Prostate cancer

Prostate cancer may seem like a small issue, but it’s a big concern for many men. In fact, 1 in 8 men will be diagnosed with prostate cancer, a slow-growing disease that typically shows up later in life. That’s why Dr. Sullivan recommends starting prostate cancer screenings by age 55 to catch it early.
It’s not just cisgender men who can get prostate cancer – transgender women and non-binary individuals assigned male at birth are also at risk. Prostate cancer develops in the prostate gland, an important part of the reproductive system. While some may choose active surveillance with no treatment, others may need radiation or surgery for fast-growing cancers.

What is prostate cancer?

What exactly is prostate cancer? It’s a disease that starts in the walnut-shaped gland below the bladder and in front of the rectum. This gland produces fluid that helps keep sperm healthy. Thankfully, most cases of prostate cancer are caught before they spread, leading to successful treatment.
Are there different types of prostate cancer? The most common is adenocarcinoma, which forms in gland cells like those in the prostate. However, there are rare types like small cell carcinomas and sarcomas to watch out for. While prostate cancer is common, many people live normal lives without needing treatment. Still, thousands die from this disease each year in the UK, making early detection and treatment crucial.

Symptoms and Causes

Prostate cancer is a stealthy disease, often growing quietly inside the prostate gland without causing symptoms. However, as the disease progresses, symptoms such as frequent urination, weak urine flow, and pain during urination may arise. Other signs can include erectile dysfunction, blood in semen or urine, and pain in the lower back, hips, or chest.

Not all prostate issues are indicative of cancer, as conditions like benign prostatic hyperplasia (BPH) and prostatitis can mimic prostate cancer symptoms. BPH enlarges the prostate without increasing cancer risk, while prostatitis is a benign inflammation usually caused by bacterial infections.
The exact cause of prostate cancer remains a mystery, but experts believe it occurs when cells in the prostate begin to divide uncontrollably, forming a tumour. While cancer cells can spread to other parts of the body, prostate cancer generally grows slowly and is often caught before spreading beyond the prostate, making it highly treatable.

Several risk factors such as age, race, family history, and genetics can increase the likelihood of developing prostate cancer. Studies have also suggested potential links between smoking, obesity, sexually transmitted infections, and exposure to certain chemicals like Agent Orange and prostate cancer, although the evidence is not definitive. Regular screenings and understanding your risk factors can help in early detection and successful treatment of prostate cancer.

Detecting prostate cancer early is crucial for successful treatment. Screening typically starts at age 55 for those at average risk, with earlier screenings recommended for high-risk individuals. The process may involve a digital rectal exam, where a healthcare provider feels for abnormal areas in the prostate gland, or a Prostate-Specific Antigen (PSA) blood test to measure levels that could indicate cancer.
Additional tests, such as imaging with an MRI or biopsy, may be necessary if initial screenings suggest the presence of cancer cells. A biopsy is the definitive way to diagnose prostate cancer and determine its aggressiveness. Genetic tests on the biopsied tissue can help tailor treatment options based on specific characteristics of the cancer cells.

Management and Treatment

To assess the severity of prostate cancer, healthcare professionals use the Gleason score to evaluate cell abnormality and assign a grade to the cancer. Staging helps determine the extent of cancer spread, whether it is localised in the prostate, invading surrounding tissues, or has metastasised to distant organs. Prostate cancer commonly spreads to the bones and lymph nodes, but can also affect other organs like the liver, brain, and lungs. Understanding the grades and stages of prostate cancer is essential in planning appropriate treatment strategies.

Treating prostate cancer involves a personalised approach based on factors like cancer progression and overall health. Working with a team of experts including urologists, radiation oncologists, and medical oncologists, most cases detected in early stages can be effectively cured.
Management strategies may involve surveillance methods like active surveillance, monitoring the cancer’s growth without immediate treatment. For cases requiring intervention, options include surgery like radical prostatectomy, which removes the prostate gland, or radiation therapy, using high-energy beams to target cancer cells.

