Types of Prostate Cancer

Prostate cancer is the 6th leading cause of cancer death and the most widespread malignancy in men. In 2012, over 1,100,000 people were diagnosed with prostate cancer, 307,000 of which lost their lives because of it. 

Most prostate cancers are low-grade diseases. They need a lot of time to grow. Compared to other cancers, prostate cancer is not always that aggressive.

Patients may not develop any symptoms of the disease in its early phases. But, later on, they can experience bone pain, anemia, renal failure, and ureteral obstruction. 

When the illness affects only the prostate, it is considered potentially curable. This is known as localized prostate cancer. However, when cancer spreads and affects the bones, it will need more rigorous treatment or surgery. But, before you can treat the problem, it’s important that you learn more about it.

That way, you may be able to understand what the body is dealing with. This detailed guideline will help you learn exactly that. You will take a closer look at all the types of prostate cancer and figure out the etiology and pathophysiology of the prostate tumor, as well as other practical information about a surgery that may prove useful. So, let’s get right to it. 

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Various Types of Prostate Cancer You Should Know About

Researchers have identified 5 unique types of prostate carcinoma. Learning about their differences can help people understand how the tumor is growing and spreading, including how to manage the health issue. 

Knowing the stage boosts your chances for recovery. Take a look at the different aggressive and non-aggressive forms of cancer to find out more. 

Acinar Adenocarcinoma

Over 95% of prostate carcinomas are adenocarcinomas. While 80% of cases are linked to aggressive prostate cancer. This cancer forms in the gland cells. More precisely, in the long line that can be found in the prostate gland. 

Cancer develops whenever there is a mutation in the cell’s genes. This mutation or abnormality will force the cell to multiply and grow, which will get in the way of normal tissue function. When the abnormal growth reaches a specific size, it could start to spread and infect other neighboring tissues. That’s when people experience a cancerous tumor. 

This is what experts call metastasis, whereas a tumor that spreads is known as malignant. Adenocarcinoma is malignant. But, in some patients, it could grow very slowly and might not even spread to other tissues. 

Also, there is a close link between prostate and skin cancer. Studies show that individuals who frequently develop skin carcinoma are also at risk of experiencing other cancers. Such as prostate, colon, breast, and blood cancer.   

Ductal Adenocarcinoma

Ductal adenocarcinoma is a rare subtype of prostate cancer. It accounts for only 5% of total prostate cancer cases. The most affected by it are the elderly. When it does happen, it has bigger chances of becoming an advanced form of cancer. To manage the issue, patients need to detect the illness in its early phases. 

This cancer begins from the primary periurethral prostatic ducts. Whereas acinar cancer starts from other periurethral prostatic ducts. The most-reported complaints about both adenocarcinomas are urinary obstruction and red, pink, or cola-colored urine. 

Data indicates that the typical 5-year survival rate for ductal cancer is 2.5% versus 17.2% in metastatic prostate cancer. In metastasis, cancer cells break away from their primary forming point and use the lymphatic system and blood vessels to spread through the system and create a new tumor. 

A ductal tumor is more focused on the prostate. But its cells can impact the periphery. It is a lot more aggressive than acinar and often creates a Gleason score of 4 or more. Both of these tumors have increased PSA levels

Transitional Cell (or Urothelial) Cancer

Transitional cell carcinoma accounts for 1% to 4% of all prostate carcinomas. Based on reports, the incidence rate of urothelial cancer ranges from 21.8% to 36.7%. More than 90% of affected individuals are diagnosed with bladder cancer. 

This cancer starts to develop in the urethra and affects the entire prostate. In rare cases, it emerges inside the prostate. But, the odds of that happening are relatively low. What’s typical about this cancer is that people often diagnose it when they start developing symptoms. 

Cancer tends to affect the urinary system and bladder control. Most have trouble urinating. A common precursor for prostate carcinoma is prostatic intraepithelial neoplasia (PIN). This is a health problem known for epithelial cell growth. Since the PIN is a premalignant condition, it is also recognized as a sign of prostate cancer

Squamous Cell Cancer

This is another prostate cancer that could pose a serious threat. The actual prostate cancer cells start to form from flat cells present in the prostate. They spread and grow faster than adenocarcinomas. But, this is a very rare tumor. It makes up just 0.5% to 1% of prostate cancer cases. 

Those affected can experience various symptoms, such as lower urinary tract complications. However, it’s not uncommon for this cancer to spread to the bones. According to experts, this is an aggressive illness and needs immediate treatment. 

Small Cell Prostate Cancer

This prostate cancer features plenty of tiny round cells. It is a tumor that affects the prostate and hinders its normal bodily function. Small cell carcinoma is another extremely rare condition, with less than 1% of prostate cancer patients suffering from it. 

These prostate cells tend to manifest in individuals over the age of 65. It can affect their bone, organ metastases, and lymph node. Technically, it is quite similar to small cell carcinoma in the lungs. It could be pure or mixed as a component of acinar cancer. 

