Prostate Cancer Causes and Risk Factors

Prostate cancer, a typically slow-developing malignancy, originates in the prostate gland. This cancer starts when mutations in the DNA of prostate cells trigger uncontrolled growth and division. 

While the precise causes are still unclear, it’s believed that this cancer arises from multiple factors.

Key risk factors for this disease encompass age, ethnicity, and geographic location. Additionally, there is ongoing research into possible links with environmental factors like exposure to pesticides and herbicides, dietary habits, lack of vitamin D, and even sexual activity. 

Moreover, having a family history of prostate cancer and certain genetic variations are known to be linked with earlier onset of the disease.

Types of Prostate Cancer

The majority of prostates cancers are classified as adenocarcinomas. This type of cancer arises from the gland cells in the prostate, which are responsible for producing the fluid in semen.

Other, less common types of prostates cancer include:

• Small cell carcinoma, also known as small cell neuroendocrine carcinoma.
• Other neuroendocrine tumors, such as large cell carcinoma.
• Transitional cell carcinoma.
• Sarcomas.

These less common types are rare, so if diagnosed with prostate cancer, it is highly likely to be adenocarcinoma.

The growth and spread rates of prostate cancer vary; while some can progress rapidly, most grow slowly. 

For further details, you can refer to information about prostate cancer grades in the section on Tests to Diagnose and Stage Prostate Cancer.

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Symptoms of Prostate Cancer

Prostate cancer typically does not exhibit symptoms until the prostate has enlarged sufficiently to impact the urethra, the tube that transports urine from the bladder out through the penis.

When this occurs, symptoms can include:

• A heightened frequency of urination.
• Difficulty or strain during urination.
• A sensation that the bladder hasn’t completely emptied.

Although these symptoms warrant attention, they don’t necessarily indicate prostate cancer. They are more commonly associated with other conditions, such as prostate enlargement.

Causes

Medical professionals understand that prostate cancer starts when prostate cells undergo DNA alterations. 

DNA in a cell provides the guidelines for its functions. These alterations cause the cells to proliferate and divide faster than usual. Unlike normal cells that perish, these abnormal cells persist.

These accumulating abnormal cells then create a tumor, which has the potential to extend into adjacent tissues. 

Eventually, certain abnormal cells may detach and disseminate (metastasize) to different body areas.

Common Risk Factors for Prostate Cancer

Several factors can heighten the likelihood of developing prostate cancer:

• Age: The risk escalates with age, particularly after 50.
• Race: African individuals face a higher risk of prostate cancer for reasons that are still being studied. In African populations, the cancer tends to be more aggressive or advanced.
• Family History: Your risk increases if a close blood relative (parent, sibling, or child) has been diagnosed with prostate cancer. Additionally, a family history of breast cancer risk genes (BRCA1 or BRCA2), or a strong family history of breast cancer, also elevates the risk of prostate cancer.
• Obesity: Obese individuals may face a higher risk of prostate cancer. Studies on this are varied, but in obese individuals, the cancer is often more aggressive and more likely to recur after the initial treatment.

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Other Possible Risk Factors

Vitamin D Deficiency and Sun Exposure:

Vitamin D, which acts similarly to a hormone in the body, is produced in the skin when exposed to the sun’s ultraviolet light. 

It has been observed for a while that males living in northern regions are at a higher risk of developing certain diseases compared to those in southern latitudes, and this increased risk is thought to be linked to a deficiency in vitamin D by some.

Recent studies have indicated that higher levels of vitamin D in the blood may lower the risk of aggressive prostate cancer. 

Fortunately, vitamin D levels can be easily checked through a blood test, and males can discuss with their healthcare providers about taking supplements if necessary.

Sexual Activity:

There was a previous belief that males who had a higher frequency of sexual activity (more ejaculations per month) were at a greater risk of prostate cancer.

This was thought to be due to a higher likelihood of contracting a sexually transmitted disease causing inflammation in the prostate, potentially leading to cancer, or due to elevated testosterone levels, which can fuel the growth of prostate cancers.

This concept is somewhat analogous to colon cancer, where less frequent bowel movements are linked to a higher risk, possibly because toxins in the stool remain in contact with the bowel’s mucosa for an extended time. A similar mechanism was hypothesized for prostate cancer, where fewer ejaculations might allow carcinogens to stay in contact with prostate tissues for longer durations.

Prostatitis:

Chronic prostatitis, often resulting from sexually transmitted infections, has been associated with an increased risk of prostate cancer in some studies. 

However, other research presents conflicting evidence, and the current consensus on this association remains inconclusive.

Complications

Prostate cancer and its treatments can lead to various complications, such as:

Metastasis: 

Prostate cancer has the potential to spread to neighboring organs like the bladder or travel via the bloodstream or lymphatic system to bones or other organs. 

When it spreads to the bones, it can cause pain and fractures. Even though prostate cancer that has metastasized to other body parts may still respond to treatments and be manageable, curing it at this stage is unlikely.

Urinary Incontinence: 

Urinary incontinence can be a consequence of either prostate cancer itself or its treatment methods. 

The treatment for incontinence is based on its type, severity, and the potential for improvement over time. Options include medications, the use of catheters, and surgical procedures.

Erectile Dysfunction: 

Prostate cancer or its treatments, such as surgery, radiation, or hormone therapies, can lead to erectile dysfunction. 

There are treatments available for this condition, including medications, vacuum devices to help achieve erection, and surgical interventions.

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Prostate Cancer Diagnosis Process

If prostate cancer is suspected, various tests may be conducted, including:

PSA Blood Test

This test measures prostate-specific antigen (PSA) levels produced by both healthy and cancerous prostate cells. 

