Prostate Cancer • A Simple Introduction
04 April 2019
The prostate gland makes the fluid that forms part of semen. This gland sits below the bladder, above the rectum, and around the urethra.
Prostate cancer happens when functioning cells in the prostate gland become malignant and grow out of control.
Differences with Benign Enlargement
Prostate cancer is distinguished from prostate enlargement whereby abnormal cell growth begins at the peripheral zone of the prostate, and keeps growing outwards, invading surrounding tissues.
Meanwhile, benign prostatic enlargement or hyperplasia begins in the inner prostate, where a ring of tissue forms a circle around the urethra. In this scenario, abnormal cells grow inwards and towards the prostate’s core, gradually tightening around the urethra, which interferes with normal urination.
Existing conditions of an enlarged prostate do not increase the likelihood prostate cancer.
While prostate enlargement produces nagging symptoms akin to urinary infections and bladder stones, prostate cancer often occurs silently, producing no symptom for months or years on end.
Prostate enlargement is the fourth most common diagnosis in older men. It affects half of all men over 50, and 9 out of 10 men over 80. These numbers are similar across the world.
Prostate cancer, on the other hand, is much less common in Asian men than their Caucasian and Black counterparts. It is among one of the biggest causes of cancer deaths in American and European men. To compare, the are 594 prostate cancer deaths in Malaysia during year 2018.
Notwithstanding the high survival rate, prostate cancer remains a significant issue as the fourth most common cancer among Malaysians of all ethnicities, and the second most common form of cancer among Indians.
Prostate cancer most often affects men above 50 years old. Most men do not die from it, since the cells usually grow slowly.
In general, men are less likely to ask for medical advice voluntarily, and are more likely to be hospitalised due to delayed action.
Most Malaysian men find out about their cancer following persistent symptoms of urinary problems. Ultrasound examination and PSA test during medical screenings and health checks help detect an enlarged prostate, which may alert the doctor towards recommending a biopsy.
Men with a family history of prostate cancer have an increased risk by 68%, and are encouraged to sign up for prostate screening.
Screening includes the prostate-specific antigen (PSA) test— a simple blood test— and the digital rectal exam (DRE). At DRE, the urologist feels for abnormal areas surrounding the prostate, since the cancer usually begins in the peripheral zone of the gland.
If the urologist suspects cancer, he would then take a small sample of the prostate tissue for biopsy, to be looked at under a microscope, which would decide the outcome of the diagnosis. Occasionally, an MRI scan is also requested to locate the abnormal growth.
Once prostate cancer is diagnosed, the next step is staging to find out how far it has advanced.
As many cases of prostate cancer are slow growing and do not cause any symptoms, elderly patients may cope better without undergoing invasive treatment.
The patient will receive case-specific advice with due consideration to variables such as stage of cancer, age, underlying health problems, and personal preferences.
When the cancer is not life-threatening, doctors may recommend observation for older patients or active monitoring for younger ones instead of traditional cancer treatment. The goal is not to cure the cancer, but to keep it in control.
Patients with aggressive cancer has the choices of chemotherapy, radiotherapy, and hormone therapy.
Prostate cancer becomes more likely as a man grows older, and its numbers may yet soar in the ageing population. Early diagnosis allows for a larger window for treatment and recovery, with minimal compromise to quality of life.