Prostate Cancer

What is prostate cancer?

Prostate cancer is the growth of abnormal cells in the prostate gland. The prostate gland is part of a man's reproductive system. It is, on average, a little bigger than a walnut. It is located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra. (The urethra carries urine from the bladder out through the penis.) The prostate makes the fluid that nourishes and carries sperm.

In the US, prostate cancer is the most commonly diagnosed cancer in men. Some types of prostate cancer grow and spread quickly and may appear at an early age. Others tend to grow very slowly and usually appear when men are older. Prostate cancer is often found at an early stage and can be treated successfully.

What is the cause?

The cause of prostate cancer is not known. However, some things do seem to increase your risk, such as:

• Age: Age is the main risk factor for prostate cancer. Prostate cancer is rarely found in men younger than 45. The chance of getting it gets higher as a man gets older. Most men diagnosed with prostate cancer are older than 65.
• Heredity: A man's risk is 2 to 3 times higher if his father or brother had prostate cancer.
• Race: Prostate cancer is more common and more likely to be fatal in African-American men.
• Diet and obesity: Studies suggest that men who eat a diet high in red meat and fat have a higher risk for prostate cancer. Men who are overweight may be more likely to die of it. Men who eat a diet rich in fruits and vegetables may have a lower risk.

What are the symptoms?

Prostate cancer often has no symptoms, especially in the early stages. When symptoms do appear, they may include:

• weak flow of urine
• urine flow that starts and then stops too soon
• trouble starting or stopping the flow of urine
• frequent and urgent need to urinate, especially at night
• blood in the urine or semen
• pain or burning when you urinate
• trouble having an erection, or pain when semen comes out of the penis (ejaculation)
• frequent pain in the lower back, hips, or upper thighs (usually because of a spread of the cancer beyond the prostate gland)

These symptoms can be caused by other problems, such as infection or an enlarged prostate, also called benign prostatic hypertrophy or BPH. BPH is a growth of the prostate that is not caused by cancer. It’s normal for men to have BPH as they get older. If you have any of the signs or symptoms listed above, you should see your healthcare provider so that problems can be diagnosed and treated as early as possible.

How is it diagnosed?

Because prostate cancer often does not cause any signs or symptoms, it may be found just during a routine exam or an exam done for some other problem.

A rectal digital exam and prostate-specific antigen (PSA) test may be done to screen for prostate cancer. For the digital rectal exam, the healthcare provider puts a gloved finger in a man's rectum to feel the prostate gland. Prostate cancers feel very hard compared to normal prostate tissue. If your provider feels something abnormal, then you may have other tests to see if there is a tumor and whether it is a type of cancer that will spread.

The PSA test is a blood test. Cancer can cause the prostate to make more PSA, increasing the level of PSA in the blood. However, like many cancer-screening tools, the PSA test is not perfect and can give misleading results. A normal result does not necessarily mean that there is no cancer in the prostate. And if the result is a bit high, it may not be from cancer.

The benefits of the PSA test and the rectal digital exam for prostate cancer screening are not certain. The current recommendations are that men age 75 and older do not need to be screened for prostate cancer. Men younger than 75 should discuss the benefits and harms of screening with their healthcare provider.

If you have a sign, symptom, or test that suggests prostate cancer, your provider will likely recommend a test called a transrectal biopsy. For this test your healthcare provider inserts a needle through the rectum into the prostate. A piece of prostate tissue is removed to look for cancer cells. It is the only sure way to diagnose prostate cancer.

If a biopsy shows cancer cells, you will have other tests, such as a bone scan, CT scan, or MRI, to see if the cancer has spread and help decide how to treat it.

How is it treated?

Treatment depends on how aggressive the tumor is, whether it has spread to other parts of the body, your symptoms, your overall health, and your age. Some of the treatments, and their side effects, are:

• Surgery to remove the prostate (prostatectomy). The standard surgical treatment is called a radical prostatectomy. Nearby lymph nodes are also removed. The hospital stay is usually 2 to 3 days. For a short while after surgery you may have some problems, such as discomfort and some loss of control of the flow of urine (incontinence). You will have a catheter (a tube to drain the urine from the bladder) for 1 to 2 weeks after surgery. Most men are able to control their bladder again after a few weeks. Surgery may also cause erectile dysfunction (trouble having or keeping an erection, also called impotence). Nerve-sparing surgery may help so that this problem does not last or is not as severe. However, in some cases, men become permanently impotent. Also, when your prostate is removed, you will no longer produce semen. You will have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.

  New methods of surgery to remove the prostate are being developed. For example, the prostate may be removed with a laparoscope and sometimes with robotic techniques. The newer techniques can be done with much smaller cuts than needed for the standard procedure. This means that there is less pain after surgery and the hospital stay may be shorter.

• Radiation therapy. This treatment uses high-energy rays to kill cancer cells. Sometimes it causes long-term problems such as diarrhea, erectile dysfunction, and poor control of the flow of urine. The radiation may be given externally (radiation beamed at your prostate from a machine). This may cause the urethra, rectum, and anus to become inflamed. Sometimes the radiation may be given internally, which means the radiation comes from radioactive substances placed in the prostate gland. This may cause erectile dysfunction and loss of bladder control.
• Hormone therapy. Prostate cancer cells need the male hormone testosterone to grow. The testicles make most of the testosterone in your body. Surgery to remove both testicles may be used to keep prostate cancer cells from getting a lot of testosterone. Drugs are another way to do this. Drug treatment can include medicines that keep the testicles from making testosterone, blocking the action of male hormones on the prostate cancer cells, or medicines that keep the adrenal gland from making testosterone. Side effects of treatment depend on the treatment. They may include erectile dysfunction, hot flashes, loss of sexual desire, weaker bones (osteoporosis), breast tenderness or slight enlargement of the breasts, nausea, or diarrhea.

Instead of treatment, your provider may suggest watchful waiting. This means monitoring your PSA and checking for symptoms and growth of the cancer but not having treatment. This approach may be recommended if:

• The risks and possible side effects of treatment outweigh the possible benefits.
• You are an older adult.
• You have other serious health problems.
• You are diagnosed with early-stage prostate cancer that seems to be growing slowly and is not causing any symptoms. In this case, in addition to monitoring your PSA, your healthcare provider may recommend another prostate biopsy in 1 year.

How can I take care of myself?

• Follow the full course of treatment prescribed by your healthcare provider.
• Eat a healthy diet and get regular exercise and rest.
• Try to reduce stress and take time for activities that you enjoy. It may help to talk with a counselor about your illness.
• Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexuality, support groups, and anything else that concerns you.
• For more information, contact:
  • American Cancer Society, Inc.
    Phone: 800-ACS-2345 (800-227-2345)
    Web site: http://www.cancer.org
  • National Cancer Institute
    Phone: 800-4-CANCER (800-422-6237) (TTY: 1-800-332-8615)
    Web site: http://www.cancer.gov

How can I help prevent prostate cancer?

Because the cause of prostate cancer is not known, doctors don’t know how to prevent it. However, researchers are actively studying possible methods of prevention, such as diet, supplements, and drugs.