Prostate Cancer

Prostate cancer is the most commonly diagnosed cancer in American men. The American Cancer Society estimates that in 2012:

  • Roughly 241,740 new cases of prostate cancer will be diagnosed
  • 28,170 men will die from it
  • Roughly 1 in 6 men will be diagnosed with prostate cancer during their lifetimes

Prostate Cancer: What Is it?

Prostate cancer results from the uncontrollable growth of abnormal cells in the prostate gland. When cells in the prostate are malignant, they cluster together to form small “islands” of cancer. In many cases, it takes years for the cancer to spread and often times it does not.

This type of cancer typically grows slowly and occurs mainly in older men. Nearly two thirds are diagnosed in men aged 65 or older and it is rare before age 40. The average age at the time of diagnosis is about 67.

Symptoms of Prostate Cancer

Initially prostate cancer is symptom-free, and quite often the majority of men who are diagnosed never display symptoms. As the disease progresses you may experience:

  • Difficulty urinating
  • Urinating more frequently
  • Pain or a burning sensation while urinating
  • Blood in your urine or semen
  • Pain in your back, hips or pelvis

If your prostate cancer has invaded the lymph nodes, bones or other organs you also may experience:

  • Weight loss
  • Shortness of breath
  • Bone pain
  • Fatigue
  • Swollen legs, feet, penis and scrotum

Risk Factors for Prostate Cancer

While the exact cause of prostate cancer isn’t known, you should be aware of the factors that may increase the likelihood that you will contract the disease.

  • Age: Men over 50 are at greater risk, with two-thirds of all cases being found in those 65 and older.
  • Race: Prostate cancer is most common in African Americans. They are more likely to be diagnosed when the disease is advanced and more than twice as likely to die from this cancer than white men and five times more likely than Asians.
  • Family history: Men with a family history of prostate cancer are at greater risk. Having one man in your family with the disease doubles your chances, while three members increase your chances 11-fold. The HPC1 gene is associated with the inherited type of this cancer.
  • Diet: Some studies link prostate cancer to diets that are high in red meat and high-fat dairy products, and low in fruits and vegetables.

Testing for Prostate Cancer

The most common screening test for prostate cancer is the prostate-specific antigen (PSA) blood test. The decision concerning who should—or shouldn’t—have a PSA test is split. Some medical professionals have specific guidelines while others leave the decision up to the individual and his doctor.

Those who recommend PSA screening generally encourage the test for men between 40 and 75 and for those with an increased risk of prostate cancer. You should make your own decision after discussing it with your physician and considering your risk factors. If you decide to have the test you need to tell your doctor if you’re taking any medications for an enlarged prostate. Certain drugs, like finasteride (Proscar) and dutasteride (Avodart), can affect your PSA reading.

Your doctor also will perform a digital rectal exam (DRE). During the exam your doctor will feel part of your prostate through the rectal wall. Any swelling or enlargements, firm spots or lumps may suggest cancer.

If cancer is suspected, your physician will order a biopsy to remove a small sample of your prostate tissue. If the results are positive additional tests may be performed to determine if the cancer has spread.

  • Bone scans and x-rays will show if the cancer has reached the bones.
  • Computed tomography (CT) of magnetic resonance imaging (MRI) scans can identify other areas where the cancer may have invaded.

Stages of Prostate Cancer

Prostate cancer is measured in four stages. Stage I cancers are considered early stage and Stage IVs are the most advanced, having spread to other parts of the body. The stage depends on whether the tumor has attacked nearby tissue (i.e., the bladder or rectum), whether the cancer cells have spread to your lymph nodes or other parts of your body, the grade of your tumor and your PSA level.

  • Stage I: The cancer is confined to your prostate and may not be detectable during a digital rectal exam. Your Gleason score would be under six and the PSA level would be below 10.
  • Stage II: The tumor is more advanced but still is only in your prostate.
  • Stage III: The tumor expands beyond your prostate. Although it may not have spread to your lymph nodes, the tumor may have invaded a seminal vesicle.
  • Stage IV: The tumor may have attacked your bladder, rectum or other nearby structures and spread to your lymph nodes, bones or other areas of your body.

