Understanding prostate cancer, from symptoms to treatment | Don’t Miss This

Sierra Marling

The prostate is a part of the reproductive system that includes the penis, prostate, seminal vesicles, and testicles, located just below the bladder and in front of the rectum.

This walnut-sized organ produces fluid that partially makes semen in people who were born with male anatomy.

Who should be tested?

People who were Assigned Male at Birth (AMAB), including men and trans women, should be aware of the signs and risks of prostate cancer, even if the individual underwent gender reassignment surgery.

According to an article from Harvard Medical School, “Because removing the prostate can lead to urinary incontinence and other complications, doctors leave the gland in place when initiating hormonal treatments to induce female sex characteristics in transitioning people.”

Other sources confirm that the prostate isn’t removed during gender-affirming surgery because taking it out could damage your nerves and other organs.

So, for all AMAB people, CDC data shows that the most common risk factor for prostate cancer is age. Generally, the older a person is, the greater the chance of getting prostate cancer.

What are the symptoms?

According to the CDC, “Different people have different symptoms for prostate cancer. Most men do not have symptoms at all.”

Vickie Frisby, an oncology nurse navigator with Baptist Health Richmond, commented that there are some more prevalent signs to watch out for.

“Sometimes they are having frequent urination through the night, or when they urinate, there may be a very weak stream. So if you have those changes when you’re going to the restroom, that would be a big sign that a person may need evaluation to make sure it’s not something with their prostate,” she explained, adding that blood in the urine could be another indicator of prostate cancer.

The CDC also outlined the following symptoms as potential indicators of prostate cancer:

Difficulty starting urination.

Weak or interrupted flow of urine.

Urinating often, especially at night.

Trouble emptying the bladder completely.

Pain or burning during urination.

Blood in the urine or semen.

Pain in the back, hips, or pelvis that doesn’t go away.

Painful ejaculation.

These symptoms may be caused by conditions other than prostate cancer.

“It could be an infection, but you would want to make sure that you’re not having something going on with your prostate,” Frisby said.

Testing and diagnosing for prostate cancer

There is no standard test for prostate cancer, says the CDC.

However, according to Frisby, there are two typical screenings for prostate cancer: a rectal exam and a prostate specific antigen (PSA) test.

The digital rectal examination is when a physician inserts a gloved, lubricated finger into a man’s rectum to feel the prostate for anything abnormal, such as cancer. This is what people generally picture as a prostate screening; however, the U.S. Preventative Services Task Force does not recommend DRE as a screening test because of a “lack [of] evidence on the benefits.”

The PSA test; however, specifically measures PSA in the person’s bloodstream. This substance is created by the prostate, and elevated levels can signal an issue with the prostate.

The downside of this test is that there can be more than one reason for elevated PSA, including medications, infections, and that some individual prostate glands create more PSA than others.

Frisby recommends that people begin getting screenings around 50 years old; however, high-risk patients should begin earlier, around 45.

These recommendations are shared by the U.S. Preventative Services Task Force — an organization made up of doctors and disease experts who look at research on the best way to prevent diseases and make recommendations on how doctors can help patients avoid diseases or find them early.

Frisby explained, “That would include men that have a direct relative, such as a father or a brother, that’s been diagnosed with prostate cancer or African American men. They would want to start earlier since they are at higher risk for developing prostate cancer.”

“That’s important,” she added. “Their mortality rate is higher with prostate cancer, and some of that comes with not being screened or getting late to treatment, because diagnosis and treatment of prostate cancer is very curable.”

The American Cancer Society recommends that those at an even higher risk — those with more than one first-degree relative who had prostate cancer at an early age — be screened at age 40.

The CDC explained that prostate cancer is diagnosed by conducting a prostate biopsy, which removes a small piece of tissue from the prostate. It is then examined under a microscope to see if cancer cells are present.

A prostate biopsy can cause pain, blood in semen, and infection; however, the CDC emphasized that these complications are more likely to occur in older men.

“Early screening and diagnosis for everyone is the most important thing for your health care. Because if you can find these things early, and get the appropriate treatment with the technology in the after day month, a lot of things are very true curable or treatable. and so I just encourage people to get their screenings and say on top of that, so that they can get the appropriate care,” Frisby said.

She said that early treatment also prevents the cancer from metastasizing to the bone, which makes it harder to treat.

After being diagnosed, the cancer will then be graded and staged.

The cancer’s grade serves as an indicator to physicians about how quickly the cancer is likely to spread. This is done by examining different biopsy samples to come to a summative conclusion, called a Gleason Sum, that is based on how abnormal different prostate samples look.

Staging the cancer helps physicians treat it by understanding how widespread throughout the body the cancer is.

The American Cancer Society relies on information from the SEER (Surveillance, Epidemiology, and End Results) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.

Instead of staging the cancer by number (e.g. stage one, stage two, etc.), it groups cancers into localized, regional, and distant stages.

Not all cancer treatment is the same. For example, a physician treating prostate cancer may recommend expectant management over an aggressive treatment. This would occur if the doctor thinks the prostate cancer is unlikely to grow quickly, according to the CDC.

In expectant management, doctors may suggest active surveillance, or closely monitoring the cancer with regular biopsies and PSA tests, or they may instead advise watchful waiting, where no tests are conducted and symptom management is the priority.

However, the CDC clarified that watchful waiting is “usually recommended for men who are expected to live for 10 more years or less.”

A doctor may recommend surgery, including a prostatectomy, which is an operation where the prostate is removed. Another option is a radical prostatectomy, which also removes the seminal vesicles.

Both external and internal radiation therapy is also an option for some prostate cancer patients.

However, per the American Cancer Society, “i{span}t’s important to discuss all your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs.”