Prostate Cancer - Types, Diagnosis and, Staging

Where Is the Prostate Gland Located?

The prostate gland is situated in front of the rectum and behind the base of the penis. The size of this gland is comparable to a walnut. The tube-like urethra, which carries urine and sperm through the penis, is encircled by the prostate gland. The primary job of the prostate is to produce the liquid in semen (seminal fluid) that nourishes, shields, and aids in the movement of sperm. As age increases, the prostate continues to grow larger. When the urethra gets clogged, a condition known as benign prostatic hypertrophy (BPH) might result from this. BPH is a typical disease brought on by aging. However, there is no evidence that it increases prostate cancer risk.

What Is Prostate Cancer?

• Sometimes, a change in the prostate's normal cells results in their uncontrolled proliferation (high-speed growth) and development into a tumor or cancer that may be benign or malignant.

• Malignancy refers to the ability of a cancerous tumor to develop and spread to other parts and regions. If a tumor is benign, it will grow in size but will not spread to other areas of the body.

• Prostate cancers develop very slowly and do not readily spread to other body areas. Some forms of prostate cancer may remain for years or even decades without showing any signs or issues. It is frequently treatable, even when it has spread to other body areas.

• Prostate cancer is the most frequent cancer occurring among males after skin cancer. Men aged 65 years and older are diagnosed with prostate cancer. Monitoring growth over time to determine whether it is expanding slowly or rapidly is crucial for controlling it.

• Therefore, even those with advanced disease may have a long lifespan of good health and quality of life.

• However, cancer can result in symptoms like pain and exhaustion and occasionally cause mortality if it is not appropriately treated with current therapies. The doctor can choose the most effective treatments and when to provide them based on the growth pattern.

Under a microscope, histology shows how cancer cells appear. For example, the various types of cancers of the prostate gland are as follows:

1. Adenocarcinoma - The most typical prostate cancer histology.

2. Small Cell Prostate Cancer - Less prevalent histologically.

3. Neuroendocrine Type - Less frequently found tumor.

These variations typically expand outside the prostate early, are more aggressive, and generate significantly less prostate-specific antigen (PSA).

What Is the Role of Prostate-Specific Antigen (PSA)?

The cells in the prostate gland produce a protein called prostate-specific antigen (PSA) and are released into the bloodstream. Blood tests are used to determine PSA levels. Men with prostate cancer tend to have higher-than-average PSA levels.

A high PSA level can also result from benign prostate enlargement or prostatitis. The inflamed or infected prostate is known as prostatitis. In addition, actions such as ejaculating might momentarily raise PSA levels. Thus, ejaculations should be avoided before a PSA test to prevent false results. Because of revised screening recommendations and reduced PSA testing, prostate cancer incidence rates fell in the late 2000s and early 2010s. Before utilizing PSA testing to screen for prostate cancer patients, one should consider the advantages and disadvantages of the procedure with the doctor.

How Is Prostate Cancer Diagnosed?

1. Digital Rectal Examination (DRE) -

DRE is the first screening test used in conjunction with PSA testing. A digital rectal exam (DRE) is a test that checks a person's lower rectum, pelvis, and lower abdomen to discover abnormal areas of the prostate by probing the room with a finger. It offers the advantage of identifying cancers that do not secrete PSA. The positive predictive value of DRE has been approximately 50 % in research conducted since the initial assessment of its accuracy in 1956.

However, even in the hands of skilled examiners, it misses a significant portion of cancer cases and, when compared to PSA, it finds malignancies earlier in the pathological process. In fact, in the pre-PSA era, 75 % of men with prostate cancer who had a DRE diagnosis subsequently passed away from their condition.

2. Prostate Specific Antigen (PSA) Test -

The initial description of PSA, a serine protease, was made in 1979. It is an organ-specific biomarker that is not cancer-specific and has shown promise as a diagnostic aid for benign epithelial tumors. The researchers determined the initial reference range between 4 and 10 ng/mL. In addition, age-specific cutoff thresholds are created to strengthen the test's specificity because benign epithelium production rises with advancing years.

While age-specific levels make PSA easy for spotting cancer in younger people, they lessen the test's sensitivity in older men, especially for early-stage and treatable cancers.

The value of PSA density (PSAD = PSA [ng mL-1] divided by prostate volume [mL]) has been studied to increase test specificity. Compared to total blood PSA, a PSAD of > 0.15 enhances the specificity of prostate cancer diagnosis, while the ideal cutoff remains debatable.

