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Prostate cancer: Causes, symptoms & treatment

A patient meeting with his doctor.
Prostate cancer is the second most common type of cancer in men but the survival rate is high.
(Image: © Shutterstock)

Prostate cancer occurs when the cells in the prostate gland grow uncontrollably, which can spread or cause complications due to an abnormally enlarged prostate. This type of cancer is the second most common form of cancer in men globally, according to the World Health Organization (WHO).

The prostate gland is a small, walnut-shaped gland that sits below the bladder and surrounds the urethra, the tube that carries urine out of the body. The gland is responsible for producing the nutrient-rich seminal fluid that houses and carries sperm. Prostate cancer doesn't occur in women because females don't have a prostate gland.

The prevalence of prostate cancer seems to be the highest in Australia, New Zealand, North America and western and northern Europe, primarily because the practice of getting tested for prostate cancer is far more common in those parts of the world than it is elsewhere, according to the WHO. 

Prostate cancer is the fifth leading cause of cancer death in men globally and the second leading cause of cancer death in American men (after lung cancer), according to the American Cancer Society (ACS). But most men with prostate cancer won't die from it. In the U.S., the five-year relative survival rate for all stages after the cancer is first diagnosed is 98%, according to the latest ACS data.

What causes prostate cancer? 

In general, cancers occur when abnormal cells start replicating and growing out of control rather than dying and becoming replaced by healthy cells. This can happen because of DNA defects that were either inherited or caused by environmental factors, such as smoking tobacco or being exposed to radiation. Scientists aren't exactly sure what causes prostate cancer, but the disease is closely associated with several risk factors.

The first one is age: 90% of prostate cancer cases are diagnosed in men age 56 or older, according to the National Cancer Institute (NCI). And the probability of being diagnosed with prostate cancer increases with age, with the highest probability being 1 in 12 for men 70 years or older. 

Having a family history of prostate cancer is another major risk factor. The inherited risk of prostate cancer may be as high as 60%, according to the NCI. The prevalence of prostate cancer suggests that the risk of developing the disease is highest for black men, lowest for native Japanese men and intermediate for white men, but researchers haven't come to a consensus as to why. 

Hormone production also may play a role, as studies have shown that deficient or abnormal patterns of testosterone production seem to lower the risk of developing prostate cancer, according to the NCI. 

Diagram of the male reproductive system. The walnut-sized prostate gland sits right below the bladder and surrounds the urethra.  (Image credit: Shutterstock)

Symptoms and diagnosis

If prostate cancer is caught early enough, the patient may never experience symptoms. In more advanced stages, symptoms may include trouble urinating, blood in the urine or semen, erectile dysfunction or pain in the lower back, hips or thighs, according to the ACS. Those symptoms also may be caused by something other than prostate cancer, such as an enlarged-but-noncancerous prostate gland. Still, it's important to tell your doctor if you're experiencing any of those symptoms, as you may need to be screened for prostate cancer. 

Most early cases of prostate cancer are caught after a prostate-specific antigen (PSA) blood test or a digital rectal exam, according to the ACS. 

PSA is a protein produced by the prostate. Higher levels of PSA in the blood are correlated with an increased risk of prostate cancer, but there's no set cutoff that determines for sure whether a man has the disease. 

The doctor also may perform a digital rectal exam, during which the doctor feels for any bumps or hard areas on the prostate that would indicate cancer growth. This can help the doctor figure out where the cancer is on the prostate and if it's likely to spread. 

Depending on the results of these tests, your doctor may decide further testing (such as a biopsy or a CT scan) is warranted to confirm the presence of prostate cancer. 

Age, overall health and family history are all important factors to consider when deciding whether to get screened for prostate cancer. The American Cancer Society recommends that men discuss the decision with their doctors to ensure they understand the uncertainties and potential risks involved.

Treatment

The treatment plan for prostate cancer depends on several factors and can vary widely, according to the Mayo Clinic

For patients with low-risk, or slow-growing prostate cancer that's not causing symptoms, treatment may not be necessary; instead, the doctor may recommend regular testing to keep an eye on it. This may also be the treatment plan for very old patients or patients with other serious health conditions that could make cancer treatment difficult.

