Prostate cancer

Prostate cancer is a common type of cancer in men in Romania (the third most common cancer affecting men) with about 4,000 new cases diagnosed each year.

Prostate cancer usually develops slowly, so there may be no signs of prostate cancer for several years.

Symptoms of prostate cancer

Normally, prostate cancer doesn’t show symptoms until the cancer has grown enough to put pressure on the urethra. This results in urination-related problems.

Symptoms may include:

  • The need to urinate more frequently, often during the night;
  • The need to go to the toilet;
  • Difficulty starting to urinate or urination (hesitancy);
  • Difficulty urinating (dribbling) or a long duration during urination;
  • Jet slab;
  • Feeling that the bladder has not emptied completely.

These symptoms should not be ignored, but neither does it mean with certainty that you have prostate cancer. Many men’s prostates enlarge as they get older as a result of a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia.

Symptoms that may indicate the spread of cancer include bone and back pain, loss of appetite, pain in the testicles and unexplained weight loss.

Causes and risk factors in prostate cancer

It is not known exactly what causes prostate cancer, but there are a number of risk factors that lead to prostate cancer.These include:


The risk increases with age, with most cases being diagnosed in men over 50.

Family history

A close male relative – such as a brother, father or uncle – who has had prostate cancer appears to increase the risk of developing the disease. Research also shows that having a female relative who has developed breast cancer can also increase the risk of developing prostate cancer.


Recent research suggests that there may be a link between obesity and prostate cancer.

Physical activity

Men who are physically active on a regular basis have been found to have a lower risk of developing prostate cancer.


Research into the link between diet and prostate cancer is ongoing. There is evidence that a diet high in calcium is linked to an increased risk of developing prostate cancer.

In addition, some research has shown that the number of cases of prostate cancer is lower in men who eat foods containing certain nutrients such as lycopene, found in tomatoes and other red fruits, and selenium, found in Brazil nuts.In addition, some research has shown that the number of cases of prostate cancer is lower in men who eat foods containing certain nutrients such as lycopene, found in tomatoes and other red fruits, and selenium, found in Brazil nuts.

Diagnosing prostate cancer

If you have symptoms that could be caused by prostate cancer, you should see a doctor or urologist.

There is no single definitive test for prostate cancer, so your doctor may ask you to undergo the following tests:

  • Urine sample to check for infection;
  • Prostate-specific antigen (PSA) blood test;
  • Examination of the prostate (digital rectal examination/ rectal examination).

Prostate specific antigen (PSA) testing

Prostate-specific antigen (PSA) is a protein produced by the prostate gland. All men have a small amount of PSA in their blood and this increases with age.

Since prostate cancer can increase PSA production, prostate-specific antigen (PSA) testing detects elevated PSA levels in the blood that could be a sign of early-stage disease.

However, PSA testing is not a specific test for prostate cancer. Most men who have prostate cancer will not have a high PSA level. More than 65% of men with high PSA levels will not get cancer, as PSA levels rise in all men as they get older.


The urologist assesses the risk of developing prostate cancer based on a number of factors, including PSA levels, digital rectal examination results and age, family history. If you are at risk of prostate cancer, you will be referred to a hospital/oncologist to discuss options for further testing.The most commonly used test is transrectal ultrasound biopsy (TRUS).

During this biopsy, an ultrasound probe (a device that uses sound waves to build up an image of the inside of the body) is inserted into the rectum. It allows the doctor or specialist nurse to see exactly where to insert the needle through the wall of the rectum to take small samples of prostate tissue.

Examining the Gleason score

Tissue samples from the biopsy are studied in a laboratory. If cancer cells are found, they can be studied further to see how quickly the cancer will spread.

This measure is known as the Gleason score. The lower the score, the less likely the cancer is to spread.

  • A Gleason score of 6 or less means that cancer is unlikely to spread;
  • A Gleason score of 7 means that there is a moderate chance of the cancer spreading;
  • A Gleason score of 8 or higher means that there is a high chance of the cancer spreading.

Additional tests

If there is a good chance that the disease has spread from the prostate to other parts of the body, further tests are recommended.

These include a Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan – these examinations build up a detailed picture of the inside of the body.

Stages of prostate cancer

Doctors will use the results of the prostate examination, biopsy and scans to identify the ‘stage’ of the prostate cancer (how far the cancer has spread). The stage of the cancer will determine what types of treatment will be needed. It is a relatively complex system, reflecting the many types of prostate cancer.

Doctors identify the stage of prostate cancer using the TNM system (tumour, nodule, metastasis):

  • “T” describes the tumour: whether it can be felt on DRE, how much cancer was found at the time of biopsy (Gleason score) and whether it has spread from the prostate gland to nearby tissues.
  • “N” indicates whether the disease has spread to the lymph nodes (where the lymph fluid circulating through the body is filtered and where cancer often spreads).
  • “M” indicates whether the disease has spread (metastasized) to other parts of the body.

