Prostate Cancer

 

Prostate Cancer: The Present Global Condition, 2021

Vivek Rao and Dr Lopamudra Das Roy

Publication @ 2021

@BreastCancerHub, All Rights Reserved

Abstract

Prostate Cancer is the second most common cancer in American males with nearly 248,300 new cases and 34,130 deaths in 2021 alone.  Cancer is formed when there is mutation or abnormality in our cell production, and these abnormal cells continue to grow at a harmful rate obstructing other parts of the body and forming cancerous tumors[1,2,3]. This work provides a comprehensive overview of several aspects of prostate cancer. More specifically, it compiles various sources of information on topics about prevention, treatment, and even risk factors. I have conducted a systematic review of several pieces of literature relating to the screening,symptoms, detection, and global scenario of prostate cancer. Additionally, I have used Google Spreadsheets to analyze various data points. Based on this extensive review of several articles we claim that on average both developing countries and late-detection cases have a significantly lower survival rate. Surprisingly, we were able to notice how even countries with highest reported cases have some of the highest reported survival rates. In this work you will find an in-depth analysis as to why this is the case, and what can increase and decrease your chances of survival or death.   

What is Prostate Cancer

Prostate Cancer is the second most common cancer in American males with nearly 248,300 new cases and 34,130 deaths in 2021 alone. Cancer is formed when there is mutation or abnormality in our cell production, and these abnormal cells continue to grow at a harmful rate, obstructing other parts of the body and forming cancerous tumors. Similarly, prostate cancer is when cancerous cells start to form in the male prostate[1,2,3]. The Prostate is the part of the body that controls the flow and production of seminal fluid; it is located below the bladder(the organ that stores urine). Unfortunately, in some cases the cancer can spread to other parts and regions of our body through our blood stream in a process called metastasis. However, there are various ways to diagnose and screen for prostate cancer before it becomes harmful, and even clinically proven methods to treat cancer if it does become malignant.    

Prevention

There are a plethora of ways to protect yourself from prostate cancer. The first way is by enhancing your overall health, this can be done through ensuring you have a healthy diet with ample nutrients, getting exercise several days a week, and maintaining a healthy weight and BMI. Furthermore, the best way to prevent any complications is frequent and early screening and testing, as the best way to treat and prevent any type of cancer is through early detection. You can refer to the early detection card provided by BCH in Figure 1. Additionally it is important to note a popular stigma around prostate cancer that causes many men to not undergo regular screening or testing. In other words, many men are simply ashamed of being diagnosed with prostate cancer, creating a prevalent taboo around prostate cancer. However, there is absolutely nothing to be ashamed about by taking proper care about your health.[4]

 

Figure 1[5]

Risk Factors

There are many factors that can increase your chance of developing prostate cancer. Although some have more clear effects than others, those who may have such risk factors should take extra caution and may need to receive screening and testing earlier than others.  Moreover, risk factors can be based on various different aspects of life such as ethnicity, economic status, gender, age, geography, family history, genetics, and even lifestyle choices.  For example you may be at significantly increased risk if you are:

      ●           Over the age of 50

      ●           Are black or Caribbean with African Ancestry

      ●            Live in the Western Hemisphere (North America, Australia, the Carribean Islands, and Northwestern Europe)

      ●           Related to someone who has had prostate cancer

     ●         Have inherited either the BRACA1 or BRACA2 genes (breast cancer genes/mutations)

     ●         Diagnosed with Lynch Syndrome

There are several other factors that have been proved to have an effect on the chance of prostate cancer, however, how significantly they impact your chances still remains unclear. Some of these more uncertain risk factors include[1,2,3]:

      ●           Obesity

      ●           Diet (increased dairy products or calcium intake)

      ●           Smoking

      ●           Chemical Exposure(ex. firefighters)

      ●           Sexually Transmitted Diseases

      ●           Vasectomy

      ●           Inflammation of the Prostate

 

Screening

Screening is being proactive and looking for Cancer even before any possible symptoms or side effects. Prostate Cancer Screening has been extremely low and stagnant for the past several years, even though it is the second most dangerous type of cancer in America. As of 2018, only 39% of Americans(all races) were screened for Prostate Cancer using the Prostate Specific Antigen (PSA). [6] We(and many other institutions) highly recommend that you do get your screening completed periodically especially if you are in one of those risk factors.[7] As this form of early detection is the best possible way to prevent any major complications of Prostate or any type of Cancer.

