Question 1: What is the prostate gland?
A: The prostate is one of the male gonadal organs that secretes prostatic fluid (a viscous liquid) that forms part of the semen. The normal prostate is about the size of a chestnut (20cc) and is located below the bladder and in front of the rectum, with the urethra passing through it.
Question 2: What is prostate cancer?
A: Prostate cancer is caused by cancer of the glandular cells in the prostate gland. In Europe and the United States, prostate cancer is one of the most common malignant tumors in men, and its incidence is increasing year by year in China as the standard of living improves. The exact cause of prostate cancer is still not well understood, and is most likely related to elevated androgen (testosterone) levels, as well as familial inheritance, high-fat diet and ethnicity. Young men are less likely to develop prostate cancer, and as they age, the risk of prostate cancer increases.
Most prostate cancers are adenocarcinomas, and other types of cancers have a small chance of occurring. In the last 20 years, the incidence of prostate cancer has gradually increased. This is mainly related to the improvement of prostate cancer detection methods, especially the widespread use of serum PSA testing in clinical practice, which is easy and fast and has greatly facilitated the early diagnosis of prostate cancer.
Early prostate cancer is confined to the prostate gland, but if it continues to develop, it can metastasize to the nearby lymph nodes and even invade the surrounding organs, such as the bladder and rectum; in severe cases, distant metastasis can occur, the most common site being the bones, and others such as the liver and lungs.
Question 3: What are the main symptoms of prostate cancer?
A: There are usually no obvious symptoms in early stage of prostate cancer, which can be screened by doctor’s rectal exam and serum PSA. Patients with high suspicion of prostate cancer can be diagnosed clearly by prostate puncture biopsy.
If early prostate cancer continues to develop, it will enter the progressive stage, when the patient may experience weakness in urination, difficulty in urination, and a sense of incomplete urination, and when it continues to develop to advanced prostate cancer, it may have symptoms such as blood in urine, weight loss, and even bone pain. However, these symptoms are not unique to prostate cancer, but are actually similar to some other diseases of the prostate and bladder, such as benign prostatic hyperplasia, cystitis, bladder tumors, etc., which require further consultation by the patient at the hospital to clarify.
Question 4: How is prostate cancer diagnosed?
A: For the first visit, patients need to have PSA test, prostate finger examination and ultrasound of the prostate gland. If prostate cancer is suspected, the definitive diagnosis is to have a prostate puncture biopsy, which is performed under the guidance of ultrasound and operated by a professional doctor, and the removed specimen is sent to the pathology department for diagnosis, thus detecting prostate cancer. A few patients are diagnosed with prostate cancer in the specimens from transurethral electrolysis of the prostate for the treatment of benign prostatic hyperplasia.
Once prostate cancer is diagnosed, the patient will need further imaging to clarify the extent of the lesion. A nuclear bone scan is sensitive for detecting bone metastases from prostate cancer; pelvic CT and magnetic resonance imaging (MRI) are used to detect the extent of localized prostate cancer lesions and the presence of lymph node metastases. These tests are helpful in staging prostate cancer.
Question 5: How can I tell if I am at risk for prostate cancer?
A: Although the exact cause of prostate cancer is still unclear, clinical studies have identified a variety of factors that may contribute to the development of prostate cancer, broken down as follows
Age: Prostate cancer is rare in men under the age of 50, and the incidence of prostate cancer is significantly higher in men over the age of 50, with more than 80% of prostate cancer patients being over the age of 65. Therefore, it is recommended that men over the age of 50 should have their serum PSA checked at least annually at a hospital, and if possible, have a specialist do a rectal exam.
Family history: Prostate cancer has a high genetic predisposition. Studies have found that if there are patients with prostate cancer in your immediate family (father and brother), your risk of developing the disease is 2-7 times higher than the general population, and this risk is even higher if there are multiple patients in your family.
Benign prostatic hyperplasia: Prostatic hyperplasia (BPH) is a common benign condition in older men. Although many studies have confirmed that there is no significant relationship between BPH and the development of prostate cancer, doctors still recommend that patients with BPH should have their serum PSA and rectal examinations routinely checked for early detection of prostate cancer.
Diet: Numerous studies have confirmed that a high-fat diet is likely to be a risk factor for prostate cancer. Whether excessive consumption of fatty foods or too little consumption of fruits and vegetables will cause prostate cancer is still inconclusive. Recent studies have found that lycopene (which is abundant in fruits and vegetables) and vitamin E can reduce the incidence of prostate cancer.
Race: Prostate cancer is highly prevalent among men in Europe and the United States, with a particularly high incidence among black Americans. The incidence of prostate cancer in Asian men, including China, is relatively low, but in recent years, the incidence rate in China is also gradually increasing.
Question 6: How is prostate cancer treated?
A: The treatment of prostate cancer is determined by the stage of the tumor.
The standard treatment for early stage prostate cancer includes surgery (radical prostatectomy) and radiotherapy; elderly patients or patients with early stage prostate cancer in poor physical condition can choose close observation or endocrine therapy.
There is no curative treatment for patients with progressive and advanced stages; treatment is mainly to control disease progression and relieve symptoms. Endocrine therapy (anti-androgen therapy) is currently the most common treatment, including orchiectomy and or the use of anti-androgen drugs.
Question 7: What is radical prostate cancer surgery?
A: Radical prostatectomy is one of the commonly used methods to treat early stage prostate cancer and is especially suitable for early stage patients who are in good health and less than 70 years old. The scope of surgery is to radically remove the prostate gland and some of its surrounding tissues. The laparoscopic surgery is a minimally invasive surgical procedure that has been widely carried out in the clinic in recent years. The patient’s trauma is less than that of open surgery, and the postoperative recovery is significantly faster, so it is highly recommended by both the specialist and the patient. Of course, there are currently clinical treatments for each stage of prostate cancer, including external radiation therapy, internal radiation therapy (also known as brachytherapy), endocrine therapy and chemotherapy, and patients can visit a specialist clinic to make individualized choices based on their own conditions.