Prostate Cancer

Prostate Cancer

What is prostate cancer?

Prostate cancer is the growth of abnormal cells in a man’s prostate gland. The prostate gland is part of a man’s reproductive system. It makes a fluid that mixes with sperm and other fluids during ejaculation. A normal-size prostate is about the size of a walnut. Prostate cancer is one of the most common types of cancer in men. Most types of prostate cancer grow slowly. However, some types can grow quickly and spread to other parts of the body. When cancer spreads, doctors say the cancer has “metastasized.”

Symptoms of prostate cancer

Prostate cancer, especially in its early stages, often does not have any symptoms. Symptoms usually appear as the cancer grows. Those can include:

  • Difficulty starting to urinate.
  • A weak urine stream.
  • Dribbling after you finish urinating.
  • A need to urinate often, especially at night.
  • Pain during urination.
  • Blood in the urine or semen.
  • Difficulty having or maintaining an erection.
  • Pain with ejaculation.
  • Pain or stiffness in the lower back, hips, pelvis, and upper thighs.
  • Unplanned weight loss and/or loss of appetite.

What causes prostate cancer?

Doctors don’t know exactly what causes prostate cancer. However, they do know that certain risk factors may increase your risk for the disease. Those risk factors include:

  • Older age: Men of any age can get prostate cancer. However, it is most common in men older than 65 years of age.
  • Race: African-American men are more likely to develop prostate cancer than Caucasian men.
  • Family history: Men who have had a father or brother with prostate cancer are at increased risk of developing the disease.
  • Obesity: Obese men who are diagnosed with prostate cancer are more likely to have an advanced or aggressive cancer.

How is prostate cancer diagnosed?

Prostate cancer is diagnosed with a biopsy of the prostate. A biopsy is usually done if symptoms or a screening raises concern. A prostate cancer screening is a test that your doctor uses to look for the disease before you have symptoms. There are two screening tests available: a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. Most doctors will recommend that you have both screenings. However, these tests can only tell your doctor whether or not your prostate is healthy. Abnormal test results do not mean that you have cancer. How often you should be screened depends on your age and your personal risk factors.

During a digital DRE, your doctor will insert his gloved, lubricated finger a few inches into your rectum to feel your prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suggest additional testing to check for prostate cancer.

During a PSA test, you will get a blood test. A blood test involves inserting a small needle into a vein to take a sample of blood. The test measures the level of PSA (a substance produced by the prostate) in your blood. Men who have prostate cancer may have a higher level of PSA in their blood. However, a PSA level can also be high because of less serious causes, such as infection or enlarged prostate.

If your screening test results are abnormal, your doctor may recommend additional other tests to check for cancer. Those tests may include:

  • Ultrasound: A transrectal ultrasound provides your doctor with a look at your prostate. During the test, your doctor will insert a small probe into your rectum. This probe sends out sound waves (called ultrasound) that bounce off your prostate. A computer uses the sound waves to create a picture of your prostate.
  • Biopsy: A transrectal biopsy is when your doctor removes a very small piece of your prostate to check it for cancer cells. A biopsy is a reliable way to diagnose prostate cancer. During the biopsy, your doctor will insert a needle through your rectum and into your prostate. The needle collects tissue from your prostate. Your doctor may take tissue samples from several different areas of your prostate.

If your biopsy is normal, you do not have prostate cancer. Talk to your doctor about whether another condition may have caused your symptoms or your high PSA level. Ask your doctor how often you should have checkups.

If your biopsy results are positive for cancer, your doctor will grade and stage the cancer.

  • Grading tells you how aggressive (fast-growing) the cancer is. Higher grade cancers are more likely to grow and spread. A common system of grading is called the Gleason score. Gleason scores range from 2 (not aggressive) to 10 (very aggressive).
  • Staging tells you how advanced the cancer is. Also, it tells you how far it has spread. To determine the stage, your doctor may order imaging tests such as ultrasound, bone scan, computerized tomography (CT) scan, or magnetic resonance imaging (MRI). Stages I or II mean the cancer was caught early and has not spread outside of the prostate. Stages III and IV mean the cancer has spread to nearby tissues, organs, or to other body parts.

Some medical professionals argue that screening isn’t necessary. For people who have fast-growing (aggressive) tumors, catching it early can help. Cancer is usually easier to treat and more likely to be cured when caught early. However, most cases are not fast-growing. Another argument is that PSA tests aren’t always accurate. In fact, a significant number of PSA tests are false-positives. This causes unnecessary worry and expense for men who get the false-positives. For these reasons, some medical organizations, including the U.S. Preventive Services Task Force and the American Academy of Family Physicians (AAFP), recommend against routine PSA testing for men of all ages. Talk to your doctor. Consider the pros and cons of screening, your health, individual risk factors, your preferences regarding diagnosis and treatment, and your doctor’s opinion and advice.

Can prostate cancer be prevented or avoided?

Some risk factors, such as family history and hormone levels, cannot be prevented. However, your weight, physical activity, and diet may lower your risk for prostate cancer. Work toward a healthy lifestyle by eating the recommended daily amount of fruits and vegetables, exercising, and maintaining a healthy weight (or losing weight, if you need to).

