Prostate Cancer

What is prostate cancer?

Prostate cancer starts in the cells that make up the prostate. The prostate is a male gland about the size and shape of a walnut. It surrounds the upper part of the urethra. This is the tube that carries urine from the bladder

Prostate cancer is the most common cancer in men in the U.S. (not counting skin cancer). It's mostly found in older men. And in most cases, it's found before it has spread to other parts of the body. Cancer that has spread tends to be easier to treat and cure. When cancer spreads, it’s called metastasis. The more cancer spreads (metastasizes), the harder it is to treat.

Overview

What are the different types of prostate cancer?

Nearly all types of prostate cancer start in the gland cells that make the prostate fluid. These cancers are called adenocarcinomas. Other types of cancer can also start in the prostate. These include small cell carcinoma, transitional cell carcinoma, and sarcoma. But these types of cancer are rare. Most men with prostate cancer have adenocarcinoma.

Other types of growth can form in the prostate. Some of these are not cancer. They are benign growths. Other kinds of growths in the prostate include:

• Benign prostatic hyperplasia (BPH). As a man ages, the prostate gets bigger. This can lead to BPH. It’s a common condition. BPH is not cancer. It doesn't turn into cancer. But BPH can cause the prostate to press on the urethra. This can lead to urinating symptoms, such as trouble urinating, which might need to be treated.
• Prostatic intraepithelial neoplasia (PIN). This is an abnormal growth of prostate cells that may be found with a prostate biopsy. It's not cancer. A PIN can be low grade or high grade. Low-grade PIN is common, especially as men get older. Most health care providers don’t think it's linked to prostate cancer risk. Men who have high-grade PIN have a higher chance of prostate cancer. More testing might be done, and these men will be watched closely for signs of cancer.

Symptoms

What are the symptoms of prostate cancer?

In its early stages, prostate cancer doesn’t usually cause any symptoms. Early cancer may be found through a screening test. As with any cancer, the earlier it’s diagnosed and treated, the better your outcomes.

As cancer progresses, some people have symptoms. Others don’t. Some symptoms may indicate that cancer has spread outside the prostate. If that happens, you may need more extensive treatment.

Possible symptoms include:

• A frequent need to urinate, especially at night
• Trouble starting to urinate
• Weak or interrupted urine flow
• Trouble fully emptying the bladder
• Not being able to urinate at all
• Accidental urination
• Feeling a painful or burning sensation when you urinate
• Blood in your urine or semen
• Pain or stiffness in your lower back, hips, ribs, or upper thighs
• Trouble getting or maintaining an erection
• Weakness or numbness in legs or feet

Risk Factors

What are risk factors for prostate cancer?

Prostate cancer risk factors include:

• Gender. Only men are at risk.
• Age. Men aged 50 and older are at higher risk. Most prostate cancers are found in men older than age 65.
• Race. Prostate cancer is more common in Black and Caribbean men of African ancestry than men of any other race. And it tends to happen when these men are younger. It's less common in Asian-American and Hispanic men than non-Hispanic white men.
• Family history of prostate cancer. Having a father or brother with prostate cancer significantly raises a man's risk for the disease. The risk is even higher if more than one family member has the cancer, especially at a young age.
• Chemical exposures. The U.S. Department of Veterans Affairs says men exposed to Agent Orange during the Vietnam War are at higher risk of prostate cancer.
• Genes. Men with certain inherited gene changes are at higher risk for prostate cancer. But only a few prostate cancers are strongly linked to gene changes.
• Previous cancer. You may be at a higher risk of prostate cancer if you had previous cancer treatments targeting your pelvic region for another cancer type. 

Prevention

What causes prostate cancer?

Although there is no secret trick to staying cancer-free, there are ways to lower your chances of getting prostate cancer. In some cases, a health care provider may suggest using medicine to reduce your risk. But you can also take plenty of steps on your own, no prescription needed.