Surgical removal of the prostate gland is also an option, but this may cause urinary incontinence and erectile dysfunction. Radiation therapy to kill the cancer cells carries the same risks. 

Related: Facts about prostate cancer (infographic)

Prostate cancer cells require testosterone to grow, so hormone therapy to stop the production of testosterone can help slow or eliminate cancer cell growth. The potential side effects of this treatment include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. 

Chemotherapy, which uses drugs to rapidly kill cancer cells, may be an option for treating prostate cancers that don't respond to other forms of therapy. 

Immunotherapy, or biological therapy, also may be used to treat difficult cases of prostate cancer. In this type of treatment, doctors extract the patient's immune system cells, modify them to specifically fight prostate cancer and then inject the modified cells back into the patient's body. According to the Mayo Clinic, immunotherapy is effective for some patients, but it's very expensive and requires multiple rounds. 

Can you prevent prostate cancer? 

There's no sure way to prevent prostate cancer, but as with most diseases, maintaining a healthy lifestyle is the best way to lower the risk of getting it, according to the ACS

Certain drugs may lower a person's risk of developing prostate cancer. A class of drugs called 5-alpha reductase inhibitors prevent testosterone from turning into dihydrotestosterone, which is the main hormone that causes the prostate to grow. These drugs are prescribed to treat noncancerous prostate growth, but research suggests they also may lower prostate cancer risk. For example, one of these drugs, called finasteride, reduced the risk of prostate cancer by 25% in a large, long-term clinical trial published in The New England Journal of Medicine in 2019. These drugs aren't approved by the FDA specifically to prevent prostate cancer, but doctors can still prescribe them for this use. 

There's a bit of evidence to suggest a daily dose of Aspirin might reduce prostate cancer risk, but the side effects of such a regimen likely outweigh the potential benefits, according to the Mayo Clinic.

Additional resources:

  • likota39
    My experience—I am now 81 years old and prostate PSA normal—may prevent a cancer or at least a possibility of getting one due to an increased PSA.
    Please read this:
    https://drive.google.com/open?id=1YTBXynuFrqYAhonjNlZgb2fMXebFmZuA
    Reply
  • MagmaHombre999
    The suggested biohack using tumeric with black pepper (Piper nigrum) is an interesting one-of case study, and “one-of” reports on the internet of the reversal of PSA levels using nutrition and/or plant compounds/herbals are numerous to say the least. This is just another one but at least one in which the protocol used is well described. My conclusion that there would not be such numerous reports unless there was some veracity to them and that conclusion that nutritional aspects are important and some plant compounds are protective is supported in the research literature - see Dr. William Nelson - John Hopkins Cancer Center 2014 summary paper, “Nutrition and Prostate Cancer”- do the search for his paper on PubMed). However, if you talk to any standard-of-care practicing urologist, they will tell you that nutrition is unimportant. They clearly are oblivious to the research on plant compounds and prostate cancer - just google prostate cancer and piper longumin or silimarin for example. I have found research articles describing anti-prostate canncer activity in over 70 plant compounds and herbals - many from TCM (traditional Chinese medicine), Ayurvedic medicine (TIM - traditional Indian medicine, etc., and including turmeric.
    The current paradigm in treatments for BPH and prostate cancer is either inhibition of 5-alpha reductase (finesteride for example - taken proof that the increase of dihydrotestostorone (DHT) with age is the cause) or surgery (prosectomy) with follow-up of androgen-deprivation drug therapy (which is successful perhaps 70%) of the time (though generally destructive of function) which is taken as proof that testosterone is the driving agent behind prostate cancer. Androgen deprivation therapy is also the initial treatment of choice for metastatic prostate cancer (30% of standard-of-care treated cases). However, androgen deprivation therapy ultimately fails in 2-5 years as the cancer's growth becomes androgen independent and it then become extremely aggressive and rapidly metastatic. Consequently, I have to conclude that the paradigm that testosterone causes prostate cancer is a failed hypothesis. There are numerous, usually ignored scientific papers that point out that the real correlation between BPH and prostate cancer is with low testosterone levels. The testosterone paradigm also ignores the fact that high testosterone levels in young males does not lead to BPH or prostate cancer. In addition, prostate cancer is a uniquely human disease (though I have read on some blogs that dogs also get prostate cancer - something that I haven't confirmed from original research sources). I have read numerous research papers and review papers on prostate cancer and none even reference what I consider the seminal works of the Israeli research group of Dr. Yidal Gat an Dr. M Goren which relate the development of BPH and prostate cancer to the collapse of the valves in the seminal veins with resulting backflow of free testosterone from the testes directly into the prostate resulting in levels of free testosterone in the prostate of up to 130x normal serum testosterone (98% of which in normal blood serum is tied up in in SHBG (sex hormone binding globulin)). Now, 130x normal levels of free testosterone in the prostate cannot be good. However, it is likely that the mechanism by which excessive free testosterone results in excessive growth of the prostate gland is not as simple and direct as the Gat and Goren group assume as on this score they follow the current paradigm.
    My hypothesis is that high levels of free testosterone also trigger a homeostatic response in the body which has the purpose of normalizing the testosterone to estrogen ratio. How does it do this? It increases the aromatase levels in the prostate gland. Aromatase converts part of the testosterone to estrogen (especially to estrodiol – the most potent form) which is known to cause inflammation of the prostate gland (see Dr. Nelson's paper which reviews this research in animals). Research on aromatase show that it is often elevated in many cancers (especially endocrine related cancers and these include prostate cancer) supporting this hypothesis. Another parallel hypothesis that has merit is that exogenous xenoestrogens (plastics, fungicides, pesticides, herbicides, etc) that are ubiquitous in the modern environment are a cause of BPH and prostate cancer. In this case the body attempts to normalize the androgen-estrogen activity ratio by increasing the conversion of testosterone to (estrogen(+ xenoestrogen)) ratio by increasing the 5-alpha-reductase enzyme which converts testosterone to DHT which has 10x the androgen activity level testosterone itself. Most likely both processes are active.
    In Dr. Goren and Gat's research they found increased hydrostatically driven backflow from the testes to the prostate in 902 of 902 case study subjects with diagnosed BPH. They also found that varicocele surgery prevented this backflow in 902 of 902 cases and resulted an average decline in PSA levels of 50% and an average 50% decline in prostate volume at a six month follow-up and resulted in alleviation of most BPH symptoms. The most recent paper detailing this research was published in the journal Andrologia in late 2018, but the surgical solution was the subject of an FDA registered clinical trial which was also reported on in the journal Andrologia in 2008 (the group's paper’s date from 2006 at the earliest with other intervening supporting papers (searches on PubMed will bring up these papers)).
