Prostate care and prostate cancer

Abstract

Prostate cancer to be a very important issue to humanity since it is the second most frequent cancerous disease found in men. The walnut-sized gland known as prostate gland is also vital for reproductive health but can develop cancer, depending on age, genes, and family history. New research finds that genetic make-up plays an important role in the development of prostate cancer, and a large part of the risk is genetic. Though diet and physical activity might help with risk reduction, screening approaches such as PSA tests and digital rectal examination is vital for the best outcomes. This review focuses on the epidemiology, risk factors and prevention of PDCA, genetic risk factors and the factors that are considered in prevention of the disease. It also reviews the modern therapeutic methods that embrace the conventional ones like surgery and hormone therapy along with the innovative immunotreatment methods with reference to the implications they have on the prognosis as well as the quality of life among patients. The presented overview of primary prevention interventions was designed to support advances in knowledge and familiarize readers with prostate cancer to enhance health literacy and subsequent results.

 Introduction

The prostate gland is a small clinically smooth, walnut-sized structure situated below the bladder in men and it is an important part in the male reproductive system. It is mainly concerned with the manufacture of seminal fluid which supports sperm cells during ejaculation. Despite this, this gland is prone to cancer, an ailment that has cropped up to be a leading health threat around the world. Globally, prostate cancer takes the second position in the list of newly diagnosed malignancies and plays an essential role in cancer deaths (Ferlay et al., 2021). Being a Filipino, there are markers that may perhaps incline a man to prostate cancer; these include age, family history and genetic factors. More focus has been laid on efforts to establish these risk factors so as to inform preventive practice and raise awareness on these factors. Screening still plays a large role as the earlier it is done the better the chances of the patient will have improved prognosis. Recent developments in screening breast cancer including the PSA tests and MRI targeted prostate biopsies are designed to detect the prostate cancer at more easily treatable stages. Improved enlightenment, constant check-ups, and changes in diets and other practices could go a long way to help minimize the effect of the disease in men around the world.

Studies exploring the genetics of the disease clearly support heritability of the prostate cancer. Hjelmborg et al (2014) determined that 58% of the variance of prostate caner risk is attributable to heritable factors, thus, making it the most heritable cancer. Expanding from this study, Conti et al. (2021) undertook the largest GWAS to date that has pinpointed 269 germline risk risk variants. Jointly, these variants contribute to PRS for a highly accurate prognostication of prostate cancer risk levels in a given individual. Plym et al. (2021) have also pointed out that lifetime risk of prostate cancer can be as high as 50% for the men in the top PRS decile while risk is 10% for the men in bottom PRS decile and thereby underlined the value of PRS in the risk stratification in prostate cancer.

 Benke et al, (2018) emphasise that there is need to identify factors that can be changed to reduce, or prevent wholly prostate cancer especially among men with familial predisposition to the cancer. Despite the fact that the genetic predispositions could not be altered, such changes in lifestyle might reduce the risk. Even though there is no conclusive evidence exactly linking lifestyle to overall prostate cancer risk, more and more evidence suggests that potentially healthy lifestyles can decrease prostate cancer mortality. This review focuses on overview of Prostate cancer including epidemiological trends, associated risk factors towards the disease and preventive implications with reference to heredity disposition and screening. Also it describes the present and future treatment modalities which ranges from traditional treatments such as active surveillance, surgery and endocrine therapy to recent and advanced immunotherapy. In doing so, the review will provide a broad view on the ways to manage prostate cancer, and the techniques that might increase the chances of survival of the patients and enhance their quality of life.

 Prostate Cancer: Risk Factors and Epidemiology

The cause of prostate cancer is not as well known or researched as other, more simplistically defined cancers despite significant scientific work. The identified risk factors are age, ethnicity, genetics and, family history of the disease (Bostwick et al., 2004). Prostate cancer further has a high incidence in men of advanced age, mostly of African origin and characterized by a strong genetic aspect. Lifestyle factors also play a role, as both dietary and vitamin specific factors show that prostate cancer correlates with increased consumption of saturated fats and red meat and decreased consumption of fruit and vegetables, and coffee. Ageing; obesity, and physical inactivity are also related to increased risk because of changes in hormonal and chronic inflammation. Also, when studying the factors that increase the risk of prostate cancer, it has been found that high blood sugar level, some infections, and exposure to some chemicals or radiation have been linked to the disease that are of diverse than one.