Building a healthy lifestyle goes a long way in lowering your risk for prostate cancer. Here’s what to focus on—and a few tips to help you get started:

• Eat fruit and vegetables every day. Include tomatoes, broccoli, cauliflower and cabbage. Also include beans, peas, and lentils. 
• Save high-fat meals and high-fat dairy for special occasions. Limit foods like hamburgers, sausage, cheese and ice cream. Instead, eat lean meats, fish and low-fat or nonfat dairy foods.
• Use caution with calcium. Too much calcium may raise your risk for prostate cancer. Normal amounts of calcium in dairy foods and drinks are acceptable. But talk with your health care provider before you take calcium supplements.
• Find ways to move more. Pick physical activities you enjoy and can see yourself doing for at least 30 minutes on most days. Invite friends or family to help you stay accountable and make things more fun.
• Stay at a weight that supports your health goals.  Extra weight is linked to a higher risk for a more serious type of prostate cancer. Choosing healthy foods and adding movement to each day will help.

If you are feeling overwhelmed, that’s OK. Remember: You don’t have to change everything overnight. Gradually introduce new habits into your life. Make it a goal to try lots of different foods and activities to find what you like best. And most important, know that the best healthy habits are the ones you can maintain.

How can medicine help?

Some people have a higher risk for prostate cancer because of age, race, genetics and family history. If you are at an increased risk, your health care provider may talk with you about taking medicines called 5-alpha-reductase inhibitors. They come as tablets or capsules that you swallow.

These medicines are most often used to treat an enlarged prostate that does not have cancer. This is called benign prostatic hyperplasia (BPH). Certain studies have shown that these medicines may lower prostate cancer risk. But they sometimes have unpleasant side effects. Ask your health care provider about the risks and benefits of these medicines and whether they’re right for you.

Diagnosis

How is prostate cancer diagnosed?

If your health care provider thinks you might have prostate cancer, certain exams and tests will be needed to be sure. Diagnosing starts with your health care provider asking you questions. You'll be asked about your health history, symptoms, risk factors, and family history of disease.

A physical exam and maybe a digital rectal exam (DRE) will be done. This is when your provider puts a gloved, lubricated finger into your rectum to feel for hard bumps on your prostate.

Blood tests will also be done. These are used to get an idea of your overall health and to check your PSA level.

PSA is a prostate-specific antigen. It's a protein made by prostate cells. High PSA levels may be a sign of prostate cancer.

If the DRE and your PSA level suggest you have cancer cells, the next step is often a prostate biopsy.

What is a biopsy?

A biopsy is the removal of tiny pieces of tissue for testing. The removed tissue is called a sample. A biopsy is the best way to know for sure that a man has prostate cancer. A core needle biopsy is most often done.

What to expect during a biopsy

A core needle biopsy to check for prostate cancer is most often done by a urologist. This is a healthcare provider who is a specialist in diagnosing and treating problems of the urinary and genital tracts. The procedure takes about 10 minutes. It's often done in a healthcare provider’s office.

Treatment

How is prostate cancer treated?

Many different treatments for prostate cancer involve the clinical care of a physician or other health care professional.

Some types of treatment include:

• Expectant Therapy – Not every person with prostate cancer needs to be treated right away. In many cases, early-stage prostate cancer will not spread or cause any problems or side effects for a long time, if ever. That’s why your health care provider may suggest active surveillance.
• Hormone Therapy – Prostate cancer may be treated with hormone therapy. This is also called androgen deprivation therapy (ADT). Androgens are male hormones that are made mostly by the testicles.
• Chemotherapy – Chemotherapy can be used to treat advanced prostate cancer. It's often used if hormone therapy is no longer effective or the cancer has spread beyond the prostate gland. Chemo might also be used along with hormone therapy for the initial treatment of advanced prostate cancer, especially if the cancer has spread widely.
• Proton Beam Radiation – This advanced form of radiation can be used to treat prostate cancer at any stage.
• External Beam Radiation – This form of radiation is the most common type of radiation and comes from a type of large X-ray machine.
• Stereotactic Body Radiation – This is a special type of external beam radiation and can be used on early stage prostate cancer.
• Brachytherapy – This radiation treatment, also called internal beam radiation, is given from within the body allowing for a higher total dose of radiation over a short time period.
• Robotic Prostatectomy – This minimally invasive surgical procedure removes the prostate gland and can be done with or without nerve sparing for erectile difficulties.
• Clinical Trials

Is prostate cancer curable?

Yes. Survivability largely depends on prostate cancer staging. The American Cancer Society reports the five-year survival rate for prostate cancer that hasn’t spread and remained localized at 99%. If the cancer hasn’t spread outside of the immediate region, the survival rate is 99%.