Sometimes a simpler numerical staging system is used. The stages are:

  • Stage 1 – the cancer is very small and entirely in the prostate gland.
  • Stage 2 – the cancer is in the prostate gland, but is larger.
  • Stage 3 – the cancer has spread from the prostate and may have grown into the tubes that carry sperm.
  • Stage 4 – the cancer has spread to the lymph nodes or elsewhere in the body, including the bladder, rectum or bones; about 20-30% of cases are diagnosed at this stage.

Treating prostate cancer

The treatment you receive for prostate cancer will depend on your individual circumstances.

For many men with prostate cancer, no treatment is needed. Good care will mean following the cancer, making sure it doesn’t develop into a fast-growing cancer.

When treatment is necessary, the aim is to cure or control the disease so that it does not shorten life expectancy and affects daily life as little as possible. Sometimes, if the cancer has already spread, the aim is not to cure it, but to prolong life and delay symptoms.

People with cancer need to be cared for by a multidisciplinary team. This is a team of specialists working together to provide the best treatment and care and to make decisions within the Oncology Commission. The decision will take into account:

  • Type and size of cancer;
  • General health;
  • If the disease has spread to other parts of the body.

The main treatments for prostate cancer are as follows:

  • Surgery/ prostatectomy;
  • Radiotherapy;
  • Hormone therapy.

Other treatments include:

  • Brachytherapy;
  • Chemotherapy (for example, if the disease has spread to other parts of the body);
  • Cryotherapy;
  • Steroids (dexamethasone).

Surgery to treat prostate cancer

Radical prostatectomy is the surgical removal of the prostate gland. This treatment is an option for curing localised prostate cancer and locally advanced prostate cancer.

Like any operation, this surgery carries some risks and there may be side effects:

  • Some men have problems with urinary incontinence. This can range from urinating just a few small drops to passing large amounts of urine. However, for most men, these effects usually disappear within 3-6 months after surgery. About 2 in 10 men have long-term problems requiring the use of tampons.
  • Some men have trouble getting an erection. For some men, this improves over time, but about half of men will have long-term problems..

For many men, having a radical prostatectomy will get rid of cancer cells. However, for about 1 in 3 men, the cancer cells may not have been completely removed and are likely to return some time after surgery.

Studies have shown that radiotherapy after prostate removal surgery can increase the chance of cure (risk of death reduced by 60% – source

After a radical prostatectomy, you will no longer ejaculate during intercourse. This means that you will no longer be able to have children through sexual contact. However, you can ask your doctors about storing a sperm sample before surgery so that it can be used later for IVF (in vitro fertilisation).

Radiation therapy to treat prostate cancer

This treatment involves using radiation to destroy cancer cells. Radiotherapy is an option for curing localised and locally advanced prostate cancer. New developments in radiotherapy (IMRT and VMAT) make this treatment method a serious alternative to surgery. Today, prostate cancer patients no longer have to undergo surgery to be cured. In Western Europe and the United States, radiotherapy is used exclusively.

Radiotherapy can also be used in very advanced stages to slow the progression of metastatic prostate cancer and relieve symptoms.

With the latest IMRT-VMAT technology, it is now possible to protect at-risk organs that are close to the tumour from being affected by the treatment itself.

Radiotherapy is normally administered on an outpatient basis at a nearby hospital. It is administered in short sessions 5 days a week, from four to eight weeks.

Radiotherapy may be used:

  • As an initial treatment for cancer that is still confined to the prostate gland. Treatment success rates for men with this type of cancer are about the same as for men who opt for radical prostatectomy.
  • Before the operation to shrink the size of the tumor which will facilitate the work of the surgeon
  • After surgery, if the cancer has not been completely removed or has recurred.
  • If the disease is very advanced, to reduce the size of the tumour and provide relief from present pain and possible further symptoms.

Short-term side effects of radiotherapy may include:

  • Discomfort around the rectum and anus;
  • Diarrhoea;
  • Pubic hair loss;
  • Fatigue;
  • Cystitis.

Posibilele efecte secundare pe termen lung pot include:

  • Incapacitatea de a obţine o erecţie – acest lucru afectează aproximativ o treime dintre bărbaţi.
  • Incontinenţă urinară – acest lucru afectează aproximativ 1 sau 2 din 10 bărbaţi.

Hormonal therapy to treat prostate cancer

Hormone therapy is often used in combination with radiotherapy. For example, you can do hormone therapy before radiotherapy to increase the chances of successful treatment. Or hormone therapy may be recommended after radiotherapy to reduce the chances of cancer cells returning.

Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. The aim of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping the body from using testosterone.

There are three ways of administering hormone therapy:

  • Injections to stop the body from producing testosterone, called luteinizing hormone-releasing hormone agonists (LHRH)
  • Pills to block the effects or reduce the production of testosterone, called antiandrogen treatment.
  • Combined LHRH antiandrogen treatment.

Principalele efecte secundare ale tratamentului hormonal sunt cauzate de efectul acestora asupra testosteronului. De obicei, ele dispar la încetarea tratamentului. Efectele secundare includ pierderea apetitului sexual şi disfuncţie erectilă (acest efect este mai frecvent la tratamentul cu agonişti LHRH decât la tratamentul antiandrogen).

Alte efecte secundare posibile:

  • Bufeuri;
  • Transpiraţie;
  • Creştere în greutate;
  • Umflarea sânilor.

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