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Prostate cancer develops when cells in the prostate gland mutate and multiply uncontrollably. The exact cause is unknown, but factors such as age, ethnicity, and family history can increase the risk.

Ethnicity
Prostate cancer incidence varies among ethnic groups. African American men have the highest risk, followed by Caribbean men of African descent. Asian American and Hispanic/Latino men have a lower risk.

Age
Age is a significant risk factor for prostate cancer. The risk increases with age, with most cases occurring in men over 50. The average age at diagnosis is around 66. The younger the patient, the more aggressive the cancer is.

New Markers
Recent research has identified new markers that may improve prostate cancer detection and prognosis. These include genetic markers, such as mutations in the BRCA1 and BRCA2 genes, and biomarkers like prostate-specific antigen (PSA) isoforms. PSA doesn’t have a 100% specificity, we have a 10-12% false positives, those false positives many times are related to a chronic infection in your prostate, enlargement of the gland, stones in the prostate or cancer. Today, we count with an special and specific MRI to rule out suspicious masses inside of the prostate. Those MRI help us to reduce the number of biopsies.

Prevention
Prevention is better than cure. You should be sure that your PCP orders a PSA test every year. Starting age 40 or 35 if you have family history of prostate cancer, or you are an African descendant.

Symptoms
Early-stage prostate cancer often has no symptoms. As the cancer progresses, symptoms may include:
– Frequent urination, especially at night
– Difficulty starting or stopping urination
– Weak or interrupted urine flow
– Pain or burning sensation during urination
– Blood in urine or semen
– Painful ejaculation
– Persistent pain in the back, hips, or pelvis (metastasis to bones, very painful)

Old and New Treatments
Treatment options for prostate cancer depend on the stage and aggressiveness of the cancer. Common treatments include:
– Active surveillance: Monitoring the cancer for any changes without
immediate treatment.
– Surgery: Removal of the prostate gland (prostatectomy).
– Radiation therapy: Using high-energy rays to kill cancer cells, or the radiation
seeds.
– Hormone therapy: Lowering levels of male hormones to slow cancer growth.
Called chemical castration. Testosterona, the male hormone feed the cancer.
– Chemotherapy: Using drugs to kill cancer cells.
– Immunotherapy: Stimulating the immune system to attack cancer cells.

Newer treatments, such as targeted therapies and precision medicine, are being studied and may offer more personalized approaches to treatment.

Prognosis
The prognosis for prostate cancer varies widely depending on the stage at diagnosis and other factors. Overall, the outlook is favorable, especially for early-stage cancers. The 5-year relative survival rate is nearly 100% for localized prostate cancer. The most important recommendation is to have an annual PSA.

Raul Ayala MD
@MyDoctorOnCall.com