    So what are my conclusions: 1) treatment and prevention of BPH and prostate cancer should focus on simultaneous blocking of the aromatase conversion of testosterone to estrogen, blocking of the the 5-alpha reductase conversion of testosterone to DHT, and enhancement of enzymatic pathways that reduce the body's production of the powerful estrogen metabolite - estradiol and enhance the liver's removal of estrogen, and production of other, weaker and less active estrogen metabolites. Combining the natural compounds diindolmethane, indol-3-carbinol, and calcium-d-glucarate - all available as supplements, accomplishes these objectives. 2) addition of piperlongumine extract to the above “turmeric-piper nigrum” protocol and the 5-alpha reductase and aromatase inhibitors discussed in 1) would also likely be beneficial. The use of black cumin seed oil to replace part of the olive oil might also be advantageous as the thymoquinone and nigellone compounds in black cumin seed oil are known to inhibit prostate cancer cell growth.
    The ignorance and/or dismissal of most prostate cancer researchers of Dr. Gat and Goren's research I attribute to three factors: 1) the research glory, prestige, and money including research grant money is in detailing the molecular and genetic mechanisms of prostate cancer initiation, proliferation, and progression which, it is hoped, will lead to patentable drugs and mucho dinero; 2) the proposal that collapse of the valves in the testicular veins leads to backflow of blood carrying free testosterone into the prostate is assumed by most urologists to be an anatomical impossibility (at least according the anatomy they learned in med school), and 3) the fact the current paradigm has produced an entrenched, highly profitable treatment regimen that is regarded as proven (extends life) and unassailable (settled science - bullcrap - science is never settled) since testosterone was first identified as the growth principle for prostate cancer in 1941 when it was observed that temporary regression of prostate cancers occurred as a consequence of the castration of patients with advanced prostate cancer – which is from where the term “castration resistant prostate cancer” comes. This work was first done on incarcerated criminal patients. Of course, now androgen deprivation drugs are used instead of the knife, but the approach is conducive to one-size fits all treatment protocols (standard-of-care reductionist medicine) that is demanded and rewarded by insurance companies and government healthcare systems and coding protocols. Nutrition and natural medicine be damned. The protocol is “maim and mangle”.
    Now, where should the research really be focused? I would say it should focus on what causes collapse of the valves in the testicular veins. I propose the following causes 1) age-related cellular scenescence of the muscle cells in the values related to aging (60-90% of men get prostate cancer by age 90); 2) nutritional deficiencies, 3) toxin exposures including xenoestrogens, toxic metals including mercury from amalgam fillings and aluminum (municipal treated clarified water, colored coating on drugs, cookware, vaccines; cadmium from food grown with chemical fertilizers; etc.; 4) xenoestrogenic synthetic chemical toxins, and 5) blood sugar and related insulin spikes which are known to damage the endothelial cells lining arteries and blood vessels and by inference also likely damage the valves in the testicular veins.
    More information on nutrition, natural medicine and prostate cancer and BPH can be obtained by googling Ben's Natural Health (to which I have no connection-financial or otherwise) but whose booklet on prostate health started me on my research journey - it contains no mention of Drs. Gat and Goren's research - so don't be disappointed. Another resource for anyone currently dealing with prostate cancer, especially metastatic prostate cancer, is Jane McClelland's recent book, "How to Starve Cancer without Starving Yourself" which goes into the molecular chemistry of this approach to treating and healing cancer, including prostate cancer (again, no connection, financial or otherwise).
    Reply
  • Bambi
    MagmaHombre999 said:
    The suggested biohack using tumeric with black pepper (Piper nigrum) is an interesting one-of case study, and “one-of” reports on the internet of the reversal of PSA levels using nutrition and/or plant compounds/herbals are numerous to say the least. This is just another one but at least one in which the protocol used is well described. My conclusion that there would not be such numerous reports unless there was some veracity to them and that conclusion that nutritional aspects are important and some plant compounds are protective is supported in the research literature - see Dr. William Nelson - John Hopkins Cancer Center 2014 summary paper, “Nutrition and Prostate Cancer”- do the search for his paper on PubMed). However, if you talk to any standard-of-care practicing urologist, they will tell you that nutrition is unimportant. They clearly are oblivious to the research on plant compounds and prostate cancer - just google prostate cancer and piper longumin or silimarin for example. I have found research articles describing anti-prostate canncer activity in over 70 plant compounds and herbals - many from TCM (traditional Chinese medicine), Ayurvedic medicine (TIM - traditional Indian medicine, etc., and including turmeric.
