Prostate Cancer

Sort out the facts and examine your feelings. Read up on screening. Then, talk with your doctor.

Prostate Cancer is part of aging for nearly every man. It may be a harmless tumor that grows so slowly most men don’t know its there. Or a more aggressive tumor that could be life threatening. Research is needed. But we do know that more than 26,120 American men will die of prostate cancer this year. What’s best for you? Find the facts here, and a blog by Dr. James Richardson, Radiation Oncologist here. Talk with your physician, family and even friends about screening. Because the decision is yours.

The following information is provided for a better understanding of the disease and does not replace the conversation men should have with their physician regarding screening and treatment for prostate cancer.

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About Prostate Cancer

About the prostate gland

A small gland the size of a walnut, the prostate is exclusive to men. Located underneath the bladder and in front of the rectum the prostate is part of the body’s semen making process. It’s triggered by testosterone, a male hormone, which can influence the behavior of the prostate gland and prostate cancer. Nerves to the penis important in producing and maintaining an erection run very close to the prostate. The urethra runs through the prostate, if the prostate enlarges, it can block the flow of urine from the bladder making it difficult for a man to urinate.

About prostate cancer

A complex and usually slow growing cancer, prostate cancer is the most common non-skin cancer and the second leading cause of cancer death in men in the US today. Most prostate cancers grow very slowly so other medical illness will cause the affected man’s death. However some prostate cancers are more aggressive and at this time it can be difficult to differentiate between them. There are different types of tumors and not all are cancerous. Those that cannot spread or threaten a life are benign. Those that invade surrounding tissue and even spread throughout the body are malignant tumors. Since most prostate cancer is very slow growing it will never endanger or affect quality of life. However, sometimes these cells grow quickly and spread to nearby tissue and lymph nodes. If prostate cancer has spread to the patient’s lymph nodes when it is diagnosed, it means that there is a higher chance that it has spread to other areas of the body.

Prostate Cancer - What are the Risk Factors?

Researchers believe every man over the age of 45 is at risk for prostate cancer. One man in seven will develop prostate cancer and one in 39 will die from it. In between are men whose quality of life will be changed by it.

Age is most often a factor as 70% of men diagnosed with prostate cancer are over the age of 65. Incidence of prostate cancer rises quickly after the age of 50 and the majority of men will have some form of prostate cancer after the age of 80. It is said that that men over age 80 die with prostate cancer not from prostate cancer. It means that many men have developed the slow growing microscopic form of prostate cancer but it is not life threatening. Current screening is not perfect in discerning which type of cancer is developing.

Another risk factor is ethnicity. Men of African-American descent tend to have a higher risk of developing prostate cancer. Men of Asian, Latin or Native American descent have a lower risk. Caucasian men fall in the middle. This risk factor is not well understood. While genetics may be a factor, there is some evidence that diet may be a factor. Some studies indicate that a diet high in animal fat and/or low in fruits and vegetables may also raise risk.

Family history A father or brother with prostate cancer more than doubles a man’s risk of developing prostate cancer. With a family history of prostate cancer developed at a younger age the risk increases even more. Certain mutations in genes may carry an increase in prostate cancer risk as well as men with high levels of testosterone.

Prostate Cancer - Prevention

Little is known about this complex disease and much research is underway. Because so many men will develop prostate cancer there is a lot of interest in prevention with drug therapy and/or the consumption of certain foods or nutrients. Although certain foods and nutrients are being researched more data is needed. Studies including supplements of selenium, lycopene, vitamin A or other retinoids, vitamin D, and vitamin E found no reduction in prostate cancer risk. Several studies are now looking at possible effects of soy or isoflavones on prostate cancer risk however results are not yet available. At this time prevention includes the patient taking control over his own health and a low fat diet that is rich in fruits and vegetables is suggested.

Prostate Cancer - Screening

Prostate cancer shows a wide spectrum of behavior so screening for it begins with annual check-ups with your doctor. Any changes in your health and well-being should be discussed with your physician. Screening of men 50 and older is currently the only method of determining the health of the prostate gland and is the first step for many men as they may have an enlarged prostate and be symptom free. The American Cancer Society, the American Urological Society, and many medical communities’ experts agree: being informed and in tune with your body is important.

The role of screening is being reevaluated, based in part on cost, potential toxicity of treatment, and the fact that some men do well without treatment. Most physicians begin the conversation with their patients regarding prostate cancer and offer screening at age 50. African-American men, who are at a higher risk of death from prostate cancer than white men should begin screening at age 45. The same is true for any man with a first degree relative who has had prostate cancer. For men with more than one first degree relative with prostate cancer, screening begins at age 40 or even earlier.

Two methods are used: a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test. The digital rectal exam is done in the primary care physician's office. Because the prostate is so close to the rectum, a doctor can feel it by inserting a gloved, lubricated finger into the anus. Lumps, asymmetries, or an enlarged prostate can be detected this way though some small cancers can be missed. A PSA looks for a protein that the prostate makes. Normal prostate tissue makes a little bit of PSA, but prostate cancer usually makes much more. An elevated PSA may suggest that a malignant tumor is present. False positive tests exist. For that reason doctors really on the combination of a PSA blood test and a DRE. If there is doubt, the physician may recommend a sample of prostate tissue from a biopsy be taken for further study.

The Annals of Internal Medicine, established by the American College of Physicians is now recommending men 75 and older not be screened for prostate cancer.

* Source: http://www.annals.org/cgi/content/full/149/3/185

Prostate Cancer - Symptoms

Most early prostate cancers are detected with PSA tests or digital rectal exams before they cause any symptoms. More advanced prostate cancers can cause a variety of symptoms including:

  • trouble starting urination
  • urinating much more frequently than usual
  • the feeling that you can't release all of your urine
  • pain during urination or ejaculation
  • blood in your urine or semen
  • impotence
  • bone pain

All of the symptoms listed here can be caused by a number of things besides prostate cancer. If the patient experiences any of these symptoms further screening should be discussed.

Prostate Cancer - Diagnosis

If the patient experiences symptoms, the doctor will do a digital rectal exam and a PSA blood test. If either of those two tests is abnormal, the doctor will probably recommend a biopsy. Once the tissue is removed, a pathologist will review the specimen. The pathologist can tell if it is cancer or not; and if it is cancerous, then the pathologist will characterize it by what type of prostate cancer it is and how abnormal it looks (known as the grade).

Prostate Cancer - Treatment

There are many different ways to treat prostate cancer, and patients may consult with multiple types of doctors before making a final decision. Physicians are not always in agreement as to the way to proceed because there haven't been enough large trials that compare the different treatment modalities. A second opinion is standard. Talking with both urologists and radiation oncologists to discuss the benefits and risks of surgery, hormonal therapy, and radiation treatment including 3D-CRT and IMRT (Intensity modulated radiation therapy), brachytherapy, chemotherapy, and cryosurgery is suggested. “Watchful Waiting” may be recommended for some patients in the hopes they have a slow growing cancer. Once a patient has been treated for prostate cancer follow up visits are done on a regular schedule, often at first then less often as the patient is free of the disease.