Prostate Cancer

What Is It?

Prostate cancer is the uncontrolled growth of abnormal cells in the prostate gland, a gland near the base of the penis that produces part of the fluid in semen.

Prostate cancer is common, but not always dangerous. When cells in the prostate become cancerous (malignant), they first form small islands of cancer that are confined to the prostate. This localized form of cancer affects about one-third of men as they grow older. In many cases, it takes years, or even decades, for this limited cancer to grow beyond the prostate gland's tough outer capsule.

If cancer grows beyond the prostate gland, it may invade surrounding parts of the bladder and urethra, causing problems with urination. The cancer also may spread to nearby lymph nodes, or to the bones, liver or rectum. Prostate cancer that has spread to lymph nodes or other organs usually cannot be cured, although they often can be kept under control for a number of years with medical therapy.

Although researchers still do not know the exact cause of prostate cancer, they have identified several factors that increase the risk of getting this disease:

• Older age Microscopic islands of cancer can be seen in the prostates of about 30% of men at age 60, and 50% to 70% at age 80. Overall, about three out of four cases of prostate cancer are diagnosed in men over age 65.
• African-American heritage African-American men are more likely to get prostate cancer than other men and the cancer often is more advanced when it is diagnosed. In the United States, an African-American man is twice as likely to die of prostate cancer as a white man.
• Family history If a man's father or brother has been diagnosed with prostate cancer, his cancer risk is two to three times higher than a man with no family history of the illness. Genetic (inherited) factors may be responsible for approximately half of the rare prostate cancers that develop in men under the age of 55.
• Lifestyle factors Men who eat high-fat diets, especially animal fats, have an increased risk of prostate cancer.

In men in the United States, prostate cancer is the most common cancer and the second leading cause of cancer deaths. Prostate cancer strikes about 1 out of every 11 white men, and 1 out of every 9 African-American men. About 180,000 new cases of prostate cancer are diagnosed each year in the United States. Because the majority of prostate cancers are small, are confined to the prostate and don't cause symptoms, an additional 9 million American men may have prostate cancer without knowing it.

Symptoms

In its early stages, prostate cancer rarely causes symptoms. However, if the cancer grows to invade the urethra or bladder, it can cause the following problems:

• A less forceful urine stream
• Urinating more often than normal (frequency)
• An intense need to urinate (urgency)
• A sudden inability to pass urine (urinary retention)
• Repeated urinary tract infections
• Blood in the urine or semen

If prostate cancer spreads to the lymph nodes, bones or other organs, it can cause bone pain, weight loss, anemia, shortness of breath and other symptoms.

Diagnosis

Your doctor will ask about your symptoms, your medical history and your family history of prostate cancer. Your doctor will want to know whether you have ever been diagnosed with any noncancerous condition of the prostate, such as prostatitis (inflammation of the prostate) or enlarged prostate (benign prostatic hypertrophy), that could have symptoms similar to prostate cancer.

Your doctor will examine you, and will do a digital rectal exam to feel the prostate gland. In this exam, the doctor will insert his or her index finger into your rectum and gently feel the surface of the prostate through the rectal wall to check for lumps, hardness and enlargement. He or she also will ask you for a urine specimen, and probably will order a prostate-specific antigen (PSA) blood test. PSA is a protein made by the prostate and secreted into the semen. Prostate cancer and certain noncancerous prostate disorders can cause increased amounts of PSA to leak out of the prostate into the blood.

If the PSA level in your blood is higher than normal or your digital rectal exam shows a possible problem, your doctor may order additional tests, such as a prostate needle biopsy. In this procedure, a needle is used to remove small pieces of tissue from the top, middle and bottom parts of the prostate on both the left and the right sides. Your doctor also may want to take tissue samples from any suspicious areas identified by the digital rectal exam or ultrasound. The tissue will be examined by a pathologist, a physician who specializes in the diagnosis of diseased tissues.

If the results of your biopsy confirm that you have prostate cancer, the pathologist also will assign a Gleason score to your tumor. The Gleason score is an indication of how abnormal the cancer cells look under a microscope compared to normal prostate cells. The score provides a rough estimate of how likely the cancer is to grow and spread rapidly. Gleason scores generally indicate the following:

• Gleason score (total) of 2 to 4: Low-grade or nonaggressive cancer
• Gleason score (total) of 5 to7: Intermediate grade
• Gleason score (total) of 8 or higher: High-grade or aggressive cancer

If you are taking any prescription or over-the-counter medication to treat an enlarged prostate, be sure to tell your doctor. Certain prostate medications, such as finasteride (Proscar), dutasteride (Avodart) or saw palmetto, can affect the results of the PSA test.

Most cases of prostate cancer are detected by screening for the disease before it causes any symptoms. Doctors detect the illness by using the prostate-specific antigen (PSA) test and the digital rectal exam. A biopsy is usually recommended if either of the screening tests is abnormal.

Depending on your biopsy results, PSA level and physical findings, your doctor may order additional tests to determine whether your cancer has spread to your lymph nodes, bones or other sites. These tests may include a computed tomography (CT) scan, magnetic resonance imagining (MRI) scan or bone scan.

Expected Duration

Once prostate cancer develops, it usually grows slowly over many years. A small percentage of cases of prostate cancer grow and spread rapidly. Almost all prostate cancer will respond to one form of treatment or another.