    The current paradigm in treatments for BPH and prostate cancer is either inhibition of 5-alpha reductase (finesteride for example - taken proof that the increase of dihydrotestostorone (DHT) with age is the cause) or surgery (prosectomy) with follow-up of androgen-deprivation drug therapy (which is successful perhaps 70%) of the time (though generally destructive of function) which is taken as proof that testosterone is the driving agent behind prostate cancer. Androgen deprivation therapy is also the initial treatment of choice for metastatic prostate cancer (30% of standard-of-care treated cases). However, androgen deprivation therapy ultimately fails in 2-5 years as the cancer's growth becomes androgen independent and it then become extremely aggressive and rapidly metastatic. Consequently, I have to conclude that the paradigm that testosterone causes prostate cancer is a failed hypothesis. There are numerous, usually ignored scientific papers that point out that the real correlation between BPH and prostate cancer is with low testosterone levels. The testosterone paradigm also ignores the fact that high testosterone levels in young males does not lead to BPH or prostate cancer. In addition, prostate cancer is a uniquely human disease (though I have read on some blogs that dogs also get prostate cancer - something that I haven't confirmed from original research sources). I have read numerous research papers and review papers on prostate cancer and none even reference what I consider the seminal works of the Israeli research group of Dr. Yidal Gat an Dr. M Goren which relate the development of BPH and prostate cancer to the collapse of the valves in the seminal veins with resulting backflow of free testosterone from the testes directly into the prostate resulting in levels of free testosterone in the prostate of up to 130x normal serum testosterone (98% of which in normal blood serum is tied up in in SHBG (sex hormone binding globulin)). Now, 130x normal levels of free testosterone in the prostate cannot be good. However, it is likely that the mechanism by which excessive free testosterone results in excessive growth of the prostate gland is not as simple and direct as the Gat and Goren group assume as on this score they follow the current paradigm.
    My hypothesis is that high levels of free testosterone also trigger a homeostatic response in the body which has the purpose of normalizing the testosterone to estrogen ratio. How does it do this? It increases the aromatase levels in the prostate gland. Aromatase converts part of the testosterone to estrogen (especially to estrodiol – the most potent form) which is known to cause inflammation of the prostate gland (see Dr. Nelson's paper which reviews this research in animals). Research on aromatase show that it is often elevated in many cancers (especially endocrine related cancers and these include prostate cancer) supporting this hypothesis. Another parallel hypothesis that has merit is that exogenous xenoestrogens (plastics, fungicides, pesticides, herbicides, etc) that are ubiquitous in the modern environment are a cause of BPH and prostate cancer. In this case the body attempts to normalize the androgen-estrogen activity ratio by increasing the conversion of testosterone to (estrogen(+ xenoestrogen)) ratio by increasing the 5-alpha-reductase enzyme which converts testosterone to DHT which has 10x the androgen activity level testosterone itself. Most likely both processes are active.
    In Dr. Goren and Gat's research they found increased hydrostatically driven backflow from the testes to the prostate in 902 of 902 case study subjects with diagnosed BPH. They also found that varicocele surgery prevented this backflow in 902 of 902 cases and resulted an average decline in PSA levels of 50% and an average 50% decline in prostate volume at a six month follow-up and resulted in alleviation of most BPH symptoms. The most recent paper detailing this research was published in the journal Andrologia in late 2018, but the surgical solution was the subject of an FDA registered clinical trial which was also reported on in the journal Andrologia in 2008 (the group's paper’s date from 2006 at the earliest with other intervening supporting papers (searches on PubMed will bring up these papers)).
    So what are my conclusions: 1) treatment and prevention of BPH and prostate cancer should focus on simultaneous blocking of the aromatase conversion of testosterone to estrogen, blocking of the the 5-alpha reductase conversion of testosterone to DHT, and enhancement of enzymatic pathways that reduce the body's production of the powerful estrogen metabolite - estradiol and enhance the liver's removal of estrogen, and production of other, weaker and less active estrogen metabolites. Combining the natural compounds diindolmethane, indol-3-carbinol, and calcium-d-glucarate - all available as supplements, accomplishes these objectives. 2) addition of piperlongumine extract to the above “turmeric-piper nigrum” protocol and the 5-alpha reductase and aromatase inhibitors discussed in 1) would also likely be beneficial. The use of black cumin seed oil to replace part of the olive oil might also be advantageous as the thymoquinone and nigellone compounds in black cumin seed oil are known to inhibit prostate cancer cell growth.
    The ignorance and/or dismissal of most prostate cancer researchers of Dr. Gat and Goren's research I attribute to three factors: 1) the research glory, prestige, and money including research grant money is in detailing the molecular and genetic mechanisms of prostate cancer initiation, proliferation, and progression which, it is hoped, will lead to patentable drugs and mucho dinero; 2) the proposal that collapse of the valves in the testicular veins leads to backflow of blood carrying free testosterone into the prostate is assumed by most urologists to be an anatomical impossibility (at least according the anatomy they learned in med school), and 3) the fact the current paradigm has produced an entrenched, highly profitable treatment regimen that is regarded as proven (extends life) and unassailable (settled science - bullcrap - science is never settled) since testosterone was first identified as the growth principle for prostate cancer in 1941 when it was observed that temporary regression of prostate cancers occurred as a consequence of the castration of patients with advanced prostate cancer – which is from where the term “castration resistant prostate cancer” comes. This work was first done on incarcerated criminal patients. Of course, now androgen deprivation drugs are used instead of the knife, but the approach is conducive to one-size fits all treatment protocols (standard-of-care reductionist medicine) that is demanded and rewarded by insurance companies and government healthcare systems and coding protocols. Nutrition and natural medicine be damned. The protocol is “maim and mangle”.
