Introduction

Prostate cancer is the uncontrolled malignant growth of cells in the prostate gland (UCLAHealth, 2020). The prostate gland is a walnut sized gland in men, that can be found below the kidney, in between the penis and the bladder. The prostate gland produces and stores fluid that nourishes and transports sperm, aids urine control and secretes Prostate Specific Antigen (PSA) (Yvette, 2019). Prostate cancer is one of the most common types of cancer in males, but is usually highly treatable if caught early enough (Yvette, 2019). Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly (AskMayoExpert, 2018).

The Economic Burden and Impact of Prostate Cancer

The economic burden of prostate cancer is substantial and growing. The diagnosis of new cases has been increasing at an exponential rate since 1990, largely as the result of increased use of prostate-specific antigen (PSA) testing for screening (levy, 1998). New diagnostic and therapeutic procedures — testing for total PSA and free PSA, nerve-sparing radical prostatectomy, cryotherapy, gene therapy and others — continue to be developed and widely used. These will inevitably put additional demands on our health care resources. Health care needs are unlimited, whereas resources are finite. Public expenditures on health care have to compete with other societal priorities such as education, the environment, defence and infrastructure (Steven, 1999). Age-standardized incidence rates for prostate cancer  ranged from 4.5 to 170.2 cases per 100,000 males per year, and was 110.8 per 100,000 males per year in the EU. The annual percentage increase in prostate cancer ranged from 2.8% in Australia to 8.6% in China. The cost of Prostate cancer management in Europe was highest in France (EUR 722 million). Key cost drivers were identified as the initial year of care, radical prostatectomy, and terminal care (Rowena, 2007)

Relevant Statistics on Prostate Cancer

Figure 1: Distribution of incidence and deaths for the top 10 most common cancers among men and women in 2020. (Source: Globocan 2020)

Figure 1 above, shows that there were 1,408,900 new cases of prostate cancer in the year 2020. This resulted in 376,800 (3.8%) deaths, this is relatively low when compared with the 1,782,000 (18.0%) deaths resulting from lung cancer.

Figure 2: Estimated number of prevalent cases (5-year) worldwide, among males 0-84 years in 2020. 
Source: GLOBOCAN, 2021

Figure 2 above, shows that prostate cancer had the highest prevalence cases 4,617,606 (20.1%) worldwide among males between the ages 0-84 years when compared with other cancers between the years 2016 – 2020.

Figure 3: Estimated number of prevalent cancer cases (5-year) among African males aged 0-84 in 2020. 
Source: GLOBOCAN, 2021

Figure 3 above, shows that prostate cancer had the highest prevalence with 168,696 (35.0%) cases out of 474,169 cancer cases among African males between the ages 0 – 84 from the year 2016 – 2020.

Figure 4: Estimated number of deaths from prostate cancer in males aged 0-84 in 2020. 
Source: GLOBOCAN, 2021

An estimated 59% (8,382) of deaths in the year 2020 were as a result of prostate cancer (GLOBOCAN, 2021). Additionally, Nigeria had the highest number of deaths from prostate cancer in 2020 with 8,382 (58.5%) deaths out of 14,334 (fig 4).

Other noteworthy facts include:

1, 1 out of 8 men will be diagnosed with prostate cancer during his lifetime. 

2, Prostate  cancer is more likely to develop in older non-hispanic black men. 

3, 6 in 10 cases of prostate cancer are diagnosed in men of the ages 65 or older (Noone, 2018). The incidence rate is nearly 60% in men over the age of 65 years (SEER, 2018). The mortality rate of prostate cancer rises with age, and almost 55% of all deaths occur after 65 years of age (Ferlay, 2019)

4, Although only 1 in 350 men under the age of 50 years will be diagnosed with prostate cancer (Perdana, 2016), the incidence rate increases up to 1 in every 52 men for ages 50 to 59 years.

Figure 5: Region-specific incidence and mortality age-standardized rates for prostate cancer in 2020. (Source: GLOBOCAN, 2020)

In figure 5, above we see that Northern Europe had the highest incidence of 83.4 per 100,000 and a mortality rate of 13.0 per 100,000 in 2020, while Western Africa had an incidence rate of 33.1 per 100,000 while the mortality rate was 20.2 per 100,00. South central Asia on the other hand has the lowest incidence rate of 6.3 per 100,000 and also the lowest mortality rate.

Stages Of Prostate Cancer

In order to be better informed and make decisions about treatment, one must know the various stages of prostate cancer.

1, Stage 0: Precancerous cells are present, but they only affect a small area and are slow growing.

2, Localized (stage 1): Cancer is only present in the prostate gland. Effective treatment is possible at this stage.

3, Regional (stages 2–3): Cancer has spread to nearby tissues.

4, Distant (stage 4): Cancer has spread to other parts of the body, such as the lungs or bones (Yvette, 2019).

