Prostate cancer

Also known as: Cancer - prostate, Biopsy - prostate, Prostate biopsy or Gleason score

Definition

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Causes, incidence, and risk factors

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

People who are at higher risk include:

  • African American men, who are also likely to develop cancer at every age
  • Men who are older than 60
  • Men who have a father or brother with prostate cancer

Other people at risk include:

  • Men who have been around Agent Orange
  • Men who use too much alcohol
  • Farmers
  • Men who eat a diet high in fat, especially animal fat
  • Tire plant workers
  • Painters
  • Men who have been around cadmium

Prostate cancer is less common in people who do not eat meat (vegetarians).

A common problem in almost all men as they grow older is an enlarged prostate. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk of prostate cancer. However, it can increase your PSA blood test results.

An enlarged prostate probably means you have prostate cancer.The correct answer is myth. The prostate is a small, walnut-sized gland found next to a man's bladder. It becomes enlarged in almost all men as they age. This is called benign prostatic hyperplasia, or BPH. It does not raise the risk of prostate cancer.Which may be a sign of prostate cancer?The correct answer is all of the above, although these symptoms can also be caused by other prostate problems. Check with your doctor if you notice any changes or difficulties when you urinate. Many prostate cancers are diagnosed before any symptoms are present.A high PSA (prostate specific antigen) level is a sure sign of prostate cancer.The correct answer is myth. The PSA blood test can help detect prostate cancer, but it's not foolproof. Prostate infections or an enlarged prostate can also cause a rise in PSA. Not all experts agree about the value of using PSA test to screen for prostate cancer. Talk with your doctor about whether you should have a PSA test.Which can raise your prostate cancer risk?The correct answer is all of the above. Let your doctor know if you have any of these risk factors. Men with a family history of prostate cancer (especially a brother or father) and African-American men should consider yearly screenings starting around age 40 to 45.Men younger than 40 rarely develop prostate cancer.The correct answer is fact. Most prostate cancer occurs in men who are older than 60. It's the most common cause of death from cancer in men over age 75. Starting at age 50 (or earlier if you are at higher risk), talk with your doctor about the risks and benefits of prostate cancer screening.A biopsy is the only way tell if you have prostate cancer.The correct answer is fact. During a biopsy, your doctor will remove some tissue from the prostate to test for cancer. Your doctor may recommend a biopsy if you have a high PSA level, or if a rectal exam shows a large prostate or a hard, uneven surface.When prostate cancer is found early, treatment may involve:The correct answer is any of the above. If the cancer has not spread beyond the prostate, treatment options include surgery, radiation therapy, or both. Brachytherapy involves placing tiny radioactive seeds inside the prostate. It's often used to treat small, slow-growing cancer.Prostate cancer thrives on testosterone.The correct answer is fact. Most prostate tumors need testosterone to grow. In men whose cancer has spread beyond the prostate, hormone therapy may help reduce testosterone levels. This can relieve symptoms and keep the cancer from spreading, but it's not a cure.Prostate cancer should always be treated, no matter your age.The correct answer is myth. If you are older and have a slow-growing cancer, your doctor may recommend simply monitoring the cancer with PSA tests or biopsies.Prostate cancer treatments may cause impotence.The correct answer is fact. Possible problems after surgery or radiation therapy include problems controlling urine or bowel movements and erection problems. Medicines used to treat prostate cancer may also cause erection problems.Prostate cancer can never be cured.The correct answer is myth. Many patients can be cured if their prostate cancer is found before it has spread beyond the prostate gland. Some patients whose cancer has not spread very much outside the prostate gland can also be cured. Even when prostate cancer cannot be cured, many man can live years with the cancer present.

Symptoms

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms.

The symptoms listed below can occur with prostate cancer, usually at a late stage. These symptoms can also be caused by other prostate problems:

  • Delayed or slowed start of urinary stream
  • Dribbling or leakage of urine, most often after urinating
  • Slow urinary stream
  • Straining when urinating, or not being able to empty out all of the urine
  • Blood in the urine or semen
  • Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)

Signs and tests

A biopsy is needed to tell if you have prostate cancer. A sample of tissue is removed from the prostate and sent to a lab.

Your doctor may recommend a prostate biopsy if:

  • You have high PSA level
  • A rectal exam shows a large prostate or a hard, uneven surface

The results are reported using what is called a Gleason grade and a Gleason score.

The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 - 5. You may have different grades of cancer in one biopsy sample. The two main grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer is to have spread past the prostate:

  • Scores 2 - 5: Low-grade prostate cancer
  • Scores 6 - 7: Intermediate- (or in the middle) grade cancer. Most prostate cancers fall into this group.
  • Scores 8 - 10: High-grade cancer

The following tests may be done to determine whether the cancer has spread:

The PSA blood test will also be used to monitor your cancer after treatment. Often, PSA levels will begin to rise before there are any symptoms. An abnormal digital rectal exam may be the only sign of prostate cancer (even if the PSA is normal).

Treatment

Treatment depends on many things, including your Gleason score and your overall health. Your doctor will discuss your treatment options.

For early-stage prostate cancer, this may include:

If you are older, your doctor may recommend simply monitoring the cancer with PSA tests and biopsies.

If the prostate cancer has spread, treatment may include:

  • Hormone therapy (medicines to reduce testosterone levels)
  • Surgery
  • Chemotherapy

Surgery, radiation therapy, and hormone therapy can affect your sexual desire or performance. Problems with urine control are common after surgery and radiation therapy. Discuss your concerns with your health care provider.

After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including PSA blood tests (usually every 3 months to 1 year).

See also:

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems. See: Support group - prostate cancer

Expectations (prognosis)

How well you do depends on whether the cancer has spread outside the prostate gland and how abnormal the cancer cells are (the Gleason score) when you are diagnosed.

Many patients can be cured if their prostate cancer has not spread. Some patients whose cancer has not spread very much outside the prostate gland can also be cured.

Hormone treatment can improve survival, even in patients who cannot be cured.

Complications

The complications of prostate cancer are mostly due to different treatments.

Calling your health care provider

Discuss the advantages and disadvantages to PSA screening with your health care provider.

Prevention

You may lower your risk of prostate cancer by eating a diet that is:

  • High in omega-3 fatty acids
  • Low-fat
  • Similar to the traditional Japanese diet
  • Vegetarian

Finasteride (Proscar, generic) and dutasteride (Avodart) are drugs used to treat prostate enlargement (benign prostatic hyperplasia, or BPH). If you do not have prostate cancer and your PSA score is 3.0 or lower, ask your health care provider about the pros and cons of taking these drugs to prevent prostate cancer.

References

Theoret MR, Ning YM, Zhang JJ, et al. The risks and benefits of 5a-reductase inhibitors for prostate-cancer prevention. N Engl J Med. 2011;365:97-99.

Antonarakis ES, Eisenberger MA. Expanding treatment options for metastatic prostate cancer. N Engl J Med. 2011;364:2055-2058.

Andriole GL, Crawford ED, Grubb RI 3rd, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319.

Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol. 2008;180:1993-2004.

Schrader FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-1328.

Walsh PC. Chemoprevention of prostate cancer. N Engl J Med. 2010;362:1237-1238.

Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148:435-448.

Review date:
September 11, 2013
Reviewed by:
Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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