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Prostate Cancer 

Introduction

Prostate cancer is a common type of cancer in men.  The prostate is a golf ball size gland found only in men.  It is located underneath the bladder and in front of the rectum.  In most cases, prostate cancer occurs when the cells in the prostate gland grow abnormally or out of control.  The exact cause of prostate cancer is unknown.

Prostate cancer is typically a slow growing cancer.  Screening tests can identify most prostate cancers before symptoms develop.  Many forms of prostate cancer can be treated if detected early.  Survival rates for men treated for prostate cancer are very good.

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Anatomy
The prostate is a golf ball sized gland found only in men.  It is actually one organ composed of thirty to fifty tiny glands.  The outside layer of the gland is composed of fibrous tissue.  The prostate gland is located underneath the bladder and in front of the rectum.  The prostate gland surrounds the urethra.  The urethra is the tube that carries urine from the bladder to and through the penis.
 
Doctors do not know all of the functions of the prostate gland.  One function of the prostate gland is to add fluid and nutrients to sperm to make semen.  The fluids and nutrients energize the sperm and make them move more effectively.  The semen travels through the male urethra during the reproductive process. 
 
The prostate gland has two growth spurts.  During puberty, the prostate gland doubles in size.  The second growth period is at about age 25.  The prostate gland grows again and continues to grow throughout a man’s life.

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Causes

Cancer occurs when cells in the prostate grow abnormally and out of control, instead of dividing in an orderly manner.  The majority of prostate cancers start in the gland cells.  When cancer occurs, the prostate gland cells change in size and shape, a process termed prostatic intraepithelial neoplasia (PIN).  This type of cancer is also called adenocarcinoma. 
 
In most cases, prostate cancer grows slowly.  In fact, for some men, the prostate cancer grows so slowly that it never becomes a major problem.  However, some types of prostate cancer can grow quickly and spread to other parts of the body.  When cancer spreads from its point of origin to other locations, it is termed metastasized cancer.  Prostate cancer most commonly metastasizes to the bones, bone marrow, liver, lungs, lymph nodes, and bladder.  By far, prostate cancer most frequently metastasizes to the bones.  Prostate cancer is the second leading cause of cancer related death among American men, according to the American Cancer Society.  However, prostate cancer related deaths are decreasing, probably because of improved detection methods and treatments.

The exact cause of prostate cancer is not always known.  Researchers have recently discovered that some types of prostate cancer are linked to changes in DNA.  Your DNA is the carrier of your genetic information, including directions for how your cells divide.  You inherited your DNA from your parents. 
 
Researchers also suspect that prostate cancer may be linked to high levels of certain male hormones.  Your body produces hormones, which are chemicals that regulate the activity in your cells and organs.  It appears that high levels of some male hormones, including androgens and the IGF-1 hormones, are associated with an increased risk for developing prostate cancer.
 
Prostate cancer is not linked to an enlarged prostate gland, a condition also called Benign Prostatic Hyperplasia (BPH) or Benign Prostatic Hypertrophy.  An enlarged prostate gland is a very common condition in older men that causes difficulties with urination.  An enlarged prostate gland is not cancer and does not cause cancer.

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Symptoms
The symptoms of prostate cancer are also the same type of symptoms shared by noncancerous conditions.  Therefore, it is very important to have a doctor determine the source of the problem in men who experience changes in their genitourinary system.  Further, it is possible to have prostate cancer and not have symptoms.  It is common for prostate cancer to be detected by a doctor during an examination before symptoms develop. 
 
Problems with urination are a common symptom of prostate cancer.  For instance, it may be difficult to start urinating.  You may have a weak stream of urine or be unable to urinate.  You may lose control of your bladder and urinate at times when you do not intend to.  You may leak urine or dribble urine after urinating.  You may experience frequent urination, especially at night.  Your bladder may not empty all of the way.  It may be painful for you to urinate, have a bowel movement, or ejaculate. 
 
There may be blood in your urine.  You may also experience frequent or recurring bladder and kidney infections.  You may have lower back pain, abdominal pain, or bone pain and tenderness.  You may feel tired all of the time and lose weight.  Some people develop anemia, a decrease in red blood cells.
 