Below is the prostate cancer 5 year survival rate depending on the stage:

1, Localized – nearly 100%

2, Regional -Nearly 100%

3, Distant – 30% (American Cancer Society, 2021).

What Are The Causes Of Prostate Cancer?

Prostate cancer doesn’t have a clear cause, it usually develops as a result of specific changes to the glandular cells. Prostatic Intraepithelial Neoplasia (PIN) is the name given to cancerous cells present in the prostate gland. They are usually of 2 types: High and Low grade cells. The high grades are more likely to grow and spread, while the low grades are not (Yvette,  2019)

Risk Factors For Prostate Cancer

Age: The risk increases after the age of 50, but it is rare before the age of 45.

Race or ethnicity: It is more common in black males than white males. Asian and Hispanic males have a lower risk than black males or white males.

Family history: If a male has a close relative with a history of prostate cancer, they have a higher chance of developing it themselves (Sarto, 2019)

Genetic factors: Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk. Mutations in these genes increase the chance of breast cancer in females, too. Men born with Lynch syndrome also have a higher risk of prostate and other cancers (Cheng, 2019).

Diet: Men who eat a lot of dairy products and calcium have a slightly higher chances of getting prostate cancer

Obesity (Yvette, 2019).

Smoking: Active and passive exposure to cigarette smoke are considered carcinogenic for many human cancers (IARC, 2004).

Exposure to chemicals, such as the herbicide Agent Orange

Inflammation of the prostate gland

Sexually transmitted infections

Vasectomy

Signs and Symptoms

It is very common for symptoms not to appear during the early stages of Prostate cancer. But men who experience symptoms may notice the following:

1, Difficulty starting and maintaining urination

2, A frequent urge to urinate, especially at night

3, Blood in the urine or semen

4, Painful urination

5, In some cases, pain on ejaculation

6, Erectile dysfunction

7, Pain or discomfort when sitting, if the prostate is enlarged (Yvette, 2019).

Men at the more advanced stage of prostate cancer experience the following symptoms:

1, Bone fracture or bone pain, especially in the hips, thighs, or shoulders

2, Edema, or swelling in the legs or feet

3, Weight loss

4, Tiredness

5, Changes in bowel habits

6, Back pain (Yvette, 2019).

Prostate Cancer Screening

Screening involves a test that measures levels of PSA in the blood. High levels suggest that cancer may be present. Digital rectal exam can also be used as a screening test.

Figure 6: Results of screening 1,000 men with the PSA Test (CanadianTaskForce, 2021)

Diagnosis

If a male has symptoms that may indicate prostate cancer, the doctor will likely:

1, Ask about symptoms

2, Ask about personal and medical history

3, Conduct a blood test to assess PSA levels

4, Carry out a urine test to look for other biomarkers

5, Carry out a physical examination, which may include a digital rectal exam (DRE) (Cancer.Net, 2020)

If a doctor suspects cancer, they may recommend further tests, such as:

1, A PCA3 test: This looks for the PCA3 gene in the urine.

2, A transrectal ultrasound: This involves inserting a probe with a camera into the rectum.

3, Biomarker tests:  A biomarker is a substance that is found in the blood, urine, or body tissues of a person with cancer. Biomarker tests for prostate cancer include the 4Kscore, which predicts the chances someone will develop high-risk prostate cancer, and the Prostate Health Index (PHI), which predicts the chances someone will develop prostate cancer.

4, A biopsy: A doctor will take a tissue sample for examination under a microscope. Only a biopsy can confirm the presence and type of cancer (Woodrum, 2016)

A person who needs monitoring rather than treatment may need a routine Magnetic Resonance Imaging (MRI) test or Computerized Tomography (CT) scan (Cancer.Net, 2020)

Figure 7: Prostate cancer diagnosis

Complications

Complications of prostate cancer and its treatments include:

1, Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as the bladder, or travel through the bloodstream or lymphatic system to the bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. 

2, Incontinence. Both prostate cancer and its treatment can cause urinary incontinence.

3, Erectile dysfunction. Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments (AsMayoExpert, 2018).

Prevention 

1, Eat a healthy diet full of fruits and vegetables.

2, Maintain healthy weight

3, Exercise most days of the week (Rock, 2020)

4, Talk to doctor about increased risk of prostate cancer

5, Choose healthy meals over supplements (Mayoclinic, 2021)

Treatment

Prostate cancer treatment options depend on several factors, such as how fast the cancer is growing, whether it has spread and the affected person’s overall health, as well as the potential benefits or side effects of the treatment.

Early stage prostate cancer, if small and localized, will lead the doctor to recommend the following:

1, Watchful waiting or monitoring: The doctor may check PSA blood levels regularly but take no immediate action.

2, Surgery: A surgeon may carry out a prostatectomy. They can remove the prostate gland using either laparoscopic or open surgery.