In advanced cases, systemic therapies like hormone therapy, chemotherapy, immunotherapy, and targeted therapy may be recommended to combat the spread of cancer cells beyond the prostate. Innovative treatments like focal therapy, utilising techniques such as high-intensity focused ultrasound and cryotherapy to destroy tumours within the prostate, are also being explored.

While these treatments can be effective, they may come with side effects such as incontinence, erectile dysfunction, and infertility. However, advancements in medication and procedures can help manage these side effects to improve quality of life during and after treatment.
It is important to communicate openly with your healthcare provider about any side effects you experience, as they can offer solutions to alleviate discomfort and enhance your overall well-being throughout the treatment process.

Preventing prostate cancer may not be entirely feasible, but there are steps you can take to reduce your risk of developing this disease. Regular screenings are key, so consult your healthcare provider to determine the appropriate screening frequency based on your individual risk factors. Additionally, maintaining a healthy weight, engaging in regular exercise, and following a balanced diet rich in fruits, vegetables, and whole grains while limiting red meats and processed foods can promote overall well-being and potentially lower the risk of prostate cancer.

Quitting smoking and steering clear of tobacco products can also play a significant role in reducing your risk factors. Partnering with your healthcare provider on a smoking cessation program can greatly assist in breaking the habit and enhancing your overall health.

When it comes to the prognosis for prostate cancer, early detection is paramount. Those diagnosed in the early stages have a high likelihood of survival, with nearly 99% living at least five years post-diagnosis if the cancer has not metastasised. While metastatic prostate cancer poses greater challenges, advancements in treatment options continue to improve survival rates and quality of life for those facing more advanced stages of the disease.

If you have concerns or experience symptoms like difficulty urinating, incontinence, pain during urination, or blood in your urine or semen, do not hesitate to contact your healthcare provider promptly. Asking questions about the specific stage of your prostate cancer, treatment options, potential risks and side effects, genetic considerations, follow-up care, and warning signs of complications can help you navigate your diagnosis and treatment journey effectively.

Remember, with early diagnosis and appropriate treatment, many individuals with prostate cancer can lead fulfilling, cancer-free lives for years following their treatment. By staying informed, maintaining open communication with your healthcare team, and following recommended screening guidelines, you can take proactive steps towards managing prostate cancer and optimising your health outcomes.

What Trans Women Should Know About Prostate Cancer

Understanding Prostate Cancer Risk for Trans Women: What You Need to Know
The enigma of prostate cancer may not often be top of mind, especially for those often excluded from conversations surrounding prostate health, like transgender women and non-binary individuals assigned male at birth. Yet, prostate cancer does not discriminate – anyone with a prostate, regardless of gender identity, can develop this common cancer.

Can trans women get prostate cancer?

Even if you’ve undergone gender-affirming surgery, your prostate likely remains, as its removal could jeopardise essential bodily functions. Research on prostate cancer predominantly focuses on cisgender men, but studies indicate that trans women may have a lower risk due to hormonal changes. Nevertheless, cases of prostate cancer in trans women have been documented, emphasising the importance of awareness and proactive health management.

Signs of prostate cancer, such as urinary issues, pain, or blood in urine, are similar for all individuals with a prostate. However, certain symptoms of prostate cancer, like blood in semen or erectile dysfunction, could differ or be concealed in trans women based on hormone therapy or surgical history.
Gender-affirming hormone treatments may affect sexual function, potentially masking traditional signs of prostate cancer. Following gender-affirming surgery, changes in urinary patterns may occur as the body adjusts, indicating a new normal post-operation.

Navigating trans-specific healthcare can pose unique challenges, including finding a provider who understands and affirms your identity. Screening guidelines for prostate cancer are not explicitly tailored for trans individuals, but routine screenings starting at age 50 may be recommended. High-risk factors, such as Black ancestry, family history of prostate cancer, or genetic mutations, could warrant earlier or more frequent screenings.

Regardless of gender identity, awareness of your body and symptoms is crucial. Empower yourself with knowledge, engage in open dialogue with healthcare providers, and prioritise proactive prostate health management to safeguard your well-being.