Symptoms of advanced prostate cancer include impotence, blood in the urine, and loss of bowel or bladder control.  You may experience pain in your spine, hips, ribs, or other bones.  Additionally, your legs and feet may feel numb.

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Diagnosis
Your doctor can diagnose prostate cancer after reviewing your medical history and by conducting a physical examination.  You should tell your doctor about your symptoms and risk factors.  Your doctor will rule out other conditions with similar symptoms, such as an enlarged prostate gland or infection.  Your doctor will also conduct a few tests to help diagnose prostate cancer.
 
Your doctor will perform a digital rectal examination to check the size and condition of your prostate gland.  The vast majority of prostate cancers originate in the outer sections of the gland, which makes the digital rectal examination an excellent screening tool.  A digital rectal examination can also help determine if the cancer has spread beyond the prostate gland.
 
Your blood will be examined with a Prostate Specific Antigen (PSA) Blood Test.  There are different variations of the PSA test and your doctor will discuss which tests are most appropriate for you.  The PSA test identifies how much PSA is in your blood and is useful for detecting early cancers.  Prostate cancer can cause PSA levels to rise.  However, other non-cancerous conditions, such as an enlarged prostate gland, can also cause PSA levels to rise.  If you have an elevated PSA level, your doctor will conduct more tests to determine if you actually have prostate cancer.  For men already diagnosed with prostate cancer, the PSA levels are used to help determine if the cancer has spread outside of the prostate gland.  For individuals already treated for prostate cancer, the PSA test is frequently used to monitor for cancer recurrence.
 
Your urine will be examined for the presence of blood or abnormal cells.  Urine tests are simple to conduct.  You will provide your doctor with a urine sample.  Your urine will be tested, and your doctor will interpret the results. 
 
If your test results, examination, and symptoms suggest that you might have prostate cancer, your doctor will conduct further tests to determine if you have cancer or not.  A prostate biopsy can confirm the presence of prostate cancer.  A prostate biopsy is usually done in the doctor’s office.  A prostate biopsy involves taking a very small amount of tissue from your prostate gland for examination for cancer cells.  To take the biopsy, your doctor will numb your rectal area, and you may receive a sedative before the procedure.  A small probe will be placed in your rectum that sends pictures of your prostate gland to a video screen.  This is called transrectal ultrasonography (TRUS).  Your doctor uses the images as a guide to insert a needle into your prostate gland to take a tissue sample.  This biopsy process is completed so quickly that it usually only causes a little discomfort; however, some men may have pain.
 
If your doctor suspects that you have prostate cancer, more tests may be ordered to determine if your cancer has spread from your prostate gland to other parts of your body.  Your doctor may order blood tests, additional prostate biopsies, or a lymph node biopsy.  Your lymph nodes contain white blood cells that fight infections.  A lymph node biopsy may be performed independently or in conjunction with prostate surgery.
 
Additional testing may also include imaging tests.  A chest X-ray can determine if the cancer has spread to your lungs.  A bone scan can depict if the cancer has spread to your bones.  A ProstaScint scan is similar to a bone scan, but it can determine if the cancer has spread to the lymph nodes and other areas of the body.  Computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans are imaging tests that may also be used.  A CT scan is helpful for identifying cancer in the pelvis lymph nodes, liver, and other organs.  The MRI scan is used to detect cancer in the seminal vesicles or the bladder.  A PET scan can check the lymph nodes and other areas of the body for cancer.  These imaging tests are painless and simply require that you remain motionless.
 
If you have prostate cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests.  Staging describes the tumor size, its cells’ characteristics, and how it has grown or metastasized.  Staging is helpful to your doctor for treatment planning and recovery prediction.  There are different systems for staging prostate cancer.  You should make sure that you understand the system that your doctor is using. 
 
