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. This is the tube that carries urine out of the body.

Causes

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 high risk include:

  • African American men, who are also more likely to develop this 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
  • Obese men
  • 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. But it can increase your prostate-specific antigen (PSA) blood test result.

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

With early prostate cancer, there are often no symptoms.

The PSA blood test may done to screen men for prostate cancer. Often, PSA level rises before there are any symptoms.

The symptoms listed below can occur with prostate cancer as it grows larger in the prostate. 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 all of the urine
  • Blood in the urine or semen

When the cancer has spread, there may be bone pain or tenderness, most often in the lower back and pelvic bones.

Exams and Tests

An abnormal digital rectal exam may be the only sign of prostate cancer.

A biopsy is needed to tell if you have prostate cancer. A biopsy is a procedure to remove a sample of tissue from the prostate. The sample is sent to a lab for examination. It will be done in your doctor's office.

Your doctor may recommend a biopsy if:

  • You have a high PSA level
  • A digital rectal exam reveals a hard or uneven surface

The biopsy result is 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 through 5. You may have different grades of cancer in one biopsy sample. The two most common grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer can spread beyond the prostate:

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

Treatment

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

If the cancer has not spread outside the prostate gland, common treatments 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). It may be used for all but the earliest stage of prostate cancer. It may be given before, along with, or after other treatments.

If prostate cancer spreads even after hormone therapy, surgery, or radiation has been tried, treatment may include:

  • Chemotherapy
  • Immunotherapy (medicine to trigger the immune system to attack and kill cancer cells) 

Surgery, radiation therapy, and hormone therapy can affect your sexual performance. Problems with urine control are possible 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 checkups, including PSA blood tests (usually every 3 months to 1 year).

Support Groups

You can ease the stress of illness by joining a prostate cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (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.

A cure is possible if the cancer has not spread. Hormone treatment can improve survival, even if a cure is not possible.

When to Contact a Medical Professional

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

Prevention

Talk with your health care provider about possible ways to lower your risk of prostate cancer. These may include lifestyle measures, such as diet and exercise.

Taking extra vitamin E has not been found to reduce the risk of prostate cancer and may increase the risk. Talk with your doctor before taking larger doses of this vitamin.

There are no medicines approved by the FDA for preventing prostate cancer.

References

American Urological Association Education and Research, Inc. PSA testing for the pretreatment staging and posttreatment management of prostate cancer: 2013 Revision of 2009 Best Practice Statement. Linthicum, MD: American Urological Association Education and Research, Inc. 2013. Available at: http://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Specific-Antigen.pdf. Accessed October 3, 2013.

Drake CG. Immunotherapy for prostate cancer: an emerging treatment modality. Urol Clin N Am. 2010:37121–37129.

Eastham JA, Scardino PT. Expectant management of prostate cancer. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 101.

Klein EA, Thompson IM Jr, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306:1549-1556.

Loeb S, Carter HB. Early detection, diagnosis, and staging of prostate cancer. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 99.

National Cancer Institute: PDQ Prostate Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified 08/15/2013. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional. Accessed October 28, 2013.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate cancer. Version 4.2013. Available at: http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed October 28, 2013.

Nelson WG, Carter HB, DeWeese TL, Eisenberger MA. Prostate cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, et al., eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 88.

Review date:
February 10, 2013
Reviewed by:
Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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