In 2013, about 238,590 new cases of prostate cancer will be diagnosed, according to American Cancer Society estimates, and about 29,720 men will die of prostate cancer in the U.S. About one man in six will be diagnosed with prostate cancer during his lifetime and about one in 36 will die of it. Not counting some forms of skin cancer, prostate cancer is the most common cancer in American men and second only to lung cancer in number of cancer deaths.
Although it is a serious disease, most men diagnosed with prostate cancer do not die from it. In fact, more than 2.5 million men who have been diagnosed at some point in their life with prostate cancer are still alive today.
What Is The Prostate?
Found only in men, the prostate is a walnut-size gland that makes and stores semen, a milky liquid that nourishes sperm. Located below the bladder and in front of the rectum, the prostate surrounds the upper part of a man's urethra, the tube that empties urine from the bladder. The gland helps regulate sexual functioning as well as bladder control.
Prostate cancer forms in tissues of the prostate. Nearly all prostate cancers are adenocarcinomas — cancers that begin in the glandular cells. Developing in men as they age, the disease most likely has multiple underlying causes, which are not yet entirely understood. Not all prostate cancers are the same. More than 90 percent are found when they are confined to the gland, and while some spread early and require drug treatment, others are slow-growing and unlikely to cause serious problems during a man's lifetime. It is important to remember that prostate cancer may behave differently in individual men, spreading to other parts of the body for some and remaining contained for others.
Symptoms of Prostate Cancer
Prostate cancer is called the silent killer for a reason; many men with prostate cancer have no noticeable symptoms. The first sign of the disease for many is an abnormal finding when routinely screened. Others may notice one or more of the following symptoms, according to the Memorial Sloan-Kettering Cancer Center:
- Frequent urge to urinate
- Inability to urinate
- Waking more frequently during the night to urinate
- Trouble starting or holding back urine flow
- Frequent pain or stiffness in the lower back, hips, or upper thighs
- Painful ejaculation or trouble having an erection
Some of these symptoms are also indicative of a noncancerous condition called benign prostatic hyperplasia (BPH), an enlargement of the prostate gland.
Prostate Cancer Risks Factors
Prostate cancer occurs mainly in men who are older than 50. Nearly two thirds are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 67.
African American men are at higher risk for prostate cancer than Caucasian men. They are also more likely to have advanced disease at the time of diagnosis and are more likely to die of prostate cancer. The incidence of prostate cancer is lower in Asia and Africa than in Europe and the U.S.
Men with close relatives (such as a father or brother) who have had prostate cancer are at greater risk for the disease. Studies suggest that five to 10 percent of all cases of prostate cancer may be associated with inherited genetic factors.
Researchers believe that high levels of the male sex hormone testosterone may cause or speed the development of prostate cancer.
Prostate Cancer Detection & Diagnosis
A considerable proportion of the prostate cancers diagnosed today are "indolent"; that is, they are unlikely to cause symptoms, spread, or shorten a man's life. Because of this, the U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigent (PSA)-based screening for men that do not have symptoms. The prostate specific antigen test (PSA) measures the level of PSA, a protein that is produced by the prostate gland, in the blood. PSA may be higher in men who have prostate cancer; however, other conditions such as an enlarged prostate, prostate infections, and certain medical procedures also may increase PSA levels.
It is important to note that detecting prostate cancer early may not reduce the chance of dying from prostate cancer. For example, the PSA test can help detect small tumors that do not cause symptoms. Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man's life. "Overdiagnosis" of tumors that are not life threatening may lead to "overtreatment," which exposes men to the potential complications and harmful side effects of treatments, including surgery and radiation therapy.
Many other organizations maintain a different stance than the USPSTF, though. For instance, the Centers for Disease Control and Prevention encourages men to talk with their doctors to learn the nature and risk of prostate cancer, understand the benefits and risks of the screening tests, and make decisions consistent with their preferences and values. After all, the potential benefit of prostate cancer screening is early detection of cancer. Along with the PSA, another commonly used screening test for prostate cancer is digital rectal exam (DRE), which consists of a doctor, nurse, or other health care professional placing a gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland.
Bottom line? Medicare provides coverage for an annual PSA test for all eligible men age 50 and older. Many private insurers cover annual PSA screening as well.
Staging Prostate Cancer
After cancer has been diagnosed, further tests are done to discover the extent to which cancer cells have spread within the prostate or to other parts of the body. The process used to understand the spread of cancer is called staging. The tests and procedures used in the staging process may include magnetic resonance imaging (MRI), biopsy, pelvic lymphadenectomy (a surgical procedure explained below), and a CAT scan. The biopsy is used to determine the Gleason score, which ranges from two to 10 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread. The lower the number, the less likely the tumor is to spread.
- Stage I means cancer has been found in the prostate only.
- Stage II means the cancer is found in the prostate only but it is more extensive than Stage I.
- Stage III means the cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles.
- Stage IV means the cancer has spread beyond the seminal vesicles to nearby tissue or organs (the rectum, bladder, or pelvic wall) or to lymph nodes or to distant parts of the body, including lymph nodes and/or bones.
Treatment Options For Prostate Cancer
Commonly, doctors employ six types of standard treatment, and their recommendation for treatment is based on many