    Now, where should the research really be focused? I would say it should focus on what causes collapse of the valves in the testicular veins. I propose the following causes 1) age-related cellular scenescence of the muscle cells in the values related to aging (60-90% of men get prostate cancer by age 90); 2) nutritional deficiencies, 3) toxin exposures including xenoestrogens, toxic metals including mercury from amalgam fillings and aluminum (municipal treated clarified water, colored coating on drugs, cookware, vaccines; cadmium from food grown with chemical fertilizers; etc.; 4) xenoestrogenic synthetic chemical toxins, and 5) blood sugar and related insulin spikes which are known to damage the endothelial cells lining arteries and blood vessels and by inference also likely damage the valves in the testicular veins.
    More information on nutrition, natural medicine and prostate cancer and BPH can be obtained by googling Ben's Natural Health (to which I have no connection-financial or otherwise) but whose booklet on prostate health started me on my research journey - it contains no mention of Drs. Gat and Goren's research - so don't be disappointed. Another resource for anyone currently dealing with prostate cancer, especially metastatic prostate cancer, is Jane McClelland's recent book, "How to Starve Cancer without Starving Yourself" which goes into the molecular chemistry of this approach to treating and healing cancer, including prostate cancer (again, no connection, financial or otherwise).
    The reason that most urologists would dismiss these febrile musings as nothing more than taking advantage of a known malady to commercially exploit a vulnerable population, is because your so called "facts" are presented non contextually with conclusions based on speculation rather than any substantive findings that are repeatable.You go from hypothesis to conclusions with a breathtaking speed only equaled by your propensity to jump to conclusions not supported by anything other than the narrative you're promoting.
    Reply
  • MagmaHombre999
    Bambi said:
    The reason that most urologists would dismiss these febrile musings as nothing more than taking advantage of a known malady to commercially exploit a vulnerable population, is because your so called "facts" are presented non contextually with conclusions based on speculation rather than any substantive findings that are repeatable.You go from hypothesis to conclusions with a breathtaking speed only equaled by your propensity to jump to conclusions not supported by anything other than the narrative you're promoting.
    Reply
  • MagmaHombre999
    Hmmm. You obviously never bothered to read any of the Israeli research group's papers which provide the evidence for which you are so in desperate need. I could provide you the references but let's see if you are a capable researcher of medical literature. Here, I'll take you by the hand to PubMed and so you can do a search on Dr. Yidal Gat's and Dr. M. Goren's publications. I even gave you the name of the journal in which their publications are found. Hmmm, 902 out of 902 cases of BPH reversed by 50% in 6 months with varicocele surgery. Must be a "febrile musing". A 2008 publication detailing the the results of a FDA registered clinical trial. Must be "febrile musing". The reason most urologists dismiss these "febrile musings" is that they never read any of the research papers (fits the bill for at least two urologist I know). I also recommend peer reviewed papers by Dr. William Nelson (2014) of John Hopkins and Dr. Gann's (PhD) - professor at University of Texas - Lubbock campus and his review of the multiple roles of aromatase (2016). Now, my real "febrile musings" are my musings about why no one ever references the Gat and Goren papers. I challenge you. Read the papers and then provides me your critique about why they have no merit if you are even capable of addressing specifics. Now as to my musings having some relationship to "taking advantage of a known malady to commercially exploit a vulnerable population"? What is it that I am selling? Did I ask for money or point to commercial service? I got no skin in that game. I am not even poking holes in the basic premises of the current "standard-of-care" in diagnoses of BPH and prostate cancer. However, I am pointing that Dr. Yidal Gat and Dr. M. Goren have already done. Its your average urologist treating patients who is taking advantage of a "vulnerable population".
    Reply
  • likota39
    I am glad that this topic is full of serious medical research and conclusions,. At the same time, I know what happened to me, where did I have discomfort and pain, how I feel today, etc. I still suggest that any male over 50 reads my experience carefully and try natural turmeric paste (NOT curcumin capsules).
    Also, please read the British medical results given as a link in my material (BBC‘s ”Trust me, I am a doctor‘ series).
    Anyway, my advice will not harm you in any way. On the contrary.
    Here again:

    https://drive.google.com/open?id=1YTBXynuFrqYAhonjNlZgb2fMXebFmZuA
    Reply