About prostate cancer
Prostate cancer (PCa) is one of the most common cancers in men and develops most frequently in men over fifty. PCa is the second most deadly cancer after lung cancer. However, it is not necessarily lethal. About 20-40% of PCa diagnosed today is " indolent cancer ”, meaning that it is unlikely to progress and lead to complications for the patient. Therefore, many men eventually die of other causes before PCa has an impact on their lives.
Prostate cancer progression and related symptoms
- Tumour confined to the prostate: The prostate tumour usually grows slowly and remains confined to the prostate for many years (Figure A). During this time, the tumour produces few or no symptoms.
- Tumour spreads beyond the prostate: As the cancer advances, it can spread (metastasise) beyond the prostate, first into the surrounding tissues (local spread; Figure B). The flow of urine from the bladder diminishes and urination becomes more difficult. If the flow of urine becomes completely blocked, this results in a painful bladder. Eventually, PCa can spread to other areas of the body (distant spread), such as the lymph nodes (Figure C), bones, lungs, and liver. PCa usually spreads first to the lower spine or the pelvic bones, causing back pain. Symptoms, therefore, are more often associated with advanced prostate cancer.
Prostate cancer staging
The TNM (tumour, nodes, metastases) classification system is used to determine how advanced the PCa is, whether it is organ-confined or has spread outside the prostate. The stage at which the tumour is confined to the prostate is referred to as T1 or T2. When the tumour has spread outside of the prostate, it is referred to as T3 or T4. Men with T3-T4 PCa have a worse prognosis than men with T1-T2 PCa. The treatment options differ depending on the defined stage and expected progression of the cancer. For indolent, slow growing tumours, no treatment, but active follow-up/surveillance (called watchful waiting) can be a good option. When treatment is elected, surgical removal of the prostate (radical prostatectomy), internal or external radiotherapy and/or hormone therapy are the conventional options.