The Jewett-Whitmore system is one of the more common staging systems for prostate cancer.  This system uses the letters A through D, with the letters C and D indicating a more serious cancer.  The stages are further divided into sub-stages labeled with numbers.  The stages of prostate cancer, according to the Jewett-Whitmore system are:
Stage A:  This is a very early prostate cancer and does not have symptoms.  The cancer is confined to the prostate.
Stage A1:  The prostate cancer cells are well differentiated and slightly abnormal.
Stage A2:  Moderately or poorly differentiated and abnormal cancer cells are in several different
locations within the prostate.
Stage B:  The prostate cancer is confined to the prostate.  It is not palpable during a digital rectal
examination and/or is detectable by a PSA test.
Stage B0:  The prostate cancer is confined to the prostate.  It is not palpable during a digital rectal
examination, but it presents an elevated PSA test.
Stage B1:  One cancerous nodule is located in one lobe of the prostate.
Stage B2:  The cancer in the prostate is extensive.  It is in one or both of the prostate lobes.
Stage C:  The prostate cancer cells extend beyond the prostate to outside of the prostate
capsule (the membrane covering the prostate), the seminal vesicles, and/or the spread is confined to the surrounding tissues.
Stage C1:  The prostate cancer extends outside of the prostate capsule.
Stage C2:  There is bladder or urethral obstruction.
Stage D:  The prostate cancer has metastasized to the region lymph nodes, or to distant bones or
organs, such as the liver, lungs, and/or other tissues.
Stage D0:  The prostate cancer has metastasized locally and presents elevated PAP levels.
Stage D1:  The prostate cancer has metastasized to the regional lymph nodes.
Stage D2:  The prostate cancer has spread to the distant lymph nodes, bones, or organs.
Stage D3:  There is metastatic disease after treatment.

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Treatment

 Your doctor may refer you to an Oncologist for treatment.  An oncologist is a doctor with special training in cancer and cancer treatments.  Treatment for prostate cancer depends on the stage of the cancer, your age, and overall health.  In select cases, men with very slow growing prostate cancer that are older or have other major health problems may forgo treatment initially.  Instead, doctors closely monitor their cancer growth and symptoms.  Prostate cancer may be treated with surgery, radiation therapy, cryosurgery, hormone therapy, and in some cases, chemotherapy.
 
Radical prostatectomy and transurethral resection of the prostate (TURP) are the most common surgeries for prostate cancer.  A radical prostatectomy removes the entire prostate gland and some of the tissue around it in an attempt to cure the cancer.  This surgery is most appropriate for prostate cancer that has not spread beyond the prostate gland.  There are different types of radical prostatectomy surgeries and your doctor will help you decide which approach is best for you. 

The goal of TURP surgery is to relieve the symptoms associated with prostate cancer, such as urination difficulties, but its goal is not to cure the cancer.  TURP surgery removes cancerous tissue in the prostate to reduce pressure on the urethra, making urination easier.  The urethra is the tube that carries urine from the bladder to the penis.
 
The goal of radiation therapy may be curative.  Radiation therapy may be used for low-grade cancer that has not spread or that has only spread to nearby tissues.  It may also be used to shrink the size of advanced cancer tumors.  External beam radiation therapy uses high-energy rays to destroy or shrink cancer cells.  This type of treatment is similar to a regular x-ray and is done on an outpatient basis.  Men usually receive five treatments per week for several weeks.
 
Another type of radiation therapy uses internal radiation called brachytherapy.  For this approach, tiny radioactive pellets, referred to as seeds, are placed in the prostate.  There are different types of brachytherapy.  Some use seeds with stronger radioactive substances than others do.  Some seeds may be left in the prostate permanently and others are removed after a short period of time.
 
Cryosurgery may be used to treat prostate cancer by freezing the cancer cells.  Cryosurgery is only used for cancer that has not spread.  For this method, probes are placed in the prostate that secrete cold gases which destroy the prostate gland. 
 
Hormone therapy is another treatment option for some types of prostate cancer.  The goal of hormone therapy is to lower the level of male hormones, androgens, which cause prostate cancer cells to grow.  Lowering androgen levels can cause prostate cancer to grow more slowly or shrink the size of a tumor; however, hormone therapy cannot cure the cancer.  Hormone therapy is most appropriate for men that are not good candidates for surgery or radiation therapy.  There are several types of hormone therapies including orchiectomy, luteinizing hormone-releasing (LHRH) analog treatments, and antiandrogen treatments.
 
