Prostate Cancer

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in a man's 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 has become the most commonly diagnosed cancer in men. However, it usually grows slowly. Men who have it are more likely to die from causes other than the cancer.

How does it occur?

The cause of prostate cancer is not known. Studies have found or suggested the following risk factors for prostate cancer:

• 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 aggressive in African-American men.
• Diet: Studies suggest that men who eat a diet high in red meat and high-fat dairy products or who are obese may have an increased risk for prostate cancer. 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. Symptoms that may occur are:

• 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 during urination
• 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 an enlarged prostate, also called benign prostatic hypertrophy or BPH, or an infection. BPH is a growth of the prostate that is not caused by cancer. BPH normally occurs as men 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 causes no symptoms, it may be found as part of a routine exam or during an exam for some other problem.

A prostate-specific antigen (PSA) blood test may be done, along with a rectal exam, to screen for prostate cancer. Cancer can cause the prostate to make more PSA, increasing the levels 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 this test for prostate cancer screening are not certain.

If you have a sign, symptom, or test that suggests prostate cancer, other tests that may be done are:

• Transrectal ultrasound to look at the prostate. A probe is inserted into the rectum. The probe bounces sound waves off the prostate to create a picture of the prostate on a video screen.
• Cystoscopy. The healthcare provider uses a thin, lighted tube to look into the penis, urethra, and bladder.
• Transrectal biopsy. The healthcare provider inserts a needle through the rectum into the prostate. A piece of the 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 large the tumor is, whether it has spread to other parts of your 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). 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. 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.

  Newer and lesser surgery may be done with a laparoscope, sometimes with robotic manipulation techniques. These tools and techniques may also be used to do a radical prostatectomy. However, there is less experience with these ways of doing the surgery.

• Radiation therapy. This treatment uses high-energy rays rather than surgery 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 body 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 a radioactive substance placed in the prostate gland. This may cause erectile dysfunction and loss of bladder control.
• Hormone therapy. Drugs or surgery to remove both testicles may be used to keep prostate cancer cells from receiving the male hormone (testosterone) that they need to grow. The testicles produce the most of the testosterone in your body. Drug treatment can include medicines that keep the testicles from making testosterone, block the action of male hormones on the prostate cancer cells, or prevent the adrenal gland from making testosterone. Side effects of treatment depend on the treatment used. They may include erectile dysfunction, hot flashes, loss of sexual desire, weaker bones (osteoporosis), breast tenderness or slight enlargement, nausea, or diarrhea.

Watchful waiting, which means not having treatment, may be chosen 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.
• You have no signs or symptoms of the cancer.

How long will the effects last?

Most prostate cancer grows very slowly. Prostate cancer is often found when the cancer is at an early stage and can be treated successfully.

How can I take care of myself?

• Follow the full course of treatment prescribed by your healthcare provider.
• Eat a healthy diet.
• Recognize that having the cancer is an added stress in your life. Take more time for your important relationships and for rest.
• Be candid with your family and your healthcare providers about your concerns.
• Ask your healthcare provider any questions you have about the course of the disease, treatments, side effects of the treatments, support groups, and anything else that concerns you.
• Find a counselor to help you deal with difficult issues.
• Spend time with people and activities you enjoy.

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)
  Web site: http://www.cancer.gov

How can I prevent prostate cancer?

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