Prevention

There is some evidence that prostate cancer is less common in men who regularly eat a low-fat diet that is rich in lycopene (an antioxidant released when tomatoes are cooked).

Prostate cancer can be treated by blocking or lowering the levels of the male hormone testosterone. One large study looked at whether the testosterone-blocking drug finasteride (Proscar) can prevent prostate cancer. While men taking this drug had a lower risk of developing prostate cancer, they also appeared more likely to be diagnosed with an aggressive form of the disease. For this reason, experts are divided as to whether finasteride should be offered to men who have a higher than average risk of prostate cancer.

Treatment

Prostate cancer can be treated several ways. Together, you and your doctor should weigh many important medical and lifestyle issues before deciding on a treatment plan. Ultimately, the best treatment for you will take into account:

• The extent of your cancer
• The chances that your cancer will grow and spread rapidly
• Your age and life expectancy
• Any health conditions that would increase the risks of surgery or other treatments
• Your willingness to risk side effects

If your cancer is confined to the prostate gland alone and has not penetrated the prostate capsule, you have at least three treatment options:

• Watchful waiting In this approach, you will not be treated immediately. Instead, your doctor will monitor the status of your cancer through regular examinations and PSA tests. This strategy generally is reserved for men whose biopsy shows a low Gleason score (nonaggressive tumor). It also is a good option for elderly men who are too ill to tolerate radiation or surgery, or who have other serious medical conditions that limit their life expectancies.
• Radiation therapy Radiation therapy can take two forms. In external-beam radiation, you receive five to seven weeks of treatments from a machine that aims radiation at your prostate. In brachytherapy, radioactive seeds or pellets are implanted directly inside your prostate using a sterile needle guided by either ultrasound or MRI. Side effects of radiation therapy can include impotence, diarrhea, rectal bleeding and incontinence. More men experience side effects from external-beam radiation than from brachytherapy.
• Surgery Your doctor may suggest that you have a procedure called radical prostatectomy, which removes your entire prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes. Side effects from this procedure can include incontinence and impotence. Both incontinence and impotence are more common after radical prostatectomy than after radiation therapy. However, some experts believe that surgery offers the best chance of curing prostate cancer. A "nerve-sparing" surgical technique can help to preserve sexual potency in many men who undergo radical prostatectomy.

For men whose prostate cancer has grown through the prostate capsule but has not metastasized (spread) to other organs, watchful waiting or radiation therapy with or without hormonal therapy are usually recommended.

For men with prostate cancer that has spread to other organs, doctors usually prescribe androgen-deprivation (hormone) therapy. Androgens are male sex hormones, such as testosterone. This treatment involves reducing levels of testosterone and other androgens that stimulate the prostate cancer to grow. Today, doctors most commonly use drugs to either block the effects of testosterone or stop the testicles from producing it. An alternative approach is to surgically remove the testicles in a procedure called an orchiectomy. Side effects of androgen-deprivation therapy include impotence, weight gain, decreased sex drive and osteoporosis. Some men experience hot flashes, which often can be controlled by medication.

When To Call A Professional

Call your doctor immediately if you notice blood in your urine or semen, or if your urination is painful, uncomfortable or abnormal in any way.

If you are age 50 or older, speak with your doctor about the pros and cons of prostate cancer screening. Some experts believe that screening is the best way to prevent death and disability form prostate cancer. However, other experts worry that screening may cause more harm than good because some men will get side effects from treatment they may not have needed. Your doctor should be able to help you decide whether regular digital rectal exams and PSA testing makes sense for you.

If you decide to get screened, your doctor probably will perform a prostate exam and check your PSA level every one to two years beginning at age 50. Screening should start at age 45 for African-American men and men who have a family history of prostate cancer. Ongoing research may help to clarify some of the controversies in prostate cancer screening within the next decade.

Prognosis

The prognosis usually is excellent. About 80% to 90% of men with localized cancer are cured. Prostate cancer rarely is cured once it has spread, but many men survive for years or even decades after being diagnosed. In fact, many more men die from other causes while they have prostate cancer than die as a result of the cancer.

Additional Info

National Cancer Institute (NCI)

U.S. National Institutes of Health

Public Inquiries Office

Building 31, Room 10A03

31 Center Drive, MSC 8322

Bethesda, MD 20892-2580

Phone: 301-435-3848

Toll-Free: 1-800-422-6237

TTY: 1-800-332-8615

Email: cancergovstaff@mail.nih.gov

http://www.nci.nih.gov/

American Cancer Society (ACS)

1599 Clifton Road, NE

Atlanta, GA 30329-4251

Toll-Free: 1-800-227-2345

http://www.cancer.org/

American Urological Association

1000 Corporate Blvd.

Linthicum, MD 21090

Phone: 410-689-3700

Toll-Free: 1-866-746-4282

Fax: 410-689-3800

Email: aua@auanet.org

http://www.urologyhealth.org/

American Foundation for Urologic Disease

1000 Corporate Blvd.

Suite 410

Linthicum, MD 21090

Phone: 410-689-3990

Toll-Free: 1-800-828-7866

Fax: 410-689-3998

Fax: 410-689-3998

http://www.afud.org/