Orchiectomy is a surgery that removes both of the testicles.  The testicles are removed because they are the main source of male hormone production.  LHRH analogs are drugs given as shots every few months.  They lower the male hormone levels and are an alternative to orchiectomy.  Antiandrogen drugs block the body’s ability to produce male hormones.  They are sometimes used in conjunction with orchiectomy or LHRH analog treatment. 
 
Chemotherapy uses cancer-fighting drugs to destroy cancer cells.  Chemotherapy is not usually used as an early treatment for prostate cancer or as a cure for prostate cancer.  It is sometimes used when the prostate cancer has spread outside of the prostate gland.  Chemotherapy can help slow prostate cancer growth, reduce pain, and prolong life.
 
In addition to treating prostate cancer, your doctor can also provide treatments to reduce your pain or other symptoms.  You should discuss any concerns or symptoms with your doctor.  There are many types of pain treatments that may help to improve the quality of your life.
 
Overall, men treated for prostate cancer that has not spread or has spread only to nearby areas have very good survival rates.  Each man’s situation is unique.  You should ask your doctor what you may expect regarding cure and survival rates.
 
The experience of prostate cancer and cancer treatments can be an emotional process for men with cancer and their loved ones.  It is important that you receive emotional support.  Some people find comfort in their family, friends, co-workers, and place of worship.  Cancer support groups are another good option.  They can be a good source of information and support from people who understand what you are experiencing.  Ask your doctor about cancer support group locations in your area. 

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Prevention
The exact cause of prostate cancer is unknown.  At this time, there is no way to prevent prostate cancer.  You should discuss your risk factors, family history of cancer, symptoms, and concerns with your doctor.  Because early identified prostate cancer is easier to treat, the American Cancer Society recommends that doctors should offer yearly digital rectal examinations and PSA tests to men beginning at age 50.  The American Cancer Society recommends that men at high risk for prostate cancer be tested earlier, at age 40 or 45. 

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Am I at Risk

Risk factors may increase your likelihood of developing prostate cancer.  Men with all of the risk factors may never develop the disease; however, the chance of developing prostate cancer increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for prostate cancer:

_____ The risk for prostate cancer appears to increase with age.  The majority of prostate cancers occur in men over the age of 65; however, it may occur in younger men as well.
_____ Prostate cancer occurs most frequently in African American men.  African American men are most likely to die from prostate cancer.  The lowest rate of prostate cancer is among Asian men.
_____ Prostate cancer occurs most often in men in North America and northwestern Europe.  Men develop it less frequently in Asia, Africa, Central America, and South America.
_____ If your brother or father had prostate cancer, you are at risk for developing prostate cancer.  Your risk is higher if your family members experienced prostate cancer at a young age.  It appears that some types of prostate cancer are caused by changes in DNA.  Your DNA is inherited from your parents.
_____ Eating a diet that consists of a lot of red meat and high-fat dairy products and low amounts of fruits and vegetables appears to be associated with a greater chance of developing prostate cancer, although researchers are not sure of the exact relationship.  The lowest rates of prostate cancer occur among vegetarians.
_____ Exposure to certain environmental toxins, including cadmium, may increase the risk of prostate cancer.  Men exposed to certain chemicals from working in tire plant production, farming, and painting may have a greater risk of developing prostate cancer.

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Complications
In some cases, even with treatment, prostate cancer can return.  This is termed “recurrent prostate cancer.”  Recurrent prostate cancer may come back near the original site or in distant organs.  Your doctor can explain your risk of recurrent cancer and possible treatments if it does occur.
 
Metastases can be a complication of prostate cancer.  This means the cancer has spread from the prostate gland to distant tissues and organs.  Common sites for prostate cancer metastases include the bones, liver, lungs, lymph nodes, and bladder.  By far, prostate cancer most frequently metastasizes to the bones.  The metastasized cancer may be treated, as well as the cancer in the prostate.
 