Based on a small case report, a 60-year-old male patient with lower urinary tract symptoms was diagnosed with this prostate cancer. A digital rectal exam detected that the prostate gland was firmer and bigger than normal. His prostate size and PSA levels also increased. This is a consistent pathology found in small cell cancer patients. 

It’s important to mention that an enlarged prostate gland doesn’t always indicate cancer. It could be the result of benign prostatic hyperplasia, which basically means “non-cancerous.” Whereas hyperplasia refers to abnormal cell growth. So, it is vital for patients to do a prostate cancer diagnosis to identify the problem. 

Other Rare Cancers

There are other even rarer types of prostate cancer many people don’t know about. Although their pathology may be unusual, it is important that you learn more about them. These are sarcoma and NETs. 

Sarcoma

Soft tissue sarcoma features only 0.7% of all primary prostate malignancies. While 20% of sarcomas start to develop from the abdomen. 

Compared to other forms of prostate cancer, this one can be potentially life-threatening. Around 50% of affected individuals can die from the disease in just 2 years. 

The illness forms in the supporting tissues. That includes the fat, blood vessels, nerves, and muscles. Figuring out the grade and stage of cancer can help your doctor find the ideal form of treatment. 

Neuroendocrine Tumor (NETs) 

This extremely rare cancer begins in the neuroendocrine cells. It may take years for it to develop and might be asymptomatic during its early phases. There are only 0.35 cases per million in a year. But, because of how rare it is, its clinical features are poorly defined. 

As a resistance mechanism, patients who had hormone therapy for adenocarcinomas can experience NETs. These tumors are a potent aggressive variant that can appear on their own or as a result of hormone therapy. People with this prostate cancer may not even recognize the problem until it has already spread to a different part of the body. 

How to Diagnose the Carcinoma?

Experts use a range of diagnostic technologies and tools to identify the type of cancer and stage. The two tests mainly used during prostate cancer screening are a digital rectal exam and a PSA blood test. Diagnosing the disease can help assess the extent of its impact. 

When diagnosing the carcinoma, the first thing doctors will look at is the Gleason score. If the Gleason score is low, typically around 2 to 4, it means that the cancer is not that aggressive. But, when the score is well over 7 to 10, it signifies you need urgent prostate cancer treatment. 

Gleason scores to grade prostate carcinoma.

  • Gleason score X. This means that the score can’t be identified.

  • Gleason score 6 or less. This ignifies that the prostate cancer cell looks quite like a healthy cell. They are well differentiated.

  • Gleason score 7. The cells are moderately differentiated and somewhat similar to a healthy cell.

  • Gleason score 8 to 10. The mutation looks completely different from that of a regular cell. That means it is undifferentiated or poorly differentiated.

This is a key strategy for developing a proper treatment or surgery plan. Each treatment approach should be tailored to the patient’s needs. Here is how every diagnostic tool can identify your prostate cancer risk. 

Prostate Biopsy

Prostate biopsy is uncomfortable and often painful procedure can help spot the condition. The doctor will use a probe in the rectum to examine the tissues. It can also be used as routine screening in patients with high prostate cancer risk.  

PSA Test

Prostate-specific antigen screening. People can use the PSA count to find any signs of prostate carcinoma. In most patients, 4 nanograms per 1 ng/ml are normal. While having a high PSA count of over 10 has a 50% chance of being prostate cancer.  

Imaging 

Further testing is sometimes necessary. Options like an MRI scan, CT scan, ultrasound, and bone scan are imaging tests that could identify the stage, progression, and type of the illness. 

Who Is At Risk of Prostate Carcinoma?

Scientists haven’t found the exact cause for prostate malignancy. But, like any other carcinoma, prostate cancer can develop in individuals with a family history of the disease or constant exposure to dangerous chemicals. 

Whatever is causing the problem will trigger a cell mutation. This mutation is the one that causes the disease. Although prostate carcinoma can happen in any man, certain risk factors can make them more susceptible to the disease. These factors are:

  • Obesity

  • Genetic predisposition

  • Old age

  • Ethnicity

For example, African Americans are found to have the highest risk of this particular illness. Also, those who are obese can become more vulnerable to the disease. That’s where understanding the risk factors could prove useful. It may help lessen the risk, particularly in older adults. 

Prostate Cancer Screening Recommendation

Screening is recommended for older men. Experts suggest that taking an annual exam can help spot the problem. Sometimes, in its early stages. Therefore screening is recommended for individuals at the:

  • Age of 40. Men at high risk, particularly those who have a father, son, or a brother in the family with the disease, should do a screening. 

  • Age of 45. Men who are highly prone to the illness, such as African Americans with a relative diagnosed with the disease. 

  • Age of 50. Men with an average risk of prostate carcinoma should still do cancer screening

According to scientists, it is best for men between the ages of 55 to 69 to do prostate-specific antigen testing. But, first, it is important to consult with a doctor and discuss the potential benefits and probable harms of the diagnostic procedure.

How Are These Cancers Treated?

Treating carcinoma can be a tricky process. The challenge in treating it is that cancer can act as a passive infiltrator – grow slowly with little to no risk for serious health problems – or a full-blown attacker – spread aggressively through the system and force urgent treatment. 

