Prostate Cancer: Symptoms, Diagnosis, Treatment and Beyond

1 in 9 men will be diagnosed with this sometime in their lifetime and is the second leading cause of cancer death in American men. Those statistics are reflective of men specifically, however, prostate cancer affects men, intersex, and some transgender individuals. Anyone with a prostate can be affected by prostate cancer.

The prostate is a squishy, walnut-sized gland. It is located deep inside the groin, near the perineum, and next to the bladder and pelvic floor muscles. It has two very important tubes. The first is for reproduction and supplies seminal fluid. Seminal fluid mixes with sperm and helps it to travel from the testes. The second tube is the urethra and is necessary to eliminate urine.

Most commonly, prostate cancer is an adenocarcinoma. However, there are actually several types of prostate cancer. These other types of prostate cancer are rare but can occur. They include small cell carcinomas, neuroendocrine tumors, transitional cell carcinomas, and sarcomas.

Like other pelvic floor related cancers, prostate cancer often shows no signs or symptoms in the early stages. Later stage signs and symptoms that can occur include:

• Trouble getting, or maintaining an erection (erectile dysfunction or ED)
• Bone pain
• blood in the urine or semen
• Decreased force in the stream of urine
• Urinary difficulty (urinary frequency, and/or increased voiding at night/nocturia)
• Loss of bladder or bowel control
• Pain or discomfort in the pelvic area
• Pain during urination or ejaculation
• Pain in hips, back, chest, abdomen, or other areas
• Weakness, numbness, or swelling in the legs or feet (edema)

Many of these symptoms can also be explained by other reasons. Seek out the care of your PCP if they come on suddenly, and are not treatable by normal home care means.

According to The American Cancer Society guidelines on early prostate cancer detection, individuals that are symptom-free, and have a 10-year life expectancy should “have the opportunity to make an informed decision with their health care provider on whether to be screened for prostate cancer after receiving information about the uncertainties, risks and potential benefits associated with the screening process.”

However, those at increased risk including African Americans and those with a first-degree relative who has been diagnosed with prostate cancer prior to age 65 should start this conversation at age 40-45. There are several types of screening tests your medical team may discuss with you; a few of the most common are outlined below.

Prostate-Specific Antigen (PSA) Blood Test

A blood sample is taken from your arm and the PSA level in your blood is measured. Unfortunately, there is no set PSA measurement that definitively says one does or does not have prostate cancer. Most often, a level of 4 ng/mL or higher is the cutoff point used to determine whether more testing is needed. However, some providers might recommend taking a closure look at 2.5-5 ng/mL. If the PSA level is more than 10 the chance of having prostate cancer is over 50%.

Digital Rectal Exam (DRE)

The provider will place a gloved, lubricated finger into the rectum. They will palpate (examine by touching) the tissue of the prostate testing for any bumps, hard areas, or tenderness. When examining it they should assess both the right and left sides to see if cancer is present, and if it is unilateral, bilateral, or spread beyond this area.

Digital Vaginal Exam (DVE)

Transgender women who have undergone vaginoplasty may experience a rectal prostate exam as described. They may have a better examination experience via a digital vaginal exam, due to the location of the prostate. For this type, your provider is looking for the same things, however, they are inserting a gloved lubricated finger into the neovaginal canal. They are able to palpate the tissue of the prostate, accessing any bumps, harder areas or tenderness and examine the sides as well.

Prostate Biopsy

The only way to know for sure if someone has prostate cancer is a prostate biopsy. This is typically performed by a urologist. During the biopsy, they often complete a few other tests, including a transrectal ultrasound (TRUS) or an MRI, or both. The doctor then performs a core needle biopsy. The procedure takes about 10 minutes. The tissue samples are then examined under a microscope for any cancerous cells.

On average, prostate cancer is diagnosed around age 66. However, it is usually such slow-growing cancer that often in autopsies people are found to have prostate cancer and never knew. When diagnosing your provider will always want a full medical and family history and will perform an examination.

In order to provide a stage for your cancer, your provider will have to look to see if the cancer cells have spread beyond your prostate. In order to do this, they may recommend one or more of the following:

• Bone scan
• Ultrasound
• CT scan
• MRI
• PET scan
• Prostate-specific membrane antigen (PSMA) studies

There are several factors to consider for prostate cancer when choosing the best course of action. How fast is it growing? How much has it spread? How is your overall health? What are the potential benefits and side effects of prostate cancer treatment options? Below are the most common options available:

1 . Observation/Active Surveillance

For low-risk prostate cancer diagnosis, not causing symptoms, expected to grow slowly, confined to a small area of the prostate, or there is another serious health condition or advanced age which would cause treatment to be more difficult.

2 . Surgery

This is called a radical prostatectomy and includes removing the prostate gland, some of the surrounding tissues as well as some lymph nodes.

3 . Radiation

There are two types of radiation for prostate cancer. One occurs outside of the body and is referred to as external beam radiation. The other is small, slow-release radiation seeds placed within the prostate tissue and is called brachytherapy.

4 . Cryotherapy

This is often an option reserved for those who have not had benefits through radiation therapy. With ultrasound guidance gas is injected into the prostate causing freezing and thawing of the tissues. Cancer cells as well as surrounding healthy tissues are both killed.

5 . Hormone Therapy

Prostate cancer relies on testosterone to grow, there are three options to stop this from occurring. Medications to stop testosterone production. Medications to block the testosterone from reaching cancer cells. Surgery to remove the testicles, which lowers the overall testosterone level in the body, is known as an orchiectomy.

6 . Chemotherapy

This option is often used for those whose cancer has spread to other areas or are not responding to hormone therapy. Chemotherapy can be delivered through pills or with an IV.

7 . Immunotherapy

This is often used for those who have recurrent prostate cancer. Genetically altering your body’s own immune cells to specifically fight prostate cancer. This is expensive and requires multiple treatments.

8 . Targeted Therapy

This uses medications targeted to specific things. Every target therapy is individual and can vary.

Pelvic floor dysfunction is a common side effect of any prostate cancer treatment, yes even active surveillance. Pelvic floor physical therapy can help treat these symptoms:

• Urinary issues (incontinence, frequency, pain)
• Bowel issues (incontinence, frequency, pain)
• Erectile Dysfunction
• Low Libido
• Weight Gain/Weight Loss
• Bone Mass Loss
• Low Back Pain
• Abdominal Pain
• Scar Adhesions

Reaching out to an experienced and knowledgeable provider to help you with the above concerns is so important. A treatment plan can often be as simple as a few visits, or more complex if needed.