Bray et al. (2018) posited that age-standardised incidence rates of the disease vary by region and population around the world. New cases of prostate cancer were estimated to be 1,276,106 with 7.1% of incidence in males globally in 2018. As the research with focus from Ferlay also points out, there is nothing like the geographic distribution of prostate cancer incidence rates and this is due to several factors relating to genetic endowment, environmental and improvement of health facilities. The ASR in Oceania was realised to be a lot higher at 79.1 / 100,000 population and was followed by North America at 73.7/100, 000 then Europe 62.1/ 100,000. While the Americas had an ASR of 46.8, Europe had slightly less at an ASR of 41.9, Oceania had ASR of 8.7 and Europe had a considerably lower ASR of 11. 5 while Africa had the lowest ASR at 26 .6 with Asia following closely.

This is backed by a stark difference in the incidence rate of prostate cancer; the incidence rate range from a high of 189.1 in France (Guadeloupe) to low of 1.0 in Bhutan. Prostate cancer risk is one of the several factors that depend on age. Prostate cancer incidences range at 1/350 for men under 50 years, but 1/52 among men between 50 and 59 years. Permai et al. (2018) report that the incidence of prostate cancer is the highest in men aged above 65 years; which is approximately 60%.

Some of the explanations for these differences are well understood, though the exact causes for these variations across the global regions for prostate cancer still remain some what unknown. This means that the differences in rates of occurrence of prostate cancer across countries could be partly as a result of PSA testing carried out across the world; it is most common in the developed countries (Quinn et al., 2002). Prostate cancer alone is now the most common new cancer diagnosis for men in Europe, accounting for 24% of new male cancer diagnoses in 2018, with about 450,000 new cases diagnosed that year alone. The United States still classifies prostate cancer as the second most common neoplasm in men, which occurs in 9.5% of all newly diagnosed malignancies, including 164690 cases in 2018. Scientific papers indicate that at least one third of all prostate cancers diagnosed in developed countries such as the USA and Europe may be caused by over-diagnosis since PSA tests tend to identify small, slow-growing tumours that are unlikely to kill the patient. Draisma et al. (2009) conclude that, according to own analysis, more than 20-40% of overdiagnosis could be linked to PSA screening and it remains unclear whether early identification justifies overtreatment.

Studies show that Black men are most affected by prostate cancer globally and the likelihood of the disease affects them at a younger age than other groups (Kheirandish et al., 2011). This increased risk is not only seen for Black and African American men but also for Caribbean men and Black men living in other countries within Europe. Such patterns confirm that these populations have the inherited predisposition to develop prostate cancer, and thus more likely to be affected. However genetics alone may not fully expound on difference in incidence rate in prostate cancer among the different racial and ethnic groups.

Chu et al. noted that while incidence rates of prostate cancer among African-American men were as much as forty fold higher than similarly aged black men in Africa, the differences implied an environmental role in the development of prostate cancer. These divergences could be attributed to several socio-environmental factors such as; dietary habits, kinds of foods consumed, and levels of environmental endotoxins. Similarly, the relative trends of R2 could also attributed to factors resulting from underlying factors like inadequate or poor diagnosis, unequal access to health care and, diverse methods of screening in different parts of the continent. For instance, the African-American men in the United States can present higher diagnosis rate because of more intensive screening but this group also appears to have poorer access to timely and sufficiently effective care, so at diagnosis, the disease is likely to be more progressed. On the other hand, reduced incidence rate in African could be due to lack of adequately developed diagnostic facilities that would identify such cases and hence the cases could be unrecognized. Such multifaceted differences help to stress out the existence of a gene-environment interaction in the development and progression of the prostate cancer as well as the existence of the differences in the risk and prognosis in different populations.