PSA levels can vary, so multiple tests over time might be used to assess prostate cancer risk. It’s important to note that some men with prostate cancer may have normal PSA levels, and elevated PSA levels don’t always indicate cancer. 

Therefore, the PSA test is typically used in conjunction with other tests for a more accurate diagnosis.

Digital Rectal Examination (DRE)

DRE is not routinely recommended for asymptomatic men, but it may still be used prior to a biopsy, especially since not all prostate cancers result in high PSA levels.

Prostate Biopsy

A biopsy involves removing small tissue samples from various areas of the prostate using a rectal ultrasound. 

These samples are then examined microscopically to detect cancer and assess its aggressiveness. 

The Gleason score, ranging from 1-5, is derived from two samples, with a combined score up to 10; scores of 6 or lower suggest slow-growing cancer.

Additional Testing

If prostate cancer is confirmed, further tests like MRI, CT, or bone scans might be conducted to determine if the cancer is confined to the prostate or to assist in planning management and treatment.

Post-Diagnosis

Being diagnosed with prostate cancer can evoke feelings of shock, upset, anxiety, or confusion, which are normal reactions.

It’s crucial to discuss treatment options with your doctor, family, and friends, and seek all necessary information. The level of involvement in treatment decision-making is a personal choice.

Prostate Cancer Treatment Overview

The treatment for prostate cancer varies based on the cancer’s stage.

Prosatet Cancer Staging

Prostate cancer staging employs the TNM system, categorizing the cancer from stage 1 to stage 4. Most patients (90%) have localized disease at diagnosis. Bone and CT scans are utilized to check for metastasis.

Active Surveillance

This approach is for asymptomatic, low-risk prostate cancer, characterized by small, slow-growing tumors unlikely to spread. It typically involves PSA tests every 3-6 months, rectal exams every 6 months, and MRI scans and biopsies at 1 and 3 years.

Watchful Waiting

This method, involving regular PSA tests and check-ups, is more suited for older men whose cancer is unlikely to cause significant issues during their lifetime.

Surgical Treatment

Radical prostatectomy, the complete removal of the prostate, is performed with curative intent. Main side effects can include impotence and incontinence.

Radiation Therapy

Radiation therapy is offered to men with early-stage prostate cancer and to those for whom surgery isn’t viable.

It can be administered via external beam radiation therapy (EBRT) or brachytherapy (implanting radioactive seeds). Side effects are similar to those of surgery, but may also include bowel issues.

Androgen Deprivation Therapy (Hormone Therapy)

Used to reduce testosterone production, essential for prostate cancer growth, this therapy can be administered through injections or tablets.

It’s commonly used alongside radiation therapy, sometimes with chemotherapy. Surgical removal of the testicles is a less common option.

Palliative Care

For advanced prostate cancer, palliative care focuses on enhancing quality of life by alleviating symptoms.

It can slow cancer spread and manage pain and other symptoms, using treatments like radiation, chemotherapy, or other drugs.

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Prevention

Preventing prostate cancer is not guaranteed, as study results are often conflicting and most studies aren’t structured to definitively establish preventive measures. 

Consequently, no definitive methods for preventing prostate cancer have been established.

However, for men with an average risk of prostate cancer who are interested in prevention, doctors generally recommend adopting lifestyle choices that enhance overall health.

Choosing a Healthy Diet may prevent prostate cancer:

Evidence suggests that a diet low in fat and rich in fruits and vegetables may lower the risk of prostate cancer, although this is not conclusively proven and research results vary.

To potentially reduce prostate cancer risk:

Opt for a Low-Fat Diet:

Foods high in fats, like meats, nuts, oils, and dairy products such as milk and cheese, should be consumed in moderation.

Some studies indicate that high fat consumption correlates with an increased risk of prostate cancer, although this relationship is not conclusively proven.

Nonetheless, reducing fat intake offers other benefits, like weight control and heart health. This can be achieved by choosing leaner meats, low-fat dairy products, and cooking with less fat.

Increase Fruits and Vegetables:

Fruits and vegetables contain vitamins and nutrients that may reduce prostate cancer risk. Eating more fruits and vegetables also naturally reduces the intake of high-fat foods.

Adding an extra serving of fruits or vegetables to each meal and using them as snacks can be beneficial.

Limit Dairy Products:

Some studies suggest that high consumption of dairy products might be linked to a higher risk of prostate cancer, though results are mixed and the associated risk is considered small.

Maintaining a Healthy Weight:

Obesity, defined as a body mass index (BMI) of 30 or higher, may increase the risk of prostate cancer. To address this:

• If overweight or obese, focus on weight loss by reducing caloric intake and increasing physical activity.
• If at a healthy weight, maintain it through regular exercise and a diet rich in fruits, vegetables, and whole grains.

Regular Exercise

Most studies show that regular exercise may reduce the risk of prostate cancer. Exercise offers numerous other health benefits, including reducing the risk of heart disease and other cancers, and aiding in weight maintenance or loss. 

It’s advisable to start slowly and incorporate more physical activity into daily routines, aiming for at least 30 minutes of exercise on most days.

Consulting with a Doctor

Men who are at a heightened risk for prostate cancer are encouraged to engage in detailed discussions about their risk factors and explore potential preventive measures, including medication options, with their healthcare provider.

As a dedicated urology clinic, we are committed to offering expert guidance in this regard. We provide a complimentary consultation service, allowing individuals to connect with our medical advisors for personalized advice.

We are pleased to accommodate inquiries through various channels, including instant messaging apps for text and calls, scheduled video calls, or via email.

Our aim is to ensure that you receive comprehensive and accessible information to make informed decisions about your prostate health.

Takeaway