Prostate Cancer

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What is Prostate Cancer

Prostate cancer is the abnormal growth of cells in the prostate gland. The prostate is a walnut-sized gland that is involved in the production of semen. It is located below a man’s bladder, in front of the rectum.

How common is Prostate Cancer

Prostate cancer is the most common noncutaneous cancer in men (with a 1 in 6 lifetime risk) and the second most deadly cancer in men (with lung cancer being the deadliest).

It most often occurs in older men and is rare before age 40. The tumor biology is quite variable and is often difficult to predict in advance.

In many men, the disease behavior is indolent, whereas in others, it is aggressive and sometimes lethal.

What are the causes?

Ninety-five percent of prostate cancers are due to adenocarcinomas, 3% are urothelial (transitional cell) carcinomas, and 2% are related to other tumor types such as neuroendocrine tumor, sarcoma, lymphoma, and metastasis.

The exact cause of this condition is not known.

What increases the risk?

This condition is more likely to develop in men who:

  • Are older than age 65.
  • Are African-American.
  • Are obese.
  • Have a family history of prostate cancer.
  • Have a family history of breast cancer.

What are the symptoms?

Symptoms of this condition include:

  • A need to urinate often.
  • Weak or interrupted flow of urine.
  • Trouble starting or stopping urination.
  • Inability to urinate.
  • Pain or burning during urination.
  • Painful ejaculation.
  • Blood in urine or semen.
  • Persistent pain or discomfort in the lower back, lower abdomen, hips, or upper thighs.
  • Trouble getting an erection.
  • Trouble emptying the bladder all the way.

How is this diagnosed?

This condition can be diagnosed with:

  • A digital rectal exam. For this exam, a health care provider inserts a gloved finger into the rectum to feel the prostate gland.
  • A blood test called a prostate-specific antigen (PSA) test.
  • An imaging test called transrectal ultrasonography.
  • A procedure in which a sample of tissue is taken from the prostate and examined under a microscope (prostate biopsy).

Once the condition is diagnosed, tests will be done to determine how far the cancer has spread. This is called staging the cancer. Staging may involve imaging tests, such as:

  • A bone scan.
  • A CT scan.
  • A PET scan.
  • An MRI.

The stages of prostate cancer are as follows:

  • Stage I. At this stage, the cancer is found in the prostate only. The cancer is not visible on imaging tests and it is usually found by accident, such as during a prostate surgery.
  • Stage II. At this stage, the cancer is more advanced than it is in stage I, but the cancer has not spread outside the prostate.
  • Stage III. At this stage, the cancer has spread beyond the outer layer of the prostate to nearby tissues. The cancer may be found in the seminal vesicles, which are near the bladder and the prostate.
  • Stage IV. At this stage, the cancer has spread other parts of the body, such as the lymph nodes, bones, bladder, rectum, liver, or lungs.

How is this treated?

Treatment for this condition depends on several factors, including the stage of the cancer, your age, personal preferences, and your overall health.

Treatment may involve radical prostatectomy (involving resection of the prostate gland and seminal vesicles), radiation therapy, androgen deprivation therapy, focal ablative therapy, or active surveillance (involving close monitoring of the disease course in patients with very low risk disease).

Talk with your health care provider about treatment options that are recommended for you. Common treatments include:

  • Observation for early stage prostate cancer (active surveillance). This involves having exams, blood tests, and in some cases, more biopsies. For some men, this is the only treatment needed.
  • Surgery. Types of surgeries include:
    • Open surgery. In this surgery, a larger incision is made to remove the prostate.
    • A laparoscopic prostatectomy. This is a surgery to remove the prostate and lymph nodes through several, small incisions. It is often referred to as a minimally invasive surgery.
    • A robotic prostatectomy. This is a surgery to remove the prostate and lymph nodes with the help of a robotic arm that is controlled by a computer.
    • Orchiectomy. This is a surgery to remove the testicles.
    • Cryosurgery. This is a surgery to freeze and destroy cancer cells.
  • Radiation treatment. Types of radiation treatment include:
    • External beam radiation. This type aims beams of radiation from outside the body at the prostate to destroy cancerous cells.
    • Brachytherapy. This type uses radioactive needles, seeds, wires, or tubes that are implanted into the prostate gland. Like external beam radiation, brachytherapy destroys cancerous cells. An advantage is that this type of radiation limits the damage to surrounding tissue and has fewer side effects.
  • High-intensity, focused ultrasonography. This treatment destroys cancer cells by delivering high-energy ultrasound waves to the cancerous cells.
  • Chemotherapy medicines. This treatment kills cancer cells or stops them from multiplying.
  • Hormone treatment. This treatment involves taking medicines that act on one of the male hormones (testosterone):
    • By stopping your body from producing testosterone.
    • By blocking testosterone from reaching cancer cells.

