📄 የNCCN የሕሙማን ትምህርት ጽሑፍ

Prostate Cancer

Common in older men — understanding your options and when to seek help

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📖 What Is Prostate Cancer?

The prostate is a walnut-sized gland in men that sits below the bladder and in front of the rectum. It produces fluid that forms part of semen. Prostate cancer starts in the gland cells of the prostate. Most prostate cancers are adenocarcinomas (gland cell cancers) that grow very slowly — so slowly that many men with low-grade prostate cancer die of other causes before the cancer causes problems. However, some prostate cancers are aggressive and can spread quickly to the lymph nodes and bones. Prostate cancer is strongly linked to older age; it is uncommon in men under 50.

🔍 Warning Signs & Symptoms

Early prostate cancer usually causes no symptoms. When symptoms develop, they may include:

  • Difficulty starting urination or weak/interrupted urine stream
  • Frequent urination, especially at night (nocturia)
  • Urgency — sudden, strong urge to urinate
  • Blood in the urine (haematuria) or semen (haematospermia)
  • Pain or burning during urination
  • Painful ejaculation
  • Bone pain — especially in the hips, back, or pelvis (suggests spread to bones)
  • Note: These urinary symptoms are also common in benign prostate enlargement (BPH), which is not cancer

🩺 Diagnosis

Prostate Specific Antigen (PSA) blood test measures a protein produced by the prostate; raised PSA can indicate cancer, BPH, or prostatitis (inflammation). Digital Rectal Examination (DRE): the doctor feels the prostate through the rectum to detect hard areas. Prostate biopsy (transrectal ultrasound-guided): the definitive test — thin needles take 10–12 tissue samples from the prostate. MRI of the prostate (mpMRI) may be done before biopsy to identify the most suspicious areas. Gleason score (now Grade Group 1–5) from the biopsy indicates how aggressive the cancer cells look.

📊 Risk Stratification & Staging

Prostate cancer is classified into risk groups based on PSA level, Gleason/Grade Group, and clinical stage: Low risk: PSA <10, Grade Group 1, organ-confined — Active surveillance is appropriate. Intermediate risk: PSA 10–20 or Grade Group 2–3 — Surgery or radiation. High risk: PSA >20 or Grade Group 4–5 — Radiation + hormone therapy or radical surgery. Metastatic (Stage IV): Cancer has spread to lymph nodes, bones, or other organs — systemic hormone therapy (androgen deprivation therapy, ADT) is the main treatment.

💊 Treatment Options

NCCN Guidelines offer several evidence-based options depending on risk group:

  • Active surveillance — Regular PSA tests and biopsies for low-risk cancer; avoids overtreatment
  • Radical prostatectomy — Surgical removal of the prostate; can cure localised disease
  • External beam radiation therapy (EBRT) — Effective alternative to surgery for localised disease
  • Brachytherapy — Radioactive seeds implanted directly into the prostate (low-risk disease)
  • Androgen deprivation therapy (ADT) — Hormone injections (LHRH agonists) reduce testosterone and shrink cancer
  • Chemotherapy (docetaxel or cabazitaxel) — For castration-resistant prostate cancer
  • PARP inhibitors (olaparib, rucaparib) — For BRCA-mutated metastatic prostate cancer

💚 Living Well With Prostate Cancer

Hormone therapy (ADT) causes side effects including hot flushes, fatigue, reduced libido, weight gain, and bone thinning. Exercise (including resistance training) helps counteract many ADT side effects. Calcium and vitamin D supplements protect bone health during ADT. Sexual side effects after surgery or radiation therapy are common — discuss these openly with your doctor. Men with prostate cancer can live for many years with treatment. A plant-rich diet, physical activity, and maintaining a healthy weight support overall wellbeing.

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