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Health Tips
Prostate Cancer
What is Prostate Cancer?
American Cancer Society
You have probably heard of "prostate cancer" before, but what does it mean? Let us help you understand. Cancer occurs when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all come about because of out-of-control growth of abnormal cells. Different kinds of cancer can behave very differently. For example, lung cancer and prostate cancer are very different diseases. They grow at different rates and respond to different treatments. That's why people with cancer need treatment that is aimed at their kind of cancer.
Most kinds of cancer are named after the part of the body where the cancer first starts. Prostate cancer starts in the prostate gland. The prostate gland is found only in men; therefore, only men get prostate cancer. The prostate is about the size of a walnut. It is just below the bladder and in front of the rectum. The tube that carries urine (urethra) runs through the prostate.
The prostate gland makes a fluid that is part of semen which carries the sperm. Nerves found next to the prostate take part in causing an erection of the penis, and treatments that remove or damage these nerves can cause problems with erections (impotence). Most of the time, prostate cancer grows very slowly. Autopsy studies show that many elderly men who died of other diseases also had prostate cancer that neither they nor their doctor were aware of.
But sometimes prostate cancer can grow quickly, spreading to other parts of the body. Cancer cells can enter the lymph system and spread to lymph nodes (small, bean-shaped collections of cells that help in fighting infections). If cancer is in the lymph nodes, it is more likely to have spread to other organs of the body as well.
How Many Men Get Prostate Cancer?
American Cancer Society
Prostate cancer is the most common type of cancer found in American men, other than skin cancer. We know that there will be about 189,000 new cases of prostate cancer in the United States in the year 2002. About 30,200 men will die of this disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer.
Although men of any age can get prostate cancer, it is found most often in men over 50. In fact, more than 70% of all prostate cancers are diagnosed in men over the age of 65.
Prostate cancer is about twice as common among African-American men as it is among white American men. It is also most common in North America and northwestern Europe. It is less common in Asia, Africa, and South America.
What Causes Prostate Cancer?
American Cancer Society
We do not yet know exactly what causes prostate cancer, but we do know that certain risk factors are linked to the disease. A risk factor is anything that increases a person's chance of getting a disease. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. But having a risk factor, or even several, doesn't mean that a person will get the disease. While all men are at risk for prostate cancer, the factors listed below can increase the chances of a man's having the disease.
Risk Factors That Cannot Be Changed
American Cancer Society
- Age: The chance of getting prostate cancer goes up as a man gets older.
- Race: For unknown reasons, prostate cancer is more common among African-American men than among white men.
- Nationality: Prostate cancer is most common in North America and northwestern Europe. It is less common in Asia, Africa, Central America, and South America
- Diet: A diet high in fat may play a part in causing prostate cancer.
- Physical activity: Regular physical activity and maintaining a healthy weight may help reduce prostate cancer risk.
- Family history: Men with close family members who have had prostate cancer are more likely to get it themselves.
There is evidence that the development of prostate cancer is linked to higher levels of certain hormones. High levels of male hormones (androgens) may contribute to prostate cancer risk in some men. Also, researchers have noted that men with high levels of the hormone insulin-like growth factor are more likely to develop prostate cancer.
Can Prostate Cancer Be Prevented?
American Cancer Society
Because the exact cause of prostate cancer is not known, we can't say if it is possible to prevent most cases of the disease. Since a high-fat diet may be linked to prostate cancer, we suggest a diet low in animal fat (especially from red meats) and high in vegetables, fruits, and grains. These guidelines provide an overall healthful approach to eating that also helps lower your risk for some other types of cancer. Tomatoes, grapefruit, and watermelon are rich in a substance (lycopenes) that helps prevent damage to DNA and may help lower prostate cancer risk.
The role of vitamin supplements in reducing prostate cancer risk is not entirely certain, but some studies suggest that taking 50 milligrams of vitamin E daily can lower the risk by about one third. Although other studies found no benefit to vitamin E, reasonable doses have no significant side effects and are not expensive.