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Maintain a healthy diet.
  • Get plenty of sleep.
  • Consider joining a support group for men who have prostate cancer. Meeting with a support group may help you learn to cope with the stress of having cancer.
  • Keep all follow-up visits as told by your health care provider. This is important.
  • If you have to go to the hospital, notify your cancer specialist (oncologist).
  • Treatment for prostate cancer may affect sexual function. Continue to have intimate moments with your partner. This may include touching, holding, hugging, and caressing.

Contact a health care provider if:

  • You have trouble urinating.
  • You have blood in your urine.
  • You have pain in your hips, back, or chest.

Get help right away if:

  • You have weakness or numbness in your legs.
  • You cannot control urination or your bowel movements (incontinence).
  • You have trouble breathing.
  • You have sudden chest pain.
  • You have chills or a fever.

Summary

  • The prostate is a walnut-sized gland that is involved in the production of semen. It is located below a man’s bladder, in front of the rectum. Prostate cancer is the abnormal growth of cells in the prostate gland.
  • Treatment for this condition depends on several factors, including the stage of the cancer, your age, personal preferences, and your overall health. Talk with your health care provider about treatment options that are recommended for you.
  • Consider joining a support group for men who have prostate cancer. Meeting with a support group may help you learn to cope with the stress of having cancer.

Prostate Cancer Screening

The prostate is a walnut-sized gland that is located below the bladder and in front of the rectum in males. The function of the prostate (prostate gland) is to add fluid to semen during ejaculation. Prostate cancer is the second most common type of cancer in men.

A screening test for cancer is a test that is done before cancer symptoms start. Screening can help to identify cancer at an early stage, when the cancer can be treated more easily. The recommended prostate cancer screening test is a blood test called the prostate-specific antigen (PSA) test. PSA is a protein that is made in the prostate. As you age, your prostate naturally produces more PSA. Abnormally high PSA levels may be caused by:

  • Prostate cancer.
  • An enlarged prostate that is not caused by cancer (benign prostatic hyperplasia, BPH). This condition is very common in older men.
  • A prostate gland infection (prostatitis).
  • Medicines to assist with hair growth, such as finasteride.

Depending on the PSA results, you may need more tests, such as:

  • A physical exam to check the size of your prostate gland.
  • Blood and imaging tests.
  • A procedure to remove tissue samples from your prostate gland for testing (biopsy).

Who should have screening?

Screening recommendations vary based on age.

  • If you are younger than age 40, screening is not recommended.
  • If you are age 40–54 and you have no risk factors, screening is not recommended.
  • If you are younger than age 55, ask your health care provider if you need screening if you have one of these risk factors:
    • Being of African-American descent.
    • Having a family history of prostate cancer.
  • If you are age 55–69, talk with your health care provider about your need for screening and how often screening should be done.
  • If you are older than age 70, screening is not recommended. This is because the risks that screening can cause are greater than the benefits that it may provide (risks outweigh the benefits).

If you are at high risk for prostate cancer, your health care provider may recommend that you have screenings more often or start screening at a younger age. You may be at high risk if you:

  • Are older than age 55.
  • Are African-American.
  • Have a father, brother, or uncle who has been diagnosed with prostate cancer. The risk may be higher if your family member’s cancer occurred at an early age.

What are the benefits of screening?

There is a small chance that screening may lower your risk of dying from prostate cancer. The chance is small because prostate cancer is typically a slow-growing cancer, and most men with prostate cancer die from a different cause.

What are the risks of screening?

