Prostate Cancer Overview:
What is the prostate and what does it do?
The prostate is part of the male reproductive system about the size of a walnut located below the bladder and in front of the rectum. The prostate surrounds the urethra, the tube that carries urine from the bladder out of the body, and its function is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra at the same time as fluid from the prostate and the seminal vesicles, mixing and creating semen.
The prostate goes through two main growth periods during a man’s life. The first occurs early in puberty when the prostate doubles in size. The second growth phase begins around age 25 and continues for much of the remainder of a man’s life.
What is prostate cancer?
Prostate cancer:
- The most common cancer found in men
- The second leading cause of cancer deaths among U.S. men
- 80% of men who reach the age of 80 will have prostate cancer
- More than 180,000 U.S. men will be diagnosed this year
- More than 40,000 will die from the disease this year
- More common in African-American men and men with a family history of it
Prostate cancer is a malignant (cancerous) tumor that typically forms in the outer part of the prostate. In most men, prostate cancer grows very slowly and many men will never know they had it. Moreover, early prostate cancer is limited to the prostate gland itself, and most patients with this type of cancer can live for years with no symptoms.
Prostate cancer is classified based on the size and extent of the tumor.
- Stage I = no nodule (tumor) upon exam but elevated Prostate-specific antigen (PSA)
- Stage II = nodule (tumor) confined to the prostate
- Stage III = cancer spreads from the prostate to adjacent structures
- Stage IV = cancer spreads to lymph nodes (Stage IV, N+) and/or spreads to bones or other organs (stage IV, M+)
What causes prostate cancer?
Like many other types of cancers, the cause of prostate cancer is currently unknown. What doctors do know is that prostate cancer more common in African-American men and men who have a family history of the disease.
What are the symptoms of prostate cancer?
Prostate cancer is “silent” in its early stages. Symptoms don’t appear until later and usually start as a need to urinate more frequently, particularly at night. Prostate cancer may also cause:
- Trouble urinating
- A weak, or broken flow of urine
- Painful and burning urination
Other symptoms may include:
- Painful ejaculation
- Blood in urine or semen
- Frequent pain or stiffness in the lower back, hips, or legs
Diagnosis and Tests:
How is prostate cancer detected?
The most effective means of detecting prostate cancer early is through a physician screening that involves a digital rectal exam and measuring the amount of prostate-specific antigen (PSA) in the blood.
A digital rectal exam consists of the doctor inserting a gloved, lubricated finger into the anus to feel the shape and size of the prostate.
A PSA test measures the amount of the protein that is secreted by the prostate. Higher levels of this antigen may indicate prostate cancer.
If cancer is suspected the doctor will usually perform a biopsy (removal of a tiny piece of prostate tissue) and examining it. This can be valuable to the doctors to confirm or rule out a cancer diagnosis and determine whether the disease has spread to other regions of the body.
What if it is prostate cancer?
To help predict how aggressive the cancer is and to help develop a treatment plan your physician will look at your PSA levels and calculate a “Gleason Score” from the biopsy.
Prostate cancerous cells fall into 5 distinct patterns as they change from normal to tumor cells. The cells are scored on a scale from 1 to 5 with 5 considered “high-grade.” Based on this scale a grade is assigned to the two most predominant cell patterns in the biopsy and the grades are combined to determine a Gleason Score. Generally speaking, a lower Gleason Score (2–4) means a less aggressive cancer, with a higher Gleason Score (7–10) indicating a more aggressive one.
Men who have cancer with a higher likelihood of spreading may need staging studies such as bone scans and computed tomography scans to learn where cancer may have spread.
Management and Treatment:
What are the treatment options?
Physicians design treatment plans based on a variety of factors including patient needs, the type of cancer, the age of the person, how far the cancer has spread, and the overall health of the patient.
Some of the available treatment options include:
Observation or surveillance: For men with low-risk cancer, observation (watching) may be the first strategy after a recent prostate cancer diagnosis.
