Prostate Cancer Treatment
The Prostate Gland
The prostate gland is part of the male reproductive system and produces an important fluid component of semen. Prostatic fluid helps sperm travel through the female reproductive tract to the egg for fertilization (NCCN 2016b; Schjenken 2015).
The prostate is located just below the bladder and surrounds part of the urethra, the tube that carries urine out of the bladder (NCCN 2016b). Because the prostate sits adjacent to the rectum, it can be felt during a manual procedure called digital rectal exam.
The prostate gland needs testosterone to function properly (NCI 2017c). Testosterone and its metabolite dihydrotestosterone stimulate prostate growth, particularly during puberty (Wilczynski 2015).
Pre-cancerous and Non-cancerous Conditions of the Prostate
As men age, growth of the prostate can cause restriction or partial blockage of the urethra (NCI 2017a). This condition, called benign prostatic hyperplasia (BPH), is common in older men and is not a form of cancer. Prostatitis, or inflammation of the prostate, is another non-cancerous condition that is more common in younger men (Mayo Clinic 2016). Prostatitis is often caused by a bacterial infection, but other factors, including autoimmune processes, may also contribute (Mayo Clinic 2016; Vaidyanathan 2008).
Prostate cells can take on some of the features of cancer cells in a condition called prostatic intraepithelial neoplasia, or PIN, which is diagnosed via prostate biopsy (Voltaggio 2016; Packer 2016). High-grade PIN denotes cells that look abnormal and is considered precancerous. Men with multiple sites of high-grade PIN detected on biopsy are more than twice as likely to develop prostate cancer as men without PIN (Bjurlin 2014; Cicione 2016). Although estimates vary, the risk of prostate cancer after a diagnosis of multiple-site high-grade PIN may be higher than 30% (Cicione 2016).
Because of its precancerous nature, careful monitoring is often recommended in cases of high-grade PIN (Bjurlin 2014; Cicione 2016). Men with PIN may benefit from lifestyle and dietary changes and targeted supplements aimed at preventing cancer from developing (Cheetham 2011).
Most prostate cancers are of a type called adenocarcinomas (NCCN 2016b). Adenocarcinomas develop in the prostate when normal glandular cells become cancerous (Packer 2016). Gene mutations accumulate and promote abnormal prostate cell division, eventually leading to cancer development. As the tumor progresses, it causes alterations in surrounding tissues, making its growth easier (Yu 2017; Levesque 2017).
When a tumor is no longer confined to the prostate gland, it may spread to other nearby structures, such as the seminal vesicles (Small 2015). It can also spread to the urethra, rectum, and bladder (Zardawi 2016; Abbas 2011; Hallemeier 2010). In later stages, prostate cancer is found in the lymph nodes and distant parts of the body such as the bones, lungs, or liver (Rycaj 2017; Macedo 2017). The disease does not progress in the same manner, nor at the same rate, in all men (Pollard 2017; Peisch 2017).