There are two main types of screening for Prostate Cancer. The first and most common is the PSA, which is essentially a blood test that is analyzed for the levels of PSA. This test can be a great first method of prevention as normally those with prostate cancer tend to have higher levels of PSA. However, there are several factors that can affect PSA levels, thus high or low PSA levels are not 100% definitive of cancer.

The second type of Prostate Cancer Screening is the Digital Rectal Examination (DRE) where a health care provider will examine a man’s prostate by inserting a lubricated finger(with glove) into the man’s rectum. Although, there has been some question regarding the efficacy of this method as well, it is still definitely another great preventative measure[8].

Early Detection vs. Late Detection

It has been proven amongst multiple sources that the survival rate for prostate cancer(and all types of cancer) is higher amongst those who have discovered it in it’s earlier stage. Furthermore, the difference is significant, as the 5-year survival rate for relatively early stage cancer is at nearly 100%, while for late detection and higher stage it drops all the way down to 30%.[9,10,11] These numbers can be so different because the doctors have much more effective options to treating the cancer in a specific region, but as the cancer starts to spread it becomes much more difficult and there are many more factors to be considered. 

Diagnosis (Aggression) 

The most common way to identify how aggressive your cancer cells or how much they differ from your regular cells is by taking a sample of your prostate tissue and having it analyzed in a lab, a process called prostate biopsy. Then it will be scored using the Gleason Score, ranging from 6-10, and/or a Grade Group which has 5 groups. The higher the score and Grade is the more dangerous/aggressive the cancer.

Figure 3[12]

Diagnosis(Stage)

Identifying the stage of the cancer is different from the aggression, as the stage can help us understand where the cancer is and how far it has spread in our body. To do this your doctor may recommend one or more of the following tests that provide images of the cancer: 

       1.           Bone can - A very safe amount of radioactive material is sent to your bone through a vein 

       2.           UltraSound  - A probe using sound waves will capture an image of the prostate and surrounding organs

       3.           CT Scan  - Uses an X-Ray to take pictures of your body in different angles

       4.           MRI  - Uses powerful magnets and the energy your body releases to capture an image of your body

       5.           PET Scan - Works by detecting the photons that are released by tissue or organs

Once you have taken this imaging the doctor will likely rank you on the AJCC TNM Staging System(the most common). There are 4 stages of cancer, but some stages have multiple levels(2A or 3B). A higher number and letter indicates that cancer is more prevalent and more dangerous[13,14,15,16]. 

Treatment

The type of treatment and the length of the treatment is entirely dependent on each patient’s particular condition in regards to cancer and pre-existing conditions. Thus, it is best to consult with a physician and implement their recommendations to receive the best care. In general if the cancer is relatively benign and doesn’t seem to spread or grow much, active surveillance or regular check-ups may be the best option. However, if the cancer is proven to be aggressive but more localized, surgery is commonly recommended to remove the tumor. If the procedure fails or if the cancer continues to grow, various methods like chemotherapy or even targeted drug therapy can be used to reduce cancer cells [2,3].

Global Scenario 

Prostate Cancer remains the second most commonly occurring cancer in men across the Globe as well.  Additionally, with nearly 1.28 million new cases every year Prostate Cancer is nearly 7.5% of all types of cancer and ranks 4 amongst cancer for both men and women. [17] Unfortunately, the infection rate continues to climb dramatically, but this has also been tied to a massive push and increase for Cancer Screening worldwide. The majority of nations that have the highest incident rates are concentrated in Northern Europe.[18] However, it is once again important to note that this can be a result of extensive screening and detection.  

Created by Vivek Rao, DataSource:[21]

 Global Scenario

It is important to note some of the major differences in how different countries deal with prostate cancer.  First, we can see that in developing nations there is a lack of registries which keep track of prostate cancer diagnosis and screening. Secondly, there is a decreased level of early detection and screening in developing countries, this can be attributed to a lack of funding and resources. [19,20] Thus, it can sometimes be difficult to get an accurate number of cases in developing countries, and usually recorded numbers are lower than the actual level. However, survival rates allow us to compare countries much better. Unfortunately, developing countries tend to have significantly lower survival rates (Refer to Figure 4). Surprisingly, some countries with an increased number of reported cases actually have much higher survival rates, due to extensive detection and screening.  This idea validates the importance of early detection and screening, as it can be one of the best ways to prevent complications and ultimately death.