During the early stages of prostate cancer, patients might have to rely on watchful waiting. Active surveillance helps keep an eye on the condition. Patients are supposed to avoid treatment unless they experience prostate cancer symptoms.

This can also be recommended in individuals with a life-threatening disease, who may live 5 years or less. While with aggressive forms of cancer, patients may be advised to get intensive treatment. They will need to take urgent action and get the tumor under control. 

In cancer treatment, different doctors are working to create a viable treatment option. Surgeons, medical, and radiation oncologists will combine their efforts to treat the health complication. Here are the most used treatment options for aggressive types of prostate cancer. 

Local Treatment

Local treatment focuses on removing cancer from a specific area in the human body. It can only work with a secluded affected spot. These treatments feature radiation and surgery. In the early stage of prostate cancer, local treatment can completely remove cancer. 

But, if it spreads and affects parts other than the prostate gland, doctors may need to take a different approach. Here is how local treatment looks like. 

Surgery

Surgery will remove the prostate or the affected lymph nodes. But, the type of surgery will vary depending on how aggressive the malignancy may be. Doctors do a radical prostatectomy to remove the whole prostate. As well as the seminal vesicle. 

In some cases, the nodes in the pelvis might also be taken out. Surgery is a practical option for managing the spreading. Since the procedure can affect sexual function and cause erectile dysfunction, patients might be advised to get a penile implant or use over-the-counter medicine. 

Robotic prostatectomy is not that invasive. Doctors will insert instruments through the abdomen via a tiny incision and treat the prostate gland. It is less painful, but people can still experience some adverse effects. The surgery, however, can successfully remove cancer. 

But, when both testicles are affected, patients might have to do a bilateral orchiectomy. This surgery will remove the testicles and can get rid of the tumor. Transurethral resection may also prove useful. Although it can’t treat cancer, it can soothe the symptoms of urinary blockage. 

Radiation Therapy

High-energy rays can help destroy the malignancy. The therapy consists of a schedule with a set amount of treatments. Various radiation therapies exist that can help manage the issue.

For example, the go-to option is known as hypofractionated radiation therapy. Patients will obtain elevated doses of radiation for a short time instead of reduced doses over a longer period. Such a treatment is best designed for advanced prostate cancer. Hypofractionated therapy may also help with early prostate cancer. 

People with low-risk of prostate carcinoma who require active treatment can take low-dose therapy. This is known as brachytherapy

There is also proton therapy, which uses protons instead of X-rays. The energy can get rid of the malignancy and might be more impactful than other typical radiation treatments. However, proton therapy is very expensive care. 

Focal Therapy

Known for being a less invasive treatment approach, this therapy can kill cancer in the prostate. But, it won’t help the prostate gland. It relies on cold, heat, and other methods to manage the malignancy. 

This treatment may not be ideal for patients with advanced prostate cancer. Its primary uses are for intermediate or low-risk prostate carcinoma.

Cryotherapy uses a metal probe to freeze the mutated cell. Doctors add a small incision between the scrotum and rectum, where the metal probe can be inserted. Even though this therapy isn’t standard care for a recently diagnosed prostate cancer patient, many studies commend its benefits. 

HIFU (high-intensity focused ultrasound) is a heat-based therapy. This focal approach uses a similar tactic to cryotherapy. With the help of an ultrasound probe, the treatment can kill the mutated cell and limit the surrounding damage to the prostate gland. In 2015, HIFU received approval from the FDA. 

Systemic Therapy

Systemic treatment is a well-known approach. It uses medications to circulate and target malignancy. A medical oncologist can determine the best medicine for this type of cancer. Typically, the therapy uses an IV tube, capsules, or pills to manage cancer. 

But, they can also include:

A patient can obtain a single type of systemic therapy. But, the doctor may also suggest combining systemic therapy with novel agents in people with advanced disease. If they have advanced prostate cancer, individuals might have to rely on a combination of therapies. 

But, regardless of the medications you need to take, consuming a healthy diet will still be a top priority. Supplying the body with nutritious and prostate health foods can help the system function normally. While it can also lessen the susceptibility to the disease. Therefore, incorporating a nutritious meal packed with vitamins and minerals should be a practical preventive strategy. 

Conclusion

Prostate carcinoma is a risk for all men. But, as they grow older, their risk of developing the disease increases. When caught on time and with adequate treatment, people might get their health back on track. However, since it can be difficult to detect the malignancy in its early stages, many let the mutation linger until it begins to spread to the surrounding tissues.

That’s why annual screening might prove useful. Those who are susceptible to carcinoma might benefit from regular monitoring. What matters is that you are open with your doctor and let them know about your risk of developing the health issue. If there is anyone in your family with the illness, you may have to regularly screen for signs of cancer. 

Doctors are also suggesting healthy food. A diet rich in nutrients, minerals, and vitamins could help lessen the risk of the disease. Plus, it can improve your overall health. So, don’t forget to talk with your doctor, especially if you are at risk of prostate cancer, and add plenty of healthy meals to your diet. 

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Sources

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