Today’s video is about a disease that occurs exclusively in males. It is about prostate cancer. You may be a female watching us today to help a husband, brother, or a father who has been diagnosed with this disease. So, let’s start from the very beginning. 

What is the Prostate? 

The prostate is a gland that is part of the male reproductive system. It is located just below the bladder, in front of the rectum and surrounding the upper urethra; which is the tube that empties urine from the bladder. The prostate has the size of a walnut and its secretions make up a part of the semen that nourishes and transports sperms. 

As men age, they usually experience an enlargement of the prostate size. This increase in size causes the urethra to narrow and, subsequently, decrease urine flow. This condition is known as Benign prostatic hyperplasia and it is not the same as prostatic cancer. 

So, what is prostatic cancer? And what is the difference between it and benign prostatic hyperplasia?

When we say the term ”Cancer”, we generally mean uncontrollable abnormal division and growth of specific body part cells. Therefore, prostate cancer is the uncontrollable growth that starts in the prostate gland. 

Prostate cancer is one of the most common types of cancer. It is so common that it is the second most frequent cancer diagnosis made in men, and the fifth leading cause of death worldwide. 

The difference may now be clear between prostate cancer and benign prostatic hyperplasia whereas in benign hyperplasia or growths:

• They rarely turn malignant.
• They don’t invade tissue around them.
• They don’t spread to other body parts.
• They can be removed. 

While in cancerous growths:

• It is a threat to life sometimes. 
• May spread to other body parts. 
• Can invade nearby healthy tissue. 
• Often can be removed but it may grow back again. 

But what causes Prostate Cancer?

Cancers are not usually clear in their origin. It is multifactorial. But scientists have agreed that cancers mostly develop when a mutation occurs in the cells’ DNA. Cell DNA represents the guideline of cell behaviour. It tells the cell all the instructions, when to divide, when to stop, and even when to die. With cancers, mutations of the DNA tell the cells to divide and grow without stopping. The accumulation of these dividing cells forms the tumor mass. And so is the case with prostate cancer. 

However, researchers have identified some risk factor for getting prostate cancers, such as:

• Age. the older the age, the higher the risk of getting prostate cancer as it is most common after age 50. 
• Race. For undetermined reasons, black people have a higher risk of getting prostate cancer than other races. It is also in that race that the tumor is more likely to be more aggressive.
• Smoking. Studies show that prostate cancer risks double for heavy smokers. 
• Family history. This factor is a general role in any type of cancer. If a biological relative has prostate cancer, one is at a higher risk. 
• Obesity. Obese people have a higher risk of prostate cancer compared to people with a healthy weight. 

Now as we explained prostate cancer and its risk factors, it is time to dive into the course of the disease. 

Many prostate cancers grow slowly and are confined to the prostate gland where they don’t cause serious or fatal harm. While other types grow and metastasize very quickly and are more aggressive. But, naturally, the earlier the detection of the tumor- when it is still confined to the gland - the better the likelihood of success of the treatment. Prostate cancer may not have symptoms in its early stages. However, in more advanced cases it may show:

• Bone pain in the back, hips, or pelvis. 
• Erectile dysfunction. 
• Painful or burning urination.
• Difficulty starting urination.
• Difficulty to completely empty the bladder. 
• Blood in the urine.
• Blood in the semen.
• A weak or interrupted flow of the urine. 
• Unintentional weight loss. 
• Frequent urination especially at night. 
• Painful ejaculation. 

But you should keep in mind that these symptoms might occur with other conditions. And that’s why there is a screening test for prostate cancer to detect it early and to differentiate it from other conditions. 

There is a prostate-made substance called the “Prostate-Specific Antigen” or PSA for short. The screening includes a blood test that measures the blood level of PSA. As a rule, a high level of PSA means there is a problem in the prostate. Your doctor can interpret this level accordingly or even ask for further investigations such as biopsy, ultrasound, or MRI to rule cancer out. Another screening test is the “Digital Rectal Examination” where the doctor inserts a gloved lubricated finger into the rectum to examine the prostate. 

But what happens next, what if the investigations showed that there is cancer? 