About 70 percent of the participants stated that they have a family history of prostate cancer with the results indicating the possibility of genetic influence. Hence, the relationship may be carried forward not only genetically but also because of similar environmental factors and habits that lead to cancer (Gallagher & Fleshner et al., 1998). Sridhar, K.V.V., Sriram and ChoudaryBehind the Prostate Cancer—Experience of an Oncologist, 2011 The heredity aspect/role in Prostate cancer is that it is estimated that about 5% of prostate cancer risks are caused by inherited genes. In particular, the possessors of high penetrance genetic “risk” variants have significantly higher chances to be diagnosed with prostate cancer. These genotype have high risk impacts than high-penetrance alleles which are greatly raise risk than the low-penetrance genetic polymorphisms. It stresses the difference between genetic predisposing factors and prostate cancer risk factors, which is crucial to develop potential preventive efforts, thereby helping to discover more people that are on the high risk group so that the probability of early detection and elevated survival rates for those with genes associated with the disease.

 Prevention and Early Detection Strategies

A key method of reducing the risk or even preventions of prostate cancer is the lifestyles changes, which means a set of healthy behaviors. Many scientific works have recognized this factor as a way to minimize the risk of getting prostate prostate cancer. Some of the important guidelines drawn regarding the prevention of prostate cancer include increased consumption of fruits, vegetables, whole grain food products and lean meats. More so, a diet with fruits and vegetables, with special emphasis on lycopene rich foods like tomatoes may help to prevent prostate cancer according to Bosetti and his team (2009). On the other hand avoiding access consumption of foods that contain added sugar, high fat dairy products as well as red and processed meats will add up to the reduced risk profile (Song et al., 2020).

Finally, they mentioned that prevention is also a prerogative of an individual, especially the role of physical activity on daily basis. The analysis has indicated that performing regular exercise, walking, or jogging and cycling and other moderate activities reducing the possibility of developing prostate cancer (Littman et al., 2018). According to the health recommendation, adults should conduct at least 75 minutes of vigorous exercise or 150 minutes of moderate intensity exercise every week. Also, keeping fit is important since researchers found out that overweight and obesity increase a man’s chances of getting prostate cancer significantly. Thus, the use of exercise and balanced diet enables people to gain and retain a healthy weight In order to prevent the diseases (Dossus et al., 2021). By adopting these lifestyle changes patients may decrease their chances of getting prostate cancer and even improve their general health.

Tobacco and alcohol have been linked to the ability of a man to develop invasive types of prostate cancer. As found in this scholarly paper, and other papers, these lifestyle factors are proven to fuel the advancement of cancer, which requires preventive measures (Giovannucci et al., 2018). To manage such an outcome, the following preventive measures are practiced to avoid or minimize, smoking, and moderate alcohol consumption. Similarly, the preventive effect using particular medications or non-prescription drugs also known as chemoprevention has been discussed as an approach to minimising prostate cancer risk. Of all the studied substances, it is worth paying attention to 5-alpha reductase inhibitors like Finasteride as well as Dutasteride. These prescription medicines belongs to the class that can slow down the activity of the enzyme known as 5- alpha reductase that is responsible for converting of testosterone to dihydrotestosterone (DHT). That is why the National Institutes of Health have worked out that reducing DHT may reduce the risk of prostate cancer in certain men.

Some of the drugs have been shown to reduce the risk of developing prostate cancer by a relatively large percentage, especially among those at high risk, a finding that has been confirmed by Andriole et al. (2018). Although these drugs have some positive effects, it is important to focus on their benefits and such aspects as toxicity and other side effects might play critical role in patients’ management and outcome. Furthermore, inexpensive drugs, namely, Tamoxifen, that are often used in breast cancer therapy and prevention have also been regarded as promising agents in the prevention of prostate cancer. Data from similar studies indicate that while SERMs’ action mechanism is believed to involve the estrogen receptor family, osteoporosis prevention is yet to be sufficiently clinically proven free from safety concerns related to prostate cancer (Cuzick et al., 2021). If performed comprehensively these modalities will have to form part of clinical treatments for managing the risk of prostate cancer.

The early detection of prostate cancer

Prostate cancer screening is primarily conducted through two methods: that of the prostate-specific antigen (PSA) tests and digital rectal examination (DRE). These screening approaches are important because prostate cancer prognosis and treatment largely depend on this type of cancer detection. Diagnosis at an early stage of the disease has a positive impact to the clinicians in averting poor results from the management of the disease thereby improving the quality of outcomes. Diagnostic tools such as imaging and methods of biopsy facilitates better detection and increased probability of early treatment of prostate cancer (Dunn et al., 2011).