Prostate cancer treatment

Prostate cancer treatment depends on your age, your overall health, and the grade and stage of your cancer. If you have prostate cancer, your doctor will need to monitor the growth of your cancer. Fast-growing tumors can quickly spread to other organs in the body. This makes treatment more difficult. Men who have slow-growing tumors may not need treatment for a long time. Some never need treatment.

Common treatment options include the following:

  • Watchful waiting. During watchful waiting, you have no treatment, but you see your doctor often. During this time, your doctor will monitor the growth of your cancer through blood tests, rectal exams, and biopsies. If there’s no sign the cancer is growing, you continue to have no treatment.
  • Radiation therapy. There are 2 types of radiation therapy. One type is called external (beam) radiation therapy. With this type, radiation is given from a machine like an X-ray machine. The other type is called internal radiation therapy. With this type, radioactive pellets (called “seeds”) are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy. Both types have about the same results in curing prostate cancer. Sometimes, both are used together. The external beam radiation therapy usually takes about 10 minutes. It is given 5 days a week over 6 to 8 weeks. Some people might find this time consuming. However, you don’t need any anesthesia for this kind of treatment. Side effects are milder than the side effects that can occur with seed therapy. Seed therapy can be done with just one hospital visit. Seed therapy requires anesthesia (medicine that eliminates pain by making you relax or sleep). However, you should be able to go home right after the treatment. In seed therapy, higher doses of radiation can be put right into the cancer. You may feel more discomfort after this treatment.
  • Radical prostatectomy. Radical prostatectomy is a surgery to remove the whole prostate gland. Nearby lymph nodes also are removed. After the prostate gland is removed through an incision, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals. Other types of prostate surgery are less invasive. Each type has different risks and recovery rates.
  • Hormone therapy. Hormone therapy lowers the level of male hormones, called androgens. This hormone is produced mostly in a man’s testicles. Androgens, such as testosterone, cause the prostate tumor to grow. Androgen deprivation or suppression shots or pills can be given over a period of several months. Surgery may be required to remove the testicles. Once the level of androgens is sufficiently reduced, the prostate cancer usually shrinks and new growth slows down. Hormone treatments are often used in combination with other kinds of prostate cancer treatments. However, hormone therapy does not cure prostate cancer.
  • Chemotherapy. This therapy uses drugs to damage cancer cells and make it difficult for them to grow in number. This medicine is delivered to your body through an intravenous (IV) drip. Chemotherapy is given over the course of weeks or months, depending on the severity of your prostate cancer. It has many notable side effects. The most common side effects are nausea and hair loss.

Treatment risks and benefits

There are risks and benefits of each therapy, including:

Radical prostatectomy: The short-term risks of this surgery are low if you are young and in good health.

  • The hospital stay is usually 2 to 3 days.
  • The catheter is left in place for 2 to 3 weeks.
  • You’re usually able to go back to work in about 1 month.
  • You shouldn’t have severe pain with this surgery.
  • Most men regain bladder control a few weeks to several months after the surgery.
  • The biggest advantage is that it offers the most positive outcome. This is true if all of the cancer is removed during surgery.
  • The surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.

The main risks of radical prostatectomy are incontinence (loss of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex).

Radiation therapy: Older studies show that about one-half of patients become impotent within 5 years of having radiation therapy, but newer forms of radiation may have different outcomes.

  • Many men feel very tired at the end of the treatment period.
  • Some men have side effects like urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort, or diarrhea during or shortly after the treatment.
  • Erectile dysfunction (impotence) is a common side effect and often gets worse over time.
  • More serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes are not taken out, your doctor can’t tell the exact size of the tumor. The cancer could come back many years after radiation treatment.

Hormone therapy: Hormone therapy often is used in combination with other treatments. It does have side effects.

  • Serious side effects include loss of sex drive, weakened bones, erectile dysfunction, fatigue, and osteoporosis.
  • Hormone treatments may be used in patients who have cancer that has spread beyond the prostate gland. While prostate cancer that has spread usually responds to 1 or 2 years of hormone therapy, it does not cure the disease and most tumors eventually begin to grow again. Once this happens, the treatment goal is to control symptoms.

Chemotherapy: Chemotherapy has been shown to help some people who have advanced prostate cancer live longer.

  • Chemotherapy can have many side effects, including hair loss, nausea, fatigue, and loss of taste.

Living with prostate cancer

Living with prostate cancer depends on how early you were diagnosed. Also, it depends on the type of treatment you received. For example, if you had to have your prostate removed, you may have to live with sexual dysfunction. If you had hormone or chemotherapy, you may have long-terms effects from the medicines used on those treatments. Ask your doctor how you can improve the quality of your life after treatment.

Questions to ask your doctor

  • What could cause an enlarged prostate, other than cancer?
  • At what age should I start screening for prostate cancer?
  • How often should I get screened?
  • Will I have a normal sex life after my prostate surgery?
  • Are there any long-term side effects of chemotherapy?