Radical prostatectomy (laparoscopic): This is a minimally invasive procedure that removes the prostate gland. Unlike conventional surgery, this laparoscopic surgery only requires a few small incisions to put the instruments and a tiny camera through to perform the operation.
Radical prostatectomy (Robotic): The same procedure as above with the exception that the surgeons use a robot to guide the instruments to remove the prostate and any other affected tissue.
Radiation therapy: Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation can be produced two ways: external radiation, which comes from a machine outside the body; or internal radiation, in which radioisotopes are inserted through thin tubes into areas where the cancer cells are found.
Interstitial brachytherapy (seed implantation): A form of radiation therapy in which radioactive pellets or “seeds” are injected into the prostate to release radiation into the prostate and nearby tissue.
Intensity-modulated radiotherapy: An advanced form of radiation therapy where high doses of radiation (guided by a computer) are delivered directly to the tumor.
Cryotherapy: Small probes are inserted into the prostate to freeze and kill the cancerous cells.
Hormone therapy: Hormones are utilized to change the body’s chemical balance to prevent certain cancers from growing. Therapy may be done using drugs that change the way hormones work, or with surgery that removes hormone-producing organs such as the testes.
Chemotherapy: Chemotherapy uses drugs to kill cancer cells. This is usually a systemic treatment, which means that the drugs travel through the body, killing cancer cells wherever it may be.
Which treatment should I choose?
The best type of treatment(s) is mostly a matter of patient choice. Consider the pros and cons of each option, and keep in mind how aggressive and advanced your cancer is. Here are some issues to consider:
- Ask your doctor about the stage and grade of your cancer. With this information, you and your doctor should discuss the risks that your cancer poses to your well-being and longevity, how well each treatment might work for you, and what the side effects are.
- Consider your age and health. Younger patients may choose to treat cancer aggressively while older men may not. Also, poor health adds to the complexity and makes some treatments riskier.
- Think about your quality of life after treatment. With some treatment options, there are some difficult trade-offs to consider that may affect your left post-cancer.
- Make sure you are getting balanced and impartial information. If your doctor is a surgeon, you may want to talk with a radiation therapist and vice versa. Make sure you feel comfortable discussing all options with all of your doctors. You should also do your own research and consult with your doctors about any questions.
- Ask yourself:
- If you are considering “active surveillance,” can you deal with the knowledge that you have untreated cancer inside your body?
- Will you follow through with all physician visits for repeat testing?
- Would more aggressive treatment fit your personality and anxiety level?
Prevention:
Who is at risk for prostate cancer?
The number of prostate cancer cases has dropped among white American men while in African-American men the rates are twice as high.
The following are risk factors:
Age: More than 75% of all prostate cancers are diagnosed in men older than 65
Family history: Men with a family history of prostate cancer are at a higher risk. Having a father or brother with the disease doubles your risk. Therefore, screening for prostate cancer should be started at a younger age (40 years old).
Race: African-Americans have the highest incidence of prostate cancer, and therefore, they should also start prostate cancer screening early.
Diet: Research suggests a high-fat diet may lead to prostate cancer.
Male hormones: High levels of male hormones called androgens may increase the risk of prostate cancer for some men.
Inactive lifestyle: Getting regular exercise and maintaining an ideal weight can decrease your risk.
Outlook:
What is the prognosis for men with prostate cancer?
89% of men diagnosed with prostate cancer live at least 5 years, and 63% will live 10 years or longer.
Prostate cancer is slow-growing, and many affected men will die from other causes. Patients who have a prostate screening every year can better detect their prostate cancer and any recurrence while it still can be cured.
References:
- National Cancer Institute. Prostate cancer—for patients
- American Cancer Society. Prostate cancer
- Corn P, Logothetis C. Chapter 34. Prostate Cancer. In: Kantarjian HM, Wolff RA, Koller CA. eds. The MD Anderson Manual of Medical Oncology, 2e. New York, NY: McGraw-Hill; 2011.