The main risk of prostate cancer screening is diagnosing and treating prostate cancer that would never have caused any symptoms or problems (overdiagnosis and overtreatment). PSA screening cannot tell you if your PSA is high due to cancer or a different cause. A prostate biopsy is the only procedure to diagnose prostate cancer. Even the results of a biopsy may not tell you if your cancer needs to be treated. Slow-growing prostate cancer may not need any treatment other than monitoring, so diagnosing and treating it may cause unnecessary stress or other side effects.

A prostate biopsy may also cause:

  • Infection or fever.
  • A false negative. This is a result that shows that you do not have prostate cancer when you actually do have prostate cancer.

Questions to ask your health care provider

  • When should I start prostate cancer screening?
  • What is my risk for prostate cancer?
  • How often do I need screening?
  • What type of screening tests do I need?
  • How do I get my test results?
  • What do my results mean?
  • Do I need treatment?

Contact a health care provider if:

  • You have difficulty urinating.
  • You have pain when you urinate or ejaculate.
  • You have blood in your urine or semen.
  • You have pain in your back or in the area of your prostate.
  • You have trouble getting or maintaining an erection (erectile dysfunction, ED).

Summary

  • Prostate cancer is a common type of cancer in men. The prostate (prostate gland) is located below the bladder and in front of the rectum. This gland adds fluid to semen during ejaculation.
  • Prostate cancer screening may identify cancer at an early stage, when the cancer can be treated more easily.
  • The prostate-specific antigen (PSA) test is the recommended screening test for prostate cancer.
  • Discuss the risks and benefits of prostate cancer screening with your health care provider. If you are age 70 or older, screening is likely to lead to more risks than benefits (risks outweigh the benefits).

Prostate Cancer Prevention

What Is Prostate Cancer?

Prostate cancer is a growth of abnormal cells in the prostate gland. The prostate is a walnut-shaped gland in the male reproductive tract that makes seminal fluid, which mixes with sperm and other fluids. This gland surrounds the urethra, near its connection to the bladder. The urethra is the tube that carries urine from the bladder, through the penis, to outside the body. Cancer develops when cells mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially bones and lymph nodes. In the past 20 years, the survival rate for all stages of prostate cancer has improved because of early detection and treatment.

A higher risk of developing prostate cancer may be related to age (especially older than 65), race (African American), and family history (father, brother).

What Are the Symptoms of Prostate Cancer?

Early prostate cancer may not cause symptoms. Some men, however, may have pain, difficulty urinating, and rarely problems with erections (erectile dysfunction).

Other symptoms include a weak or interrupted flow of urine, need to urinate often (especially at night), difficulty holding back urine, inability to urinate, pain or burning when urinating, blood in the urine or semen, and nagging pain in the back, hips, or pelvis.

It is important to realize that these symptoms may have other less serious causes, such as benign prostatic hypertrophy (BPH) or infection. Always see your health care provider for a diagnosis.

How Is Prostate Cancer Diagnosed?

The health care provider will take a complete medical history and do a physical examination including a digital rectal examination (DRE). A blood test called prostate-specific antigen test (PSA test) will also be done if prostate cancer is suspected.

Although there is controversy about the benefits of screening asymptomatic people for prostate cancer with PSA tests, many health care providers usually recommend that a DRE and a PSA be done every year for men older than 50 until at least age 70. Men in high-risk groups, such as African Americans or those with a strong family history of prostate cancer, should ask about being tested at a younger age. The diagnosis of cancer can be confirmed only with a biopsy (a tissue sample of the prostate).

What Are the Complications of Prostate Cancer?

Many prostate cancers don’t cause death, but some can spread outside the prostate gland and metastasize through the blood and lymph nodes to bones and major organs. This is known as extracapsular spread.

DOs and DON’Ts in Preventing Prostate Cancer:

  • DOhave a yearly DRE as recommended by your health care provider.
  • DOhave a yearly PSA test as recommended by your health care provider.
  • DOremember that the majority of men who reach age 80 are found to have prostate cancer but generally die from other causes unrelated to their prostate cancer.
  • DON’Tignore possible symptoms of prostate cancer such as pain or difficulty urinating.
  • DON’Tsmoke.

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