Treatment of Prostate Cancer

How your doctor will choose to treat your prostate cancer depends on:

  • Whether the tumor has invaded all or part of your prostate
  • If the cancer has travelled to other parts of your body
  • Your age
  • Your general health

Several treatment options are available if your cancer is contained to your prostate:

  • Watchful Waiting or Active Surveillance: If your cancer is slow-growing, your doctor may schedule a digital rectal exam and PSA blood test every three to six months to monitor any changes in your condition. This is often recommended for older patients or those who have other health concerns. Active surveillance is deemed appropriate for men over age 70, elderly men who have early stage (T0-T2) low-grade tumors or those with low-to moderate (3-13 ng/ml) PSA levels.
  • Surgery: If your cancer is confined to your prostate, removing the entire organ—and possibly nearby lymph nodes—provides the possibility for cure. Cure rates for those with localized cancer are roughly 90%, depending on the stage and grade of the tumor, PSA levels and general health. There are risks involved so be sure to speak with your doctor about potential problems and recovery time. Potential complications from surgery are erectile dysfunction, urinary incontinence, infection and bowel problems.
  • Radiation Therapy: Radiation may be used as an initial treatment method if your cancer is contained, hasn’t been completely removed or has returned following surgery. In advanced cases, radiation is used to shrink the tumor and alleviate symptoms. This type of treatment is generally recommended for men over 70. Possible side effects of radiation are diarrhea, urinary incontinence, blood in the urine, rectal bleeding and pain, fatigue and erectile dysfunction.
  • Chemotherapy: This type of treatment is generally used when the cancer is advanced. Chemotherapy uses drugs to destroy the cancer cells. Side effects may include low blood cell count, hair loss, decreased appetite, nausea, vomiting, diarrhea, mouth and lip sores and fatigue.
  • “Seed” Implantation: Brachytherapy imbeds radioactive “seeds” into the prostate. The implants can be temporary or permanent. Temporary ones are typically used in conjunction with radiation. This method is used in slow-growing, early-stage cancers.
  • Hormone Therapy: If your cancer has spread to other areas your doctor may recommend hormone—or androgen-deprivation—therapy. Androgens are male hormones that can fuel prostate cancer. Hormone therapy lowers testosterone by prohibiting its production. Potential side effects are decreased sex drive, weight gain, nausea, hot flashes, diarrhea, enlarged breasts, changes in liver function, erectile dysfunction and lower bone density and muscle mass.

Prostate Cancer Prognosis

The prognosis for men battling prostate cancer is excellent. The survival rate for those diagnosed with localized cancer is a minimum of five years. More than 75% of men diagnosed live at least 15 years.

Additional Resources on Prostate Cancer

Here is a list of helpful resources for more information on prostate cancer.

  • American Cancer Society
    1-800-227-2345 (toll-free)
    1-866-228-4327 (TTY/toll-free)
    www.cancer.org
  • American Urological Association Foundation
    1000 Corporate Boulevard
    Linthicum, MD 21090
    1-800-828-7866 (toll-free)
    www.urologyhealth.org
  • National Cancer Institute
    Cancer Information Service
    1-800-422-6237 (toll-free)
    1-800-332-8615 (TTY/toll-free)
    www.cancer.gov/cancertopics/types/prostate
  • National Kidney and Urological Diseases
    Information Clearinghouse
    3 Information Way
    Bethesda, MD 20892-3580
    1-800-891-5390 (toll-free)
    1-866-569-1162 (TTY/toll-free)
    www.kidney.niddk.nih.gov
  • National Institute on Aging
    Information Center
    P.O. Box 8057
    Gaithersburg, MD 20898-8057
    1-800-222-2225 (toll-free)
    1-800-222-4225 (TTY/toll-free)
    www.nia.nih.gov
    www.nia.nih.gov/espanol

Written by expert writer Mary S. Yamin-Garone.

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