On the other hand, some studies suggest that taking vitamin A supplements might actually increase prostate cancer risk. As always, we recommend caution when taking vitamin supplements by avoiding very high doses.
Possible signs of prostate cancer include a weak flow of urine or frequent urination.
National Cancer Institute
These and other symptoms may be caused by prostate cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- Weak or interrupted flow of urine.
- Frequent urination (especially at night).
- Difficulty urinating.
- Pain or burning during urination.
- Blood in the urine or semen.
- Nagging pain in the back, hips, or pelvis.
- Painful ejaculation.
Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer.
National Cancer Institute
The following tests and procedures may be used:
- Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.
- Prostate-specific antigen (PSA) test: A laboratory test that measures the levels of PSA in a blood sample. PSA is a substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate, or benign prostatic hyperplasia (an enlarged, but non-cancerous, prostate).
- Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. Transrectal ultrasound may also be used during a biopsy procedure.
- Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease. There are 2 types of biopsy procedures used to diagnose prostate cancer:
- Transrectal biopsy: A needle is inserted through the rectum into the prostate and a sample of prostate tissue is removed. This procedure is usually done using transrectal ultrasound to help guide the needle.
- Transperineal biopsy: A needle is inserted through the skin between the scrotum and rectum into the prostate and a sample of prostate tissue is removed.
A pathologist will examine the sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread.
Certain factors affect treatment options and prognosis (chance of recovery).
National Cancer Institute
The treatment options and progmosis (chance of recovery) depend on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body), the Gleason score, the level of PSA, and the patient's age and general health.
After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.
National Cancer Institute
The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:
- Radionuclide bone scan: A procedure used to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
- MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).
- Pelvic Lymphadenectomy: Lymph nodes in the pelvis may be removed to see if cancer has spread to them. Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.
- CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.
- Seminal Vesicle Biopsy: A needle is inserted into the seminal vesicles (glands that help produce semen) and fluid is removed and checked for cancer cells.
The results of these tests are viewed together with the results of the original tumor biopsy to determine the prostate cancer stage.
The following stages are used for prostate cancer:
National Cancer Institute
- Stage I
In stage I, cancer is found in the prostate only. It is usually found accidentally during surgery for other reasons, such as benign prostate hyperlasia. Stage I prostate cancer may also be called stage A1 prostate cancer.
- Stage II
In stage II, cancer is more advanced, but has not spread outside the prostate. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.
- Stage III
In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles (glands that help produce semen). Stage III prostate cancer may also be called stage C prostate cancer.
- Stage IV
In stage IV, cancer has metastasized (spread) to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or to lymph nodes near or far from the prostate. Metastatic prostate cancer often spreads to the bones. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.
Recurrent Prostate Cancer
National Cancer Institute
Recurrent prostate cancer is cancer that has recurred (come back) after it has been treated. Recurrent prostate cancer may come back in the prostate or in other parts of the body.
Treatment Option Overview
National Cancer Institute
Different types of treatment are available for patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard treatment", the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI cancer.gov web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Four types of standard treatment are used:
National Cancer Institute
- Watchful waiting
Watchful waiting is closely monitoring a patient's condition but withholding treatment until symptoms appear or change. This is usually used in older men with other medical problems and early stage disease.
- Surgery
Patients in good health who are younger than 70 years old are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:
- Pelvic lymphadectomy: A surgical procedure to take out lymph nodes in the pelvis to see if they contain cancer. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.
- Radical prostatectomy: Surgery to remove the entire prostate. Radical prostatectomy is done only if tests show the cancer has not spread outside the prostate. The two types of radical prostatectomy are:
- Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. Removal of surrounding lymph nodes (lymphadenectomy) can be done at the same time.
- Perineal prostatectomy: Surgery to remove the prostate through an incision made between the scrotum and the anus. If surrounding lymph nodes are to be removed, this is usually done through a separate incision.