Prostate-specificAntigen (PSA)

In the study conducted by Bohunicky et al (2010) it is shown that, PSA is a protein produced by the prostate gland, with blood tests called the PSA tests to determine the quantity of the PSA present in the body. A significant level of PSA can be cancerous but the same value can also be caused by other issues like inflammation or BPH. Therefore, PSA test is commonly used to screen men for prostate cancer it helps determine whether a man needs a further examination. This prompted the current scientific exploration of other techniques such as the combination of other biomarkers into PSA testing and incorporation of better imaging techniques with a view of improving precision in the testing method. These approaches are intended to add a great deal of depth to the general knowledge about the state of prostate health and enhance the chances of the early-detection of malignancies.

Digital rectal Examination (DRE)

In a survey by Salomon et al (2008) DRE is described as a simple and cost effective to evaluate size, shape and hardness of the prostate gland. Although DRE is useful during the first assessment, its specificity is relatively low, mainly due to the inability of the doctor to assess the presence of tumors that are too small for the examination. Such a limitation makes it important to integrate DRE with other diagnostic tools in a way that would improve the diagnosing of prostate cancer. Most often DRE is performed in combination with the PSA test, which checks the concentration of PSA in the blood, as well as with the help of various imaging studies. These imaging procedures including ultrasound, MRI and computed tomography (CT) are important in visualizing the prostate assists in the diagnosis and staging of Prostate cancer.

 Treatment Options

Prostate cancer therapy depends with the stage of cancer, the age and general health of the patient. Measures vary from close observation for early stages to the treatment interventions of high-risk cancers.

 Active Surveillance

In the study by Singer et al. (2012) Active surveillance is appropriate in low-grade cancer especially in old man or those with other related diseases. It includes surveillance of PSA, repeated biopsy, and imaging. CO is and effective shortcut that enables patients to do everything to avoid or delay treatments that have severe side effects.

 Surgery: Prostatectomy

Radical prostatectomy, the removal of the prostate gland, is described for localized prostate cancer. Indeed, surgery is effective but not without possible complications which include, incontinence, impotence among others. Robotic assisted prostatectomy has minimized some of the above risks but whether it is better than conventional techniques it is still under research (Huynh & Ahlering, 2018).

 Radiation Therapy

External beam radiation therapy, radioisotope implantation therapy or brachytherapy is one of the widely used treatments for the localized and locally advanced cancers. There are new techniques for example the intensity-modulated radiation therapy (IMRT) enable accurate focus on the tumor without affecting the adjacent tissues (Cheung, 2006).

Hormone Therapy

Based on the work by Desai et al. (2021) hormone therapy or androgen deprivation therapy (ADT) is more often utilized for the treatment of prostate cancer at the third stage. Having realized that the growth of this cancer is androgen dependent, there are sure ways to slow the growth of the disease. However, ADT is not without side effects; it is accompanied by side such as osteoporosis, cardiovascular risks as well as metabolic change.

 Chemotherapy therapy and Immunotherapy

In metastatic diseases, chemotherapy may be useful in treatment, but it is accompanied with appreciable toxicity. Docetaxel is the current first-line chemotherapy drug while showing improved survival benefits if delivered with ADT (Farha & Kasi, 2024). Immunotherapy seems to be quite promising, especially when using checkpoint inhibitors, though the outcomes are different (Maselli et al., 2023).

Conclusion

In conclusion, prostate cancer ranks as one of the most prevalent cancers and is a major cause of death in man in the world today. Knowledge of how genes, behaviors, and the therapeutic and diagnostic needs of patients for screening tools like PSA tests help in reducing risk is essential. The reasons focus on the inherited ability of developing prostate cancer thus calling for more individualized approaches to screening and management. In addition, it was noted that dietary changes and engaging in regular physical activity can decrease the risk of prostate cancer, more so in the man at a high risk. New strategies of clinical management from active surveillance to new treatment approaches such as immunotherapy indicates emerging light at the end of the tunnel. With awareness and research increasing, the subject of genetic information fused with preventive and treatment approaches can raise the survival expectancy and standards of living in this category of men stricken with the disease.

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