation

In the event of difficulties in urinating or ejaculating, there is the inherent danger of the tumour growing to such an extent that it blocks off the urethra almost entirely, which can lead to retention, blockage or other urinary problems.

You may thus experience pain when urinating or ejaculating. Depending on the severity of your condition, you may experience mild to significant pain every time you urinate/ejaculate. The pain may either subside quickly once you are done, or may persist some time after.

As this is a possible sign of advanced prostate cancer, you should seek immediate medical attention if this symptom occurs.

Blood in Urine/Semen

Blood in the urine (hematuria) or semen (hematospermia), also known as, is viewed as a sign of underlying medical complications, one of which includes advanced prostate cancer.

Hematuria usually occurs when there may be complications in the urinary system, including your kidneys since the kidneys produce urine. You may find your urine is a pink, red, brownish-red, or tea-like colour; this is known as gross hematuria. In other cases, you may not see any blood in your urine, but your lab results may show that it is present; this is called microscopic hematuria.

Meanwhile, hematospermia could be caused by something affecting the tubes that distribute semen from the testicles, called the seminal vesicles, or the prostate gland; one such cause could be inflammation of either organ.

Frequent Lower Back/Pelvic Pain

Advanced prostate cancer can spread to other parts of your body, including your bones. This usually affects the bones and lymph nodes. Cancer cells may break away from the tumour and spread to other parts of the body via blood or lymph vessels, attaching themselves to whatever tissue they can find. However, some cancer cells may become inactive and will lie dormant for years, or even cause a recurrence of cancer.

If you begin to exhibit back or pelvic pains without warning, it may be a possibility of advanced prostate cancer. Other risks may also include low-impact fractures not caused by physical trauma, or even very minor trauma like an accidental bump into a hard surface.

Prostate Cancer Treatment

Choosing the most suitable treatment option is based solely on the patient’s profile and the cancer stage.

When considering the patient’s profile, urologists will consider their age, life expectancy, pre-existing medical conditions, and the presence of any potential illnesses. When analysing the cancer profile, they would review the extent of cancer on MRI and bone scan, Gleason score, PSA Level, and DRE finding. The goal of treatment – whether an individual is looking to improve quality of life or cure cancer – is important as well in deciding between palliative care, curative treatment, or a combination of both.

From there, doctors will be able to suggest the most appropriate and suitable treatment option for the patient.

When deciding on the type of treatment, it is also crucial to note the various side effects during and after the treatment that can affect the patient.

Here are some of the treatment options that a doctor may recommend to a person with prostate cancer:

1. Active Surveillance

Also known as watchful waiting, active surveillance is usually recommended when the cancer is in its early stages and is non-aggressive. This means that treatment is essentially delayed, but the patient will still be closely monitored through various check-ups and examinations like additional biopsies, ultrasounds, and other imaging tests.

2. Surgery

For those in good health, surgery may be offered as a treatment for prostate cancer. One surgical procedure that is done specifically for prostate cancer is called radical prostatectomy, which involves the removal of the prostate from the body in its entirety. Apart from the prostate, the seminal vesicles and tissue surrounding the area is also removed. Removing the entire prostate gland allows pathologists to fully examine cancer and risk of recurrence, and if additional treatment is needed.

Another surgical procedure known as the Da Vinci robot-assisted laparoscopic radical prostatectomy may also be recommended. This method is also a radical prostatectomy, but it uses advanced da Vinci technology to remove the prostate gland. Through the use of a high-definition camera that gives a magnified view inside your body, the technology will move the instruments with precision in accordance to the surgeon’s real-time hand movements.

3. Radiation Therapy

Methods that include radiation such as External Beam Radiation Therapy uses high-power x-rays to kill the cancer cells in the body. In this procedure, a machine is used to direct high doses of radiation to the prostate to destroy cancer cells and shrink tumours. In some occasions, patients may require pre-treatment implant of markers in the prostate to improve the accuracy of the treatment.

Alternatively, Internal Radiation Therapy, or Brachytherapy, delivers high doses of radiation through small radioactive seeds instead of external beams. These seeds are implanted internally and directly into the prostate. Unlike external radiation therapy, this form of radiation requires anaesthesia and involves mapping of the prostate gland to determine the number of radioactive seeds needed.

If you are a suitable candidate for radiation therapy, the doctor will recommend either external or internal radiation therapy according to your health and cancer profile.

