September is recognized nationally as “Prostate Cancer Awareness Month,” an ideal time to learn about the symptoms, tests and treatments to deal with this dangerous disease that affects men.
Prostate cancer is the most common cancer among men in the United States and the second most common cause of cancer-related deaths, the Food and Drug Administration (FDA) reports.
It should be noted that African American men are more likely to develop prostate cancer and twice as likely to die from the disease than men of other races.
Taking into account that awareness requires action to make a difference, the country’s health authorities and entities highlight the importance of being screened for prostate cancer, as well as taking into account ways to minimize the risk and combat its progression.
The community is encouraged to educate themselves about this disease, share information with their friends and loved ones, and start fundraising to support research into the disease and thus reduce the mortality and suffering it causes.
Warning signs
The prostate is part of the male reproductive system that produces semen. The walnut-sized gland lies beneath the bladder and surrounds the top of the urethra, the tube that carries urine from the bladder. The FDA regulates certain tests and treatments for prostate cancer to ensure their safety and effectiveness.
Prostate cancer is often a very slow-growing disease, often not causing symptoms until it is in an advanced stage. At this time, symptoms may include difficulty initiating urination (urination), weak or interrupted urine flow, and frequent urination, especially at night. Other symptoms of advanced prostate cancer may include back or other bone pain, weakness, and unintentional weight loss.
But these symptoms can have many other causes besides prostate cancer, such as a (benign) enlargement of the prostate which is harmless. If you have any concerns about any of these symptoms, please contact your healthcare professional.
Most prostate cancer patients die from other causes and many never know they have the disease. But once prostate cancer begins to grow rapidly or spread outside the prostate, it becomes dangerous.
Screening tests
A blood test that measures prostate-specific antigen (PSA) can be used to aid in the detection of prostate cancer, although it is not recommended for screening in all cases. PSA is a protein produced by cells in the prostate gland.
Other factors that can help put PSA in context to better understand prostate cancer risk include age, race, family history, prostate size, urinary tract infection or irritation, medications, and rate of PSA rise.
Because of the widespread use of the PSA test in the United States, prostate cancer is often detected early. In some cases, the detected prostate cancer may grow very slowly, which may lead to overtreatment.
The Preventive Services Task Force – a voluntary, independent panel of national experts in prevention and evidence-based medicine – recommends against PSA-based prostate cancer screening in men age 70 and older due to the following factors:
– Lack of data that screening increases survival rates.
– The risk of overtreatment, causing side effects in men who would otherwise never have experienced any symptoms.
For men ages 55 to 69, the task force recommends an individualized conversation about the risks and benefits of screening.
Prostate imaging, such as magnetic resonance imaging (MRI), can help detect prostate cancer. If the risk of prostate cancer is high, a health care professional performs a biopsy to remove a sample of prostate tissue and examine it to determine whether cancer is present and, if so, how aggressive it is.
How is this cancer treated?
– Localized prostate cancer:
Radiation or surgery are the preferred treatments for localized prostate cancer that is at risk of spreading. Radiation may be given after surgery to certain patients if they are at high risk of having any remaining prostate cancer.
Side effects of treating prostate cancer with surgery or radiation therapy can include effects on urination, erectile dysfunction, and bowel problems.
– Hormonal therapy:
Sometimes radiation therapy is combined with hormone therapy (also called androgen deprivation therapy or ADT). Androgens, such as testosterone, are hormones that can cause the growth of prostate cancer cells. ADT stops the production of testosterone or directly prevents it from acting on prostate cancer cells.
Hormone therapy may be given to patients with prostate cancer that has recurred after radiation or surgery and is the standard of care for patients with cancer that has spread outside the prostate to other areas of the body (metastatic disease).
Side effects of ADT are largely due to loss of testosterone and can include hot flashes, weight gain, loss of bone density, erectile dysfunction, and fatigue.
– Non-metastatic castration-resistant prostate cancer:
Some men who are treated with hormone therapy before experiencing metastatic disease may develop a form of prostate cancer that is resistant to normal hormone therapy (known as non-metastatic castration-resistant prostate cancer).
The FDA has approved 3 drugs for non-metastatic castration-resistant prostate cancer: apalutamide, enzalutamide, and darolutamide. These drugs block the effect of testosterone and similar hormones on prostate cancer cells.
Patients who received these drugs in clinical studies went longer without developing metastatic disease than patients who received placebo; They also lived longer.
– Metastatic castration-resistant prostate cancer:
In 2004, the FDA approved docetaxel. This is the first chemotherapy drug approved for metastatic castration-resistant prostate cancer (i.e., resistant to hormone therapy alone) to show a survival benefit, after years of research failed to find a treatment that would prolong the lives of patients with metastatic prostate cancer.
Since the approval of docetaxel, the number of therapies for metastatic prostate cancer has continued to grow. The FDA has approved 6 additional therapies for metastatic castration-resistant prostate cancer, all of which have shown improvements in survival and do not target specific mutations in the cancer. These include hormone therapy, chemotherapy, a cancer vaccine, and radioactive medications.
Additionally, the FDA has approved 4 therapies for patients with metastatic castration-resistant tumors that require testing for specific mutations in the prostate cancer to determine if the patient may be a candidate for treatment. Some of these therapies are approved in combination with a hormone therapy, such as abiraterone or enzalutamide.
– Castration-sensitive metastatic prostate cancer:
For patients with previously untreated metastatic prostate cancer, several large studies showed that adding additional therapy, including hormonal therapies (abiraterone acetate, enzalutamide, or apalutamide), docetaxel, or darolutamide with docetaxel, improved their survival. To receive docetaxel, patients must be able to receive chemotherapy.
Abiraterone acetate tablets are also approved, in combination with prednisone, for patients with high-risk metastatic castration-sensitive prostate cancer, while enzalutamide and apalutamide are approved for all patients with metastatic castration-sensitive prostate cancer.