3. Biomarker Testing -

A biomarker is a chemical that may be found in a cancer patient's blood, urine, or tissues in the body. The body produces it in reaction to cancer or as a result of the tumor. A tumor marker is another name for a biomarker. The prostate health index (PHI), a biomarker test for prostate cancer, and the 4K score, which determines a person's likelihood of having high-risk prostate cancer, are examples of such tests.

A genetic test, such as Oncotype Dx prostate, polaris, decipher, or promark, might occasionally give extra information for men who have received a prostate cancer diagnosis through biopsy to help with management decisions. It can also help low-risk or intermediate-risk localized prostate cancer patients considering active surveillance.

Additionally, it can entail performing the decipher test to determine whether additional therapy should be taken into account in some individuals after prostate surgery or prostatectomy. Finally, the professional should continuously assess the outcomes with all other relevant data. For additional information about biomarker testing, what they signify, and how the results may or may not influence the treatment plan, it is suggested to consult the doctor.

What Are the Grades and Stages of Prostate Cancer?

The staging of cancer is a method of defining the location of cancer, its spread, and its impact on other body parts. Cancer staging may not be established until all diagnostic tests are described. However, knowledge of these stages aids the doctor in recommending the best course of action and assists in determining the prognosis, or likelihood of recovery, for a patient.

For prostate cancer, there are two staging methods:

1. Clinical Staging - Based on the digital rectal exam (DRE) and prostate-specific antigen (PSA)tests. These tests will help to determine if additional tests like X-rays, bone scans, CT (computed tomography) scans, or MRIs (magnetic resonance imaging) are required to provide further information on the clinical stage.

2. Pathologic Staging - This is based on information obtained by pathology reports of the prostate tissue removed during surgery. For pathologic staging, examination of the excised lymph nodes for the pathologic stage may also yield further information.

TNM Staging System:

The American Joint Committee (AJC) on cancer devised this approach to specify the stage of the tumor.

• A Tumor (T): What is the size of the primary tumor? In which location is it present?

• Node (N): Have the lymph nodes been affected by the tumor? In such a case, how many and where?

• Metastasis (M): Has cancer metastasized (M) to other body organs? If so, how much and where?

The combined findings are used to establish the cancer stage. Stage 0 (zero) and stages I through IV comprise the five steps. For clinicians to collaborate and develop the most effective treatment plans, the stage offers a traditional manner of classifying cancer.

Stage I:

• Cancer tends to develop slowly at this stage.

• The prostate is affected on one side, or even less, and the tumor cannot be felt.

• The PSA level is low. The cancer cells mimic normal appearance.

Stage II:

• Only the prostate is affected by the tumor.

• PSA levels are either low or medium.

• Although stage II prostate cancer is modest, it may be more likely to progress and spread.

Stage IIA:

• The prostate is only partially affected by the tumor, which cannot be noticed.

• The cancer cells are highly differentiated, and PSA levels are moderate.

• As long as the cancer cells are highly differentiated, this giant tumor is identified solely in the prostate.

Stage IIB:

• The tumor is exclusively located inside the prostate and could be large enough to be evaluated during DRE.

• The PSA is at a modest level.

• The differentiation of the cancer cells might be moderate.

Stage IIC:

• The tumor is exclusively located inside the prostate and could be large enough to be evaluated during DRE.

• The PSA is at a modest level.

• The differentiation of the cancer cells might be low or moderate.

Stage III:

• The tumor is expanding; the PSA values are high.

• They all point to a locally advanced malignancy that will continue to develop and spread.

Stage III A:

• Cancer tissue has invaded the prostate's outer layer.

• The seminal vesicles may have also been affected.

• As a result, the PSA level is elevated.

Stage III B:

• The tumor has invaded the prostate gland, which may also have spread to the bladder or rectum.

Stage III C:

• The cancer cells have little to no differentiation, meaning they do not resemble healthy cells.

Stage IV:

• Cancer has spread outside of the prostate gland.

Stage IVA:

• Cancer has reached the local lymph nodes.

Stage IV B:

• Cancer has progressed to the bones, distant lymph nodes, or other organs.

What Is the Rate of Recurrence of Prostate Cancer?

Cancer that has returned after therapy is referred to as recurrent prostate cancer. It could recur in the prostate region or elsewhere in the body. If cancer does come back, more tests will be performed by the doctor to determine the amount of the recurrence. These examinations and scans frequently resemble those carried out during the first diagnosis.

Conclusion

The current focus of diagnostic efforts must be on detecting early-stage malignancies that offer a significant danger to life expectancy and quality of life. Improved clinical staging methodologies are required for more precise prediction of disease stages and, more importantly, for distinguishing responses to various treatment modalities. In addition, medical advancements must concentrate on areas that will most effectively lower the high mortality and morbidity currently connected with this illness since prostate cancer continues to be a severe health burden.