- Transurethral resection of the prostate: A surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. This operation is sometimes done to relieve symptoms caused by the tumor before other treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.
Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.
- Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Prostate cancer is treated with external and internal (implant) radiation. Radiation therapy may be used alone or in addition to surgery.
Impotence and urinary problems may occur in men treated with radiation therapy.
- Hormone therapy
Hormones are chemicals produced by glands in the body and circulated in the bloodstream. Hormone therapy is the use of hormones to stop cancer cells from growing. Male hormones (especially testosterone) can help prostate cancer grow. To stop the cancer from growing, female hormones or drugs that decrease production of male hormones may be given.
Hormone therapy used in the treatment of prostate cancer may include the following:
- Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.
- Luteinizing hormone-releasing hormone agonists also can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
- Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and bicalutamide.
Drugs that can prevent the adrenal glands from making androgens include ketoconanole and aminoglutethimide.
Orchiectomy is surgery to remove the testicles, the main source of male hormones, to decrease hormone production.
Hot flashes, impaired sexual function, and loss of desire for sex may occur in men treated with hormone therapy.
Other types of treatment are being tested in clinical trials.
National Cancer Institute
- Cryosurgery
Cryosurgery is performed with an instrument that freezes and destroys prostate cancer cells. This treatment is being studied as the alternative to conventional surgery and radiation therapy.
- Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.
- Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biologic response modifier (BRM) therapy or immunotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.
How Do I Tell My Family and Friends?
American Cancer Society
"I simply told my family this was not going to be a deathbed watch. I was in this for the fight no matter what and expected their full support and understanding. I feel their active involvement and full inclusion in what was going on was what helped my family cope with the experience." Kevin, cancer survivor.
A diagnosis of prostate cancer can be frightening not only to you, but also to your friends and relatives. People often don't know what to say to you. They may be sad and afraid of upsetting you, or they may fear what might happen. There are no absolute right or wrong ways when dealing with people because everyone copes differently and has a unique way of addressing major life occurrences.
You are coming to terms with your own diagnosis, and it may take time for you to want to talk to others about it. You may want to be the one to tell those close to you the news. When you're ready to talk about your prostate cancer, begin by talking honestly to your family members in as much detail as you're comfortable with. You may want to tell them what you expect in the weeks and months to come, talk about your feelings about the diagnosis and the future, and outline the likely effects of your cancer treatment on the family. You may also want to encourage your loved ones to share their feelings about the situation.
You're probably used to sharing many aspects of your life, happy and sad, with your friends. But you can't predict how your friends will react when you tell them you have cancer. Some close friends will support you and become very involved with helping you, while others may push away and become distant. Others will react as your family members may-they will be afraid. To put them at ease, help them to understand your diagnosis and what it means, what will change, what won't, and what's involved in your treatment. Make sure they understand that prostate cancer is not a death sentence. Talk with those you care about and encourage them to be honest with you
What Are Some Questions I Can Ask My Doctor?
American Cancer Society
As you cope with cancer and cancer treatment, we encourage you to have honest, open discussions with your doctor. Feel free to ask any question that's on your mind, no matter how small it might seem. Here are some questions you might want to ask. Print them and carry them with you during your next visit to the doctor. Be sure to add your own questions as well.
- Would you please write down the exact type of cancer I have?
- May I have a copy of my pathology report?
- What is the likelihood that the cancer has spread beyond my prostate? If so, is it still curable?
- What additional tests do you recommend and why?
- What is the clinical stage and grade of my cancer? What do those mean in my case?
- Do you recommend a radical prostatectomy for me? Why or why not?
- If you recommend a radical prostatectomy, will it be nerve sparing?
- What other treatments might be appropriate for me? Why?
- Among those treatments, what are the risks or side effects I should expect?
- What are the chances that I will have problems with incontinence or impotence?
- What are the chances of the cancer coming back with the treatment you suggest?
- What is my expected survival rate based on clinical stage, grade, and various treatment options?
- Should I follow a special diet?
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