Adenocarcinoma of the prostate is the most common form of cancer diagnosed in the male prostate gland, originating in the glandular cells. Nearly all prostate cancer diagnoses, approximately 99%, are classified as adenocarcinomas, making it the most frequent non-skin cancer in men. Because it often grows slowly, especially in the early stages, it is highly treatable when detected early, contributing to high survival rates.
Pathology and Risk Factors
The prostate is an exocrine gland, and prostatic adenocarcinoma originates in its glandular cells. This involves the uncontrolled growth of epithelial cells. The tumor’s grade, which describes how abnormal the cells appear, predicts its potential for aggression and spread.
Several non-modifiable factors significantly increase the probability of developing this disease. Age is the strongest factor, with most diagnoses occurring in men over 65. Race and ethnicity also play a role, as African American men have a statistically higher incidence and mortality rate compared to other racial groups. A family history, specifically having a father or brother with the disease, roughly doubles an individual’s risk.
Genetic mutations, such as those in the BRCA1 and BRCA2 genes, are also linked to an increased risk, particularly for more aggressive forms. While these elements cannot be changed, certain modifiable lifestyle factors, like obesity and a diet high in red meat, may influence the risk. Understanding these underlying factors helps identify individuals who may benefit most from regular screening.
Detection and Staging
Detection typically begins with two initial screening tools. The Prostate-Specific Antigen (PSA) test measures a protein level in the blood; an elevated level may suggest cancer, an enlarged prostate, or inflammation. A Digital Rectal Exam (DRE) allows a physician to manually feel the prostate gland for firm areas or nodules.
If screening results are concerning, a prostate biopsy confirms the diagnosis and collects tissue samples for analysis. The pathologist uses the Gleason grading system to assess the cancer’s aggressiveness by evaluating the cellular architecture. This score is determined by adding the two most common cellular patterns seen in the biopsy, ranging from 6 (least aggressive) to 10 (most aggressive).
The Gleason score, PSA level, and imaging results determine the clinical stage using the Tumor, Node, Metastasis (TNM) system. The T category describes the size and local extent of the primary tumor, such as whether it is confined to the prostate (T1/T2) or has extended through the capsule (T3). The N category indicates spread to nearby lymph nodes, and the M category notes distant metastasis. This comprehensive staging directly informs the selection of the most appropriate treatment strategy.
Treatment Approaches
Treatment is highly personalized, considering the cancer’s stage, the patient’s age, and overall health. For low-risk, localized disease, Active Surveillance is often recommended. This involves closely monitoring the cancer through regular PSA tests, DREs, and repeat biopsies. Treatment occurs only if the disease progresses, helping to defer or avoid the side effects of immediate intervention.
Local Therapies
When immediate intervention is necessary for localized disease, local therapies aim to remove or destroy the tumor within the prostate. Radical prostatectomy is a surgical procedure involving the complete removal of the prostate gland, sometimes including the seminal vesicles. This surgery can be performed through an open incision or minimally invasively using robotic assistance.
Radiation therapy is another common local approach using high-energy rays to kill cancer cells. External beam radiation delivers radiation from a machine outside the body, precisely targeting the prostate. Brachytherapy involves placing small radioactive seeds directly into the prostate tissue for continuous, localized delivery. Both methods effectively eradicate cancer confined to the prostate.
Systemic Therapies
For cancer that has spread or recurred, systemic therapies treat the entire body. Hormone therapy, or Androgen Deprivation Therapy (ADT), is the mainstay. Since prostate cancer cells rely on male hormones like testosterone to grow, ADT reduces the body’s androgen levels or blocks their action. This causes cancer cells to shrink or die, though it is not typically curative.
ADT often involves injections of luteinizing hormone-releasing hormone (LHRH) agonists or antagonists, which stop the testicles from producing testosterone. While effective, prostate cancer can eventually become resistant to this approach, leading to castration-resistant prostate cancer. Other systemic treatments for advanced disease include chemotherapy, which uses drugs to kill rapidly dividing cells throughout the body.
Survivorship and Long-Term Monitoring
After completing initial treatment, long-term monitoring checks for disease recurrence, primarily through routine measurement of the Prostate-Specific Antigen (PSA) level. Following radical prostatectomy, the goal is an undetectable PSA level; any rise indicates biochemical recurrence.
Following radiation therapy, recurrence is defined as a PSA rise above a threshold, typically 2.0 ng/mL above the lowest point achieved after treatment. PSA tests are usually performed every six to twelve months for the first five years, then annually. The survivorship care plan depends heavily on the original cancer stage and the type of treatment received.
Survivorship also involves managing long-term side effects resulting from treatment. Common quality of life issues include changes in urinary function, such as incontinence, and sexual function, including erectile dysfunction. Bowel issues can also occur, particularly following radiation therapy due to the prostate’s proximity to the rectum. Support and rehabilitation services are often recommended to help men manage these physical and psychological effects.