Figure 4 [21]

Conclusions

This work elucidates the relationship between developing and developed countries and the intensity of prostate cancer. Furthermore, it provides general background information regarding the various Treatment, Screening, and Detection available. Moreover, we strongly recommend everyone to follow the recommendations presented when it comes to prevention. As we can see how early detection is currently the best form of prevention. This is observed in several countries with extraordinary detection standards, as these countries have some of the highest survival rates. Even in the U.S, when we are able to detect cancer earlier, the survival rate is much higher. However, in developing countries we note that due to lack of  resources screening and detection is delayed, which has a significant impact on survival. In short, prostate cancer cases are rising every year and screening still remains stagnant. Further research should be done to indicate why screening is not being conducted and how this may impact risk factors. In the end, we conclude that prostate cancer is extremely dangerous and screening and detection is one of the best ways to keep your family and friends safe. 

 

Acknowledgments

I want to thank Dr. Lopamudra Das Roy for her extensive guidance in the compilation of this paper and for introducing me to the world of research. Additionally, I would like to thank the entire BCH organization for giving me this wonderful opportunity and all the service they do across the globe.

Bibliography

  1. What Is Prostate Cancer? American Cancer Society. (n.d.). https://www.cancer.org/cancer/prostate-cancer/about/what-is-prostate-cancer.html.

  2. Prostate cancer. Prostate Cancer: Symptoms, Diagnosis & Treatment - Urology Care Foundation. (n.d.). https://www.urologyhealth.org/urologic-conditions/prostate-cancer.

  3. Prostate cancer. Mount Sinai Health System. (n.d.). https://www.mountsinai.org/care/cancer/services/prostate/prostate-cancer.

  4. We'll say it so you don't have to: Prostate cancer is nothing to be ashamed of! Prostate Cancer Foundation. (2021, January 28). https://www.pcf.org/blog/well-say-it-so-you-dont-have-to-prostate-cancer-is-nothing-to-be-ashamed-of/.

  5. Roy, L. D. (2021, June 9). PROSTATE CANCER - EARLY DETECTION SCREENING CARD. Breast Cancer Hub. https://www.breastcancerhub.org/educational-cards/prostatecancer.

  6. Prostate Cancer Risk Factors. American Cancer Society. (n.d.). https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html.

  7. Prostate Cancer Screening. (n.d.). https://progressreport.cancer.gov/detection/prostate_cancer#:~:text=In%202018%2C%2039.0%25%20of%20men,test%20within%20the%20past%20year.

  8. Prostate Cancer: Screening. Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce. (2018, May 8). https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening.

  9. Centers for Disease Control and Prevention. (2020, August 18). What Is Screening for Prostate Cancer? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/prostate/basic_info/screening.htm.

  10. Key Statistics for Prostate Cancer: Prostate Cancer Facts. American Cancer Society. (n.d.). https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html.

  11. Survival Rates for Prostate Cancer. American Cancer Society. (n.d.). https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/survival-rates.html.

  12. What is a Gleason Score? Prostate Cancer Foundation. (2021, March 24). https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/gleason-score-isup-grade/.

  13. Krans, B. (2018, September 29). Bone Scan: Purpose, Procedure, and Risks. Healthline. https://www.healthline.com/health/bone-scan.

  14. Mayo Foundation for Medical Education and Research. (2020, February 28). CT scan. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/ct-scan/about/pac-20393675.

  15. Positron Emission Tomography (PET). Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/positron-emission-tomography-pet.

  16. U.S. Department of Health and Human Services. (n.d.). Magnetic Resonance Imaging (MRI). National Institute of Biomedical Imaging and Bioengineering. https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri.

  17. Worldwide cancer data: World Cancer Research Fund International. WCRF International. (2021, May 25). https://www.wcrf.org/dietandcancer/worldwide-cancer-data/.

  18. Prostate cancer statistics: World Cancer Research Fund International. WCRF International. (2021, May 25). https://www.wcrf.org/dietandcancer/prostate-cancer-statistics/.

  19. Prostate cancer: World Cancer Research Fund International. WCRF International. (2021, May 19). https://www.wcrf.org/dietandcancer/prostate-cancer/.

  20. Diet, Nutrition, Physical Activity, and Prostate Cancer. World Cancer Research Fund. (n.d.). https://www.wcrf.org/wp-content/uploads/2021/02/prostate-cancer-report.pdf.

  21. Cancer Survival Rates By Country 2021. (n.d.). https://worldpopulationreview.com/country-rankings/cancer-survival-rates-by-country.

 

 
Lopamudra Das Roy