Adenocarcinoma of the prostate is a cancer originating in the gland cells of the prostate. This gland, located below the bladder in males, produces some of the fluid in semen. When these gland cells grow uncontrollably, they can form a tumor.
It is the most prevalent type of cancer affecting the prostate gland. The growth rate of these cancers can vary significantly; some grow very slowly and may not cause problems for many years, while others can be more aggressive. Most cases tend to be slower-growing and present a lower risk.
Detection and Diagnosis
Initial detection of prostate adenocarcinoma often begins with screening tests. A common first step is the Prostate-Specific Antigen (PSA) blood test, which measures a protein from the prostate gland. Elevated levels can suggest cancer, although other conditions can also cause a high PSA. Another primary screening tool is the Digital Rectal Exam (DRE), where a physician manually checks the prostate for any hard or lumpy areas.
If initial tests raise concerns, a prostate biopsy is required to make a definitive diagnosis. During this procedure, a small needle is used, often guided by ultrasound, to collect several tissue samples from the prostate gland for analysis. Imaging tests may also be used to get a clearer picture of the prostate.
A pathologist examines the collected tissue to determine if cancer cells are present. If cancer is confirmed, the pathologist assigns a Gleason score based on how abnormal the cell patterns appear compared to healthy tissue. This score indicates the cancer’s aggressiveness and helps predict how quickly it is likely to grow and spread.
Cancer Staging
Once a diagnosis is confirmed, staging determines the extent of the cancer and whether it has spread. This process combines results from the biopsy, PSA levels, and DRE to create a comprehensive picture of the cancer’s status. This information is categorized using the TNM (Tumor, Node, Metastasis) system.
The stage falls into one of three general categories. Localized cancer is confined entirely within the prostate gland and has not breached its outer capsule. When the cancer has grown through the prostate capsule and may have invaded nearby tissues, such as the seminal vesicles, it is considered locally advanced.
The most advanced stage is metastatic cancer, which means the cancer has spread to distant parts of the body. Prostate cancer cells can travel through the lymphatic system or bloodstream to form new tumors elsewhere. Common sites for metastasis include the lymph nodes and bones.
Treatment Approaches
Treatment decisions for prostate adenocarcinoma are tailored to the individual, based on the cancer’s characteristics and the patient’s overall health. For slow-growing, low-risk cancers that are not causing symptoms, active surveillance may be recommended. This approach involves regular monitoring with PSA tests, exams, and periodic biopsies to track the cancer’s progress, initiating treatment only if it shows signs of progression.
Surgery is a common treatment, especially when the cancer is confined to the prostate. The standard surgical procedure is a radical prostatectomy, which removes the entire prostate gland and some surrounding tissue. This can be performed as an open surgery or through minimally invasive techniques, such as robotic-assisted laparoscopic surgery.
Radiation therapy uses high-energy rays to destroy cancer cells. It can be delivered through external beam radiation, where a machine directs radiation at the prostate, or through brachytherapy, which involves placing small radioactive seeds directly inside the gland. Sometimes, these methods are used in combination or following surgery to eliminate any remaining cancer cells.
For more advanced cancers or those that have spread, systemic treatments are used. Hormone therapy, also known as Androgen Deprivation Therapy (ADT), lowers the levels of male hormones, called androgens, that fuel prostate cancer cell growth. Chemotherapy involves using powerful drugs to kill cancer cells and is reserved for advanced cases or when hormone therapy is no longer effective.
Factors Influencing Prognosis
A patient’s prognosis is influenced by several factors identified during diagnosis and staging. The cancer’s stage is a primary determinant; a localized tumor has a more favorable outlook than one that has metastasized.
The Gleason score from the biopsy also heavily influences the prognosis. Lower scores indicate less aggressive cells that are less likely to grow quickly, while higher scores suggest a greater potential for rapid growth and spread.
The PSA level at diagnosis is also important, as a very high level can indicate a larger tumor or more advanced disease. Together, the stage, Gleason score, and PSA level are used to stratify the cancer into risk groups (low, intermediate, or high). This risk assessment helps predict the cancer’s likely behavior.