Prostate Cancer

Prostate cancer, like many other cancers, is a result of abnormal cell growth that forms a mass of tissue called a tumor.

Once started, cancer can spread – or metastasize – as cells break away from the mass and move through the body through blood vessels or the lymphatic system. Men with prostate cancer do not necessarily have symptoms. That is why it is important to have an annual prostate cancer screening as part of your routine health care.

When symptoms occur, the most common are:

  • Difficult urination
  • Inability to urinate
  • Weak urine stream
  • Frequent urination
  • Burning feeling or pain during urination
  • Pain in the lower back, hips or upper thighs

These symptoms can also be caused by a variety of other conditions. If you experience any of these symptoms, you should consult your urologist for diagnosis and treatment as soon as possible.

Causes

The exact cause of prostate cancer is not known, but it is most common among men age 65 and older. It is also more likely to occur in men who have a family history of prostate cancer, which indicates that genetic factors play some part. Prostate cancer is found more often in African-American men than in white men, and is more likely to occur in white men than in men of Asian or Hispanic descent. The reasons for this are unknown.

Men should be checked for prostate cancer annually beginning at age 50. African-Americans and men with a family history of prostate cancer should begin screening earlier, around age 40.

Diagnosis

Because prostate cancer often has no symptoms, routine screening is the key to early detection and treatment. Cancer found while the tumor is still small and localized has a much better chance of being treated successfully. The first approach is usually a digital rectal exam, which allows your doctor to check for lumps or hardened areas in the prostate. A prostate-specific antigen (PSA) blood test can also be used to detect high levels of PSA, which indicates a prostate problem. If any abnormality is found, your doctor will probably suggest additional tests to determine whether the problem is prostate cancer or some other less serious condition. If other causes are ruled out, the doctor will perform a biopsy, which is the only sure way to diagnose prostate cancer. During the biopsy, the doctor removes a small amount of tissue, which is then examined for the presence of cancer cells.

Treatment

Prostate cancer is described by grade and by stage. The grade, based on the appearance of the tumor cells, predicts how fast the tumor will grow and spread. Stage refers to the extent of the disease, or how much it has spread. Imaging tests such as a bone scan, CT scan or MRI are usually used to show whether or not the cancer has spread (metastasized). Many treatment options are available, and you and your doctor will decide on a treatment plan based on factors such as your age, type of tumor, stage of the cancer, your symptoms and your basic state of health. Your physician may also suggest that you have genomic testing done on the biopsy specimen to help determine your risk and the best course of treatment.

Usual treatments include:

  • Active Surveillance: In low risk prostate cancer, many men do not require aggressive treatment and can be closely observed with periodic examination and blood tests (PSA)
  • Surgical Therapy: Radical Prostatectomy-involves the complete removal of the prostate in an effort to give men the best chance for long term survival. It can be done conventionally or robotically. Your physician will discuss with you the pros and cons of each approach.
  • Prostate Cryoablation: A less invasive option for freezing the prostate gland and killing the tumor in a single session. It usually does not involve hospitalization and provides result comparable to radiation.
  • Radiation Therapy: This may be recommended instead of surgery for early-stage cancer or after radical prostatectomy to destroy any remaining cancerous cells. The usual method is an external beam of radiation directed at the cancerous area. Another option is internal radiation, or brachytherapy, in which radioactive “seeds” are implanted directly into the prostate. Each has its own unique effects which your doctor will discuss with you.

FAQ

What are some of the risk factors for prostate cancer? Risk is greatest in men over age 50, and in those with a family history of prostate cancer. African-American men also have a higher risk of developing this disease. There is also some evidence that obesity and/or a diet high in fat can increase risk.

Does prostatitis or enlarged prostate lead to cancer? No. Patients with prostatitis or enlarged prostate (BPH) are not at higher risk for prostate cancer. However, early symptoms of BPH are similar to those of prostate cancer and should be evaluated promptly so that cancer can be ruled out.

Can prostate cancer be diagnosed before symptoms appear? Yes. In fact, most prostate cancers are diagnosed as a result of routine health screenings, which include a digital rectal exam and PSA test. Today, 90% of prostate cancers are detected early due to these tests.

Are there any steps I can take to help prevent prostate cancer? Little can be done to prevent prostate cancer, but there are some steps that may promote prostate health in general:

  • Maintain a healthy weight
  • Reduce your intake of fat, especially animal fat
  • Maintain a moderate level of exercise and physical activity
  • Regular ejaculation also appears to contribute to prostate health