3, Radiation therapy: Brachytherapy which involves the doctor implanting radioactive seeds to deliver targeted radiation treatment. Conformal radiation therapy (MayoClinic, 2021)

As the cancer grows and spread throughout the body, the treatment plan will change to the following:

1, Hormonal therapy: Blocking and reducing testosterone and dihydrotestosterone delays or stops the growth of cancerous cells.

2, Chemotherapy: This usually kills cancer cells around the body. Although it comes with certain adverse effects.

3, Cryotherapy

4, High intensity focused ultrasound. 

5, Immunotherapy: Uses the immune system to fight cancer (MayoClinic, 2021)

Conclusion

After receiving a diagnosis of prostate cancer, the affected person will most likely experience a range of emotions. Everyone eventually comes to term with their situation and finds ways to deal with it but in the meantime they can try the following to guide them along the way:

1, Learn everything there is to know about prostate cancer, especially their specific diagnosis, in order to feel more comfortable and at ease with whatever treatment is eventually decided on.

2, Keep friends and family close. A very strong support system before, during and after treatment is necessary. This is because the whole ordeal can be very stressful and overwhelming and one will eventually need people to lean on.

3, Connect with other cancer patients and survivors. Doing this will make one feel less alone and instigate hope.

4, Some of the treatments can be draining, so the body needs to be in tip state to withstand the treatments. This can be done by eating healthy, exercising and getting enough sleep.

Reference

(IARC) IAfRoC. IARC monographs on the evaluation of carcinogenic risks in human 83. Lyon, France: IARC Press; 2004. Tobacco smoke and involuntary smoking

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

AskMayoExpert. Prostate cancer (adult). Mayo Clinic; 2018.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. [PubMed] [CrossRef] [Google Scholar]

Cancer.Net. (2020). Prostate cancer: Diagnosis. https://www.cancer.net/cancer-types/prostate-cancer/diagnosis

Cheng HH, Nelson PS. Genetic risk factors for prostate cancer. UpToDate. 2019. Accessed at https://www.uptodate.com/contents/genetic-risk-factors-for-prostate-cancer on March 19, 2019.

Cheng HH, Nelson PS. Genetic risk factors for prostate cancer. UpToDate. 2019. Accessed at https://www.uptodate.com/contents/genetic-risk-factors-for-prostate-cancer on March 19, 2019.

Ferlay J EM, Lam F, Colombet M, Mery L, Pineros M, Znaor A, Soerjomataram I. et al. Global cancer observatory: cancer today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, 

Hyuna S, Jacques F ,Rebecca L, Mathieu L, Isabelle S, Ahmedin J, Freddie B. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. ACS Journals, 71(3): 209-249.

Levy IG, Iscoe NA, Klotz LH. Prostate cancer: 1. The descriptive epidemiology in Canada. CMAJ 1998;159(5):509-13

MayoClinic. (2021). Prostate Cancer. https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087 

National Cancer Institute. Physician Data Query (PDQ). Prostate Cancer Prevention. 2019. Accessed at https://www.cancer.gov/types/prostate/hp/prostate-prevention-pdq on March 21, 2019.

National Cancer Institute. Physician Data Query (PDQ). Prostate Cancer Prevention. 2019. Accessed at https://www.cancer.gov/types/prostate/hp/prostate-prevention-pdq on March 21, 2019.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Niederhuber JE, et al., eds. Prostate cancer. In: Abeloff’s Clinical Oncology. 6th ed. Elsevier; 2020. https://www.clinicalkey.com. 

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

Perdana NR, Mochtar CA, Umbas R, Hamid AR. The Risk Factors of Prostate Cancer and Its Prevention: A Literature Review. Acta Med Indones. 2016;48(3):228–238. 

Rock CL, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians. 2020; doi:10.3322/caac.21591

Rowena N; Folakemi O; Ellen C; Hong X; Margareth L, Abraham H; Patricia Corey-Lisle. (2007). The economic burden of prostate cancer: A comparison of African American and Caucasian men. First AACR International Conference on the Science of Cancer Health Disparities– Nov 27-30, 2007; Atlanta, GA. 16(11).

SEER Cancer Statistics Review, 1975-2013 [Internet]. National Cancer Institute, Bethesda, MD. 2016. Available from: https://seer.cancer.gov/csr/1975_2015/.

Steven A; Hanna Z; Louis Co; Murray D. (1999). Prostate cancer: 12. The economic burden. Canadian Medical Association Journal, 160 (5).

UCLA Health. (2020). What is Prostate Cancer?. https://www.uclahealth.org/urology/prostate-cancer/what-is-prostate-cancer 

Woodrum DA, et al. Targeted prostate biopsy and MR-guided therapy for prostate cancer. Abdominal Radiology. 2016; doi:10.1007/s00261-016-0681-3.

Yvette Brazier, Seunggu H. (2019).  What to know about prostate cancer. Medical News Today. https://www.medicalnewstoday.com/articles/150086.