 

4. Hormone Therapy

Also known as androgen suppression therapy, hormone therapy uses drugs to stop the body from producing testosterone, which can stimulate the growth of cancer cells. This form of therapy may be used:

• If the spread of cancer cannot be cured by surgery or radiation;
• If cancer comes back or remains even after treatment with surgery or radiation therapy;
• Before radiation in an attempt to shrink the cancerous tumour in order to increase the effectiveness of the treatment;
• Alongside radiation therapy as the initial treatment, to complement the patient’s treatment if needed.
  
  

5. Chemotherapy

While chemotherapy is not commonly used for prostate cancer, it can improve symptoms of prostate cancer in patients if they are not responsive to hormone therapy. This technique involves the administration of drugs internally to stop the growth of cancer cells, either by killing the cells or preventing them from dividing. If you are still in the early stages of prostate cancer and the cancer profile is not aggressive, chemotherapy may not be the best option for you as this procedure is typically given to patients with advanced cancer.

 

Prostate Cancer Prevention

Unfortunately, there is no definite way or solution to prevent prostate cancer or eliminate the risks entirely. While there are things you can’t change about yourself like your race, genetics, or age, there are various things that you can practise to lower the risk of prostate cancer.

• Maintain A Healthy Weight

In a study conducted by the American Cancer Society, having obesity actually increases the risk of future prostate cancer in men, especially with aggressive tumours. Furthermore, it was also revealed in the same study that obesity is a significant risk factor for prostate cancer death as well. To prevent or combat obesity, one should exercise regularly and adopt healthy eating habits.

• Improve Your Diet

While the correlation between prostate cancer prevention and one’s diet have yet to be concluded, it is necessary to complete your exercise with healthy foods in order to maintain a healthy weight.

• Eat more fruits and vegetables

Fruits and vegetables are rich in vitamins and nutrients, which can help to maintain a healthy gut and prevent digestive problems. Consuming fruits and vegetables regularly can also reduce the risk of cancer and other diseases.

• Opt for a low-fat diet

While it is not necessary to eliminate fat from your diet completely, it is best to take it in moderation. Foods that are high in fats include meats, nuts, oils and dairy products. Reducing the amount of fat you eat will help you control your weight and improve your overall heart health.

• Increase Your Vitamin D Intake

While it has been proven that increasing your vitamin D intake will certainly reduce your risk of prostate cancer, there have been studies that found that men with very low levels of vitamin D (8% of men) had an approximately two-fold increased risk of being diagnosed with more aggressive prostate cancers. To effectively increase your vitamin D levels, consider spending time in the sunlight, consuming fatty fish and seafood, and taking supplements to ensure adequate intake.

• Avoid Smoking

While there haven’t been studies proving how smoking may cause prostate cancer, smoking does weaken natural cancer-fighting abilities in our body. On top of that, research conducted by the Brady Urological Institute in 2016 revealed that aggressive prostate cancer is more likely to develop among people who smoke regularly than those who don’t. If you already suffered from prostate cancer in the past and continued smoking afterwards, there is high risk that the cancer may return.

As the saying goes, prevention is better than cure. If you think that you have a high risk of prostate cancer based on your symptoms, family history, and lifestyle habits, do consult a doctor about your risk. From there, you will be given various suggestions based on your needs such as looking into outpatient or inpatient treatment, or even home care programmes for those may have difficulty travelling from one place to another.

Prostate Cancer Care At Home

Some may think that home care services are limited to assisting with regular activities of daily living such as washing, toileting, feeding, and dressing. But what they don’t know is that your loved one can still receive specialised support for cancer even if they’re at home. With Homage, individuals can receive care from licensed and trained caregivers, nurses, doctors and therapists to guide them along every step of their cancer journey. Depending on the type and stage of cancer, seniors will receive a specialised care plan specifically designed for their needs.

Are you looking for someone to care for you and your loved ones?

Homage provides caregiving services for your loved ones at every stage. Our trained care professionals are able to provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved ones active and engaged. Provide the best care to your loved one today!  Fill up the form below for a free consultation with our Care Advisory team.

Homage is a personal healthcare solution that connects caregivers, nurses and therapists with seniors that need on-demand holistic home care in their own homes, allowing them to recover and age with grace, control and dignity. You can find Homage Malaysia on Facebook at @homagecaremy and on Instagram at @homagecare_my

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