The next step is probably staging. When the biopsy confirms the presence of cancer, doctors need to know the level of aggressiveness of the tumor, in other words, its stage, to decide which treatment plan is best for the patient. The following step is to investigate for any distant metastasis by imaging tests such as bone scan, ultrasound, CT, or MRI.

If you have been diagnosed with prostate cancer, you will probably start searching about the best lines of treatment, recent guidelines, options of affordable treatment, and rates of treatment success. 

This process is time-consuming and could be very frustrating, especially if you don’t know where to start. Surfing the internet may give you a general idea about your disease, however, it will not give you a customized personal plan for your situation. 

So, is there a treatment? Yes, there is, but it depends on several factors such as how fast your cancer grows, the extent of spread, and your overall health. 

For low-grade cancer prostate, treatment may not be necessary. Regular follow-up by blood tests, rectal exams, and prostate biopsies will be performed to monitor the progression of your tumor. 

Treatment options for prostate cancer are: 

1. Surgery to remove the tumor. It is the treatment option for tumors confined to the gland where they remove the whole gland and some lymph nodes; a surgery known as Radical prostatectomy. 
2. Radiation therapy. It’s using high-powered energy to kill cancer cells. It’s further divided into “External beam radiation” which is an option for cancers confined to the gland. It can also be used after surgery to make sure that all cancerous cells have been eradicated. The other type is “Brachytherapy”, whereby radiation is placed inside the patient’s body. It is also an option for tumors that haven’t spread beyond the prostate. 
3. Hormone therapy. Prostate cancer cells depend on testosterone to grow. Hormone therapy cuts off testosterone which results in cancer cell death or slow growth. 
4. Chemotherapy. It is using drugs to kill rapidly growing cancer cells, especially in cancers that have spread to other body parts. 
5. Freezing or heating prostate tissue. This technique is an ablative therapy that destroys cancer cells with heat or cold. Options include freezing the prostate tissue by using a very cold gas, then the tissue is allowed to thaw and the process repeats. The process of freezing and thawing kills cancer cells and some of the surrounding healthy tissue. The other option is heating the prostate tissue; a new technique known as High Intensity Focused Ultrasound or HIFU that uses high energy to target and kill cancer cells. 

These are the traditional treatment options for prostate cancer. And since science and medicine are in continuous and constant progress, it is inevitable for other methods of treating prostate cancer to emerge. 

In India, for example, they offer the traditional surgical option but in a brand-new way. They do Robotic prostatectomy which allows the surgeon to make more precise movements with meticulous surgical tools compared to the traditional way. 

In the United States, they offer immunotherapy. Cancerous cells are so vicious, they produce some proteins that make them hide from your disease-fighting system, your immune system. Immunotherapy works by interfering with this process.

It works through two pathways; the first pathway helps your immune system to identify cancer cells. The second pathway programs your cells to fight against cancer. They also offer targeted therapy. 

In Turkey, they offer coordinated multidisciplinary care and treatment at affordable prices. They also offer new trends in radiation therapy such as “True Beam” which opens up options for complicated cases.

In South Korea, they have very skilled surgeons in prostatectomy. Many pieces of research have been done about prostate cancer treatment in South Korea and they showed significant progress in this field. 

In Israel, they also offer robotic surgeries and Lutetium-177 Prostate-Specific Membrane Antigen therapy.

The cancer journey is long and tiring. Getting the right diagnosis and starting the right treatment early can greatly shorten this journey for you. You only need to summon your courage and lay your feet on the starting point. 

Today we have Doctor Park who is a leading doctor at Hanyang University Hospital. He is going to discuss with us about prostate cancer from an experienced medical point of view.

Interview

The first question will be about prostate cancer. Can you please tell us what is prostate cancer and what are the usual symptoms?

We've all heard of 'prostate' before but there are many people who don't know exactly what it is. Women don't have it. Only men have a prostate.

When we make a baby, semen comes out, and the pockets that store semen are connected, and the prostate serves as a channel through which semen is ejaculated to make a baby. So, in a way, it's a reproductive organ, an organ needed to make babies. But only men have prostate.

