What Is the Prostate and What Is Prostate Cancer?

The prostate is a small gland located just below the bladder and close to the rectum. It has two functions: generating the thick white fluid that mixes with sperm to form semen; and generating the protein (prostate-specific antigen (PSA)) that ensures that semen is liquid. The gland is found in the bodies of cisgender men, trans women, and nonbinary individuals assigned male at birth, as well as in the bodies of some intersex people.

As with any cancer, prostate cancer is due to abnormal cell growth. It can be a slow or rapid growth and metastases (where the cancer spreads to other parts of the body) can occur. It is one of the most common cancers in cisgender men worldwide. Its risk is significantly lower in trans women who use hormone treatments during their transition.

The warning signs of prostate cancer are pain while urinating or difficulty urinating; erectile dysfunction; and blood in the urine. Pain in the bones and a feeling of compression in the lumbar spine are also reported by patients. The issues with urination are caused by the tumor compressing the urethra, which runs through the gland.

Early or localized prostate cancer is diagnosed when the cancer has not spread to other tissues or organs. Locally spread prostate cancer means that the abnormal cell growth has spread to tissues like the seminal vesicles, local lymph nodes, rectum, or the bladder. Metastases mean that the cancer has spread to other parts of the body. Metastatic prostate cancer most commonly affects the lymph nodes, bones, liver, or lungs.

Does Prostate Stimulation Reduce the Risk of Prostate Cancer?

Stimulation of the prostate gland during sexual intercourse can be pleasurable. Although some non-peer-reviewed reports suggest that massaging or stimulating the prostate can reduce the risk of prostate cancer, there is no firm evidence to support this hypothesis. Such massages can be helpful with non-cancerous inflammation of the prostate, which can reduce the risk of cancer. In addition, there is some evidence that massaging the prostate before some screening methods can improve the test sensitivity.

Do Cisgender Women or Trans Men Have Prostate Glands?

There is no prostate gland in the bodies of cisgender women, trans men, or nonbinary individuals assigned female at birth. Rather, they have Skene’s glands, which are sometimes referred to as “the female prostate gland”, despite having a very different structure. Skene’s glands produce the same protein as the prostate gland, PSA, but are otherwise different. Cancer of the Skene’s glands is believed to be extremely rare.

How Can Physicians Screen for Prostate Cancer?

Screening for prostate cancer is common, especially after patients turn 50. A digital rectal exam, where the doctor inserts a finger into the rectum to examine the texture, shape, and size of the prostate, is the most well-known test, mainly due to its use in comedy that plays on outdated and homophobic ideas regarding anal examinations. It is unfortunate that this trope persists as it may prevent some people getting screened regularly or early.

Another regular screening test is the prostate-specific antigen test. A blood sample is analyzed for the protein. Higher than expected levels for a person of that age may indicate prostate inflammation, infection, or cancer.

Diagnostic tests would use an ultrasound, magnetic resonance imaging, or a prostate biopsy (where a sample of cells from the prostate is taken for analysis). If prostate cancer is determined, these are followed by determination of the aggressiveness and potential metastasis of the cancer. Genomic testing may be done at this stage.

Why Is Genomic Testing Helpful?

Genomic testing results support treatment decisions by providing information on the genetic mutations that are present. Some mutations indicate a treatment approach that may be more effective than another. There are several common gene mutations associated with a predisposition to prostate cancer and research is progressing on the implications of the various patterns of mutation.

The case report “Genetic Analysis of a Family with Multiple Incidences of Prostate Cancer” reports on a single-family genomic test performed in China. Such a case does not provide statistically significant information that can be broadly applied, but it does contribute to the store of knowledge on the topic of mutations and prostate cancer. In the case, three brothers in a family were diagnosed with prostate cancer, and BRCA1 G275D appeared to have a high impact on the progress of the cancer. Since prostate cancer with mutations in DNA damage repair genes like BRCA1 and BRCA2 respond favorably to the drugs olaparib and rucaparib, this information would be valuable to the clinical team.

Should I Discuss My Risk of Prostate Cancer with My Primary Care Physician?

It is always advisable to talk about the risk of prostate cancer if you have a prostate and there is any cancer in your family, and especially if there is prostate cancer in your family. Discuss whether early genomic screening, regular physical examination or annual prostate-specific antigen tests might be helpful. Any change in your urination pattern, especially blood in the urine, demands a consultation with a doctor.