The side effects of surgery, radiation therapy, chemotherapy, and hormone therapy may be harsh and emotionally difficult for some men.  The type of side effects that you experience may depend on the type of treatment or combination of treatments that you receive.  You should tell your doctor about any pain or side effects that you experience.  In many instances, treatments may help reduce pain and steps can be taken to reduce side effects.
 
The main side effects of radical prostatectomy include incontinence and impotence.  Incontinence is the inability to control your bladder.  You may urinate or leak urine when you do not intend to.  You should tell your doctor if you experience incontinence.  There are medications and treatments that can help. 
 
Surgery and radiation therapy can also cause impotence and sterility.  Impotence means that the penis is unable to achieve an erection.  Difficulty attaining an erection may depend upon your age and the type of surgery that you had.  Your doctor can recommend devices or medications that may help.  For men that had surgery and can experience an orgasm, the orgasm will be “dry” because semen will not be produced.  Because sperm is not produced, these men are sterile and unable to impregnate a woman.  Men that are interested in having their own biological children may opt to bank their sperm before their surgery. 
 
Improvements in radiation therapy have reduced the amount of side effects associated with these treatments.  External beam radiation and brachytherapy may cause bowel and bladder problems, along with impotence.  Cryosurgery can also cause similar side effects along with pain and burning sensations.  Always inform your doctor about your side effects, as there may be treatments to help them.
 
The majority of men who receive hormone therapy, including orchiectomy, experience significant side effects.  Most men become impotent and lose the desire for sex.  Other side effects may include hot flashes, breast growth, and breast tenderness.  You may lose muscle and gain weight.  You may develop weak bones, cholesterol problems, anemia (low red blood cell counts), and reduced mental sharpness.  You may also feel tired and depressed.  Make sure to tell your doctor about your side effects, as many of them may be treated.
 
The side effects from chemotherapy may include temporary hair loss, nausea, vomiting, diarrhea, loss of appetite, mouth sores, rashes, fatigue, low blood counts, an increased risk for infection, and bleeding or bruising after minor cuts or injuries.  Most side effects go away after the chemotherapy treatments are over.  Again, talk to your doctor about your side effects and possible treatments.

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Advancements

Researchers are studying ways to prevent and detect early prostate cancer.  In 2007, researchers identified a gene that contributes to an aggressive deadly form of prostate cancer identified as 2+Edel.  Surgery and aggressive treatment is recommended for men with this fatal form of prostate cancer.  The researchers implore testing for this variation at the time of diagnosis to ensure that men in need of aggressive treatment receive it and to spare those that do not need such radical treatment.

Researchers have identified a gene product called alpha-methylacyl CoA racemase (AMACR).  AMACR is a protein that appears to trigger the production of a specific protein found only in cancer cells.  Researchers suggest that potentially a blood test for AMACR may be more helpful for identifying early prostate cancer than the PSA test. 

Genetic studies will continue to be a big part of prostate cancer research.  In particular, researchers are analyzing the genes that are linked to prostate cancer.  They are hoping to find genetic clues to predict which cancers will grow faster or slower and which men are at the highest risk.

Proteomics is another area of research regarding prostate cancer detection.  Proteomics uses sensitive mass spectrometry techniques to identify small amounts of peptides, proteins, and other small molecules from a blood sample that are linked with certain types of cancer.  It is hoped that proteomics can identify men with prostate cancer and eliminate the need for biopsies.

Researchers are also studying new ways of diagnosing prostate cancer with medical imaging techniques.  This includes color Doppler ultrasound that measures blood flow into the prostate and enhanced MRI scans to identify cancerous lymph nodes.

Additionally, researchers are examining foods and vitamins that may affect cancer risk.  It appears that some substances in tomatoes and soybeans may help lower the risk of prostate cancer.  Researchers are also trying to determine the link between prostate cancer and high dairy fat and red meat diets, and the possible reduced risk associated with vegetarian diets.  These studies are ongoing and are not yet conclusive.

Finally, researchers are studying new ways to treat prostate cancer.  The development of new technology, new medications, and even a vaccine are being tested in clinical trials.  Further, researchers are examining new ways to treat bone pain and impotence.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.