When the urine flows out of the urethra, the prostate wraps around it, so if there is a disease here, you may have difficulty urinating and there may be symptoms. There are many different diseases in the prostate but the common one is enlarged prostate which causes the prostate to enlarge. This is more common than prostate cancer. Although prostate cancer is less common than enlarged prostate, just like other cancers, it progresses quickly and has a huge effect on the human body.

You asked about symptoms earlier, but in early stages, a lot of cancers have no symptoms at all. So all you can do is have regular health checkups to see whether you have cancer or not and when you feel you’re at risk, you should be examined in advance to diagnose the cancer early. When you have symptoms already, for most cancers, you would have already passed stage 3, meaning the cancer has progressed.

Like so, prostate cancer has no symptoms at the beginning, but when it progresses to a certain extent, the symptoms can be very similar to that of enlarged prostate. Such as the need to urinate frequently, thin urine. But otherwise, characteristics of cancer are pain and hematuria. And when the cancer progresses further, unlike other cancers, prostate cancer transmits to the bone.

Once it is transmitted to the bone, it can cause pain in your bones. So, there are cases where people go to the orthopedics due to bone pain, but then end up being diagnosed with prostate cancer.

Therefore, it is very difficult to tell with just symptoms. To summarize, just like other cancers, prostate cancer has no symptoms at the beginning.

However, even if there are symptoms, there may be only symptoms that make urinating uncomfortable, and if it gets a little worse, you may bleed or have pain, or in severe cases, your bones may hurt. That's how we can summarize it.

For the diagnosis of prostate cancer, what kind of examinations can we do?

Actually, if the diagnosis is very complicated and difficult, it is difficult to diagnose the disease, but prostate cancer is very characteristic and can be suspected at first by simply doing a blood test. There's a blood test figure that's characteristically elevated in prostate cancer.

Even if you don't have any symptoms, whether you have a regular health checkup or there are many prostate cancers in your family, the first thing you should do is a prostate blood test. There is a specific antigen of the prostate called PSA, which rises when there is cancer. If that goes up, you should first suspect prostate cancer.

In addition, a lump may be seen on the ultrasound that simply uses the anus to see the prostate. Another more accurate way is to take an MRI to see the inside of the prostate in great detail. But fundamentally, to confirm that there is no cancer, we usually do a biopsy.

The biopsy is not by wounding the stomach, but by stabbing the prostate like this with a needle through the anus to obtain several tissues. If cancer comes out, the final diagnosis is made for cancer.

Can you tell us a little bit more about the levels of prostate cancer?

All other cancers are similar, but prostate cancer is generally divided into stage 1, stage 2, stage 3, and stage 4, just like gastric cancer and liver cancer.

However, until stage 1 and stage 2, it is expressed as early cancer because it is still in the prostate. From stage 3, it has progressed slightly further out from the prostate.

In this case, since the cancer has only progressed a little, we would do a combination of surgery and additional radiation treatment, or surgery and additional drug treatment. Stage 4 is the highest right? Stage 4 means it has eventually ended up spreading far out. So, the disease is not only in the prostate but in the whole body as the cancer has spread in different parts of the body.

In this case, rather than surgery or radiation therapy that only treats that one place, it is done through some kind of injection or medicine to treat the whole body, such as chemotherapy, or other treatment for the whole body. So, the levels of prostate cancer are also divided into 1,2,3 and 4.

After the surgery, does the prostate cancer come back again?

Prostate cancer, of course, has good treatment results after surgery. Because of the initial treatment, there are many cases where cancer has not developed for a long time. Cancer can progress from bad habits such as eating too much meat or smoking. So, because the surgery is done doesn't mean it's finished.

After the surgery, you have to change the bad habits from before, but just because the surgery is done, people stop caring about that and stop looking after themselves and that can always bring the cancer back. The probability of getting cancer again, as I said earlier, in terms of stage 1, stage 2, and stage 3, the higher the number, the higher is the probability.

Although stages 1 and 2 are very safe, they can still happen again even after 10 years.

How about hereditary? Does it play a role in prostate cancer?

For example, if somebody in your family or you have a family history of prostate cancer, does it help in you getting prostate cancer?

In general, prostate cancer is said to increase from age 60 or older, whether Asian or Western.

If you have a prostate patient in your family, especially if you have prostate cancer among your cousins, close family members, father's siblings or any brothers, if one of them has prostate cancer, you would have a bigger chance of having prostate cancer up to 3 or 4 times than the average person. And if there are 2 people in the family with cancer, your chances go up to 10 times.

So, it is said that it increases a lot from our 60s, but if you have prostate cancer in your family, you should actually start checking it from your 30s. Because it can occur at a much younger age. So, prostate cancer is very common. In western countries, it is the 1st place among male cancers. It is also ranked 4th in Korea.

So, if any of the men in your family had cancer, they must start testing for cancer when they reach the age of 30. Even if there are no symptoms. It's one of the cancers with a lot of genetic factors.

As a doctor can you give any suggestions to prevent prostate cancer?

The cause of cancer is the same for all cancers, not just for the prostate, there are risks that we are born with. It's said to be a genetic factor, it can't be changed by any effort. You can’t change parents, right?

Second is lifestyle, and then food. But this lifestyle and food can be changed through our efforts. Fat is the most representative of prostate cancer. It does not say that we should not eat meat, but animal fat, for example, beef with a lot of fat.

So, it doesn't matter if you eat meat, but if you eat too much of the fat side, it is said that there is a risk of prostate cancer.

Chuck is rich in fat. But tenderloin beef has less fat, and if possible, especially if you are overweight, it is very important to avoid such food. But you can eat fish or meat with less fat.

Otherwise, if you are overweight, you can lose weight and if possible, eat vegetable-oriented food rather than meat. Like other cancers, it is very important to maintain balance in our body through moderate exercise and calorie consumption.

As you know well, alcohol and cigarettes are in many ways bad for our health and it's also fatal in case of cancer.

There are foods well known for preventing prostate cancer.

I said earlier that there are many cases of prostate cancer in the West, European countries. But there is a country that is an exception.

Italy has very low rates of prostate cancer. Why? It’s because they eat a lot of tomatoes in that country. There is a red ingredient called lycopene in tomatoes. Eating a lot of lycopene can especially help prevent prostate cancer so there is even a nutrient made with that ingredient.

When eating tomatoes, rather than just putting them raw in a salad, it is better to boil or cook them in oil just like Italian food so that the ingredients can be absorbed much better. So, eating tomatoes is especially good for prostate cancer. 

And in the East, we eat a lot of beans. This soybean contains a lot of ingredients that have various anticancer effects such as isoflavones. So, eating a lot of beans prevents various cancers, especially prostate cancer.

Then green tea. It is also said to be good for cancer because it has a great antioxidant activity, and it is said to be effective for prostate cancer.

Conclusion

According to Dr. Park’s interview, while many have heard of the prostate, many do not know its role. The prostate’s key role is in reproduction by providing secretions that make up a part of the semen that nourishes and transports sperms. The most common illness of the gland is Benign prostatic hyperplasia, which is the enlargement of the gland. However, prostate cancer is a common cancer that affects many men. In the early stages, there are few or no symptoms. Thus, early detection is key as many arrive for help when the cancer stage is in the late stages. There are many serious symptoms as it progresses, for example blood in the urine or in semen as well as bone pain as the cancer expands to the bones.

The diagnosis for prostate cancer is quite simple. Just with a blood test for PSA, we can ascertain the possible presence of cancer. If that is positive, we can also go for additional tests such as MRI and biopsy to make sure we are dealing with cancer.

Prostate cancers can be divided into four stages. If we catch it in the early stages of one or two, typically the localized treatment can be successful. If treated early, the likelihood of recurrence is low but can still happen if the patient reverts to his old bad habits.

If one has a family history of prostate cancer, early check ups even in his 30’s is key for preventing the disease.

In order to prevent the disease, it is important to limit the intake of fat, especially with meats. It's recommended eating fewer fatty cuts of meat or fish. Also, in Italy, prostate cancer is low due to the intake of tomatoes, which is high in lycopene. In Asia, many consume beans, which is high in isoflavones. And green tea which is high in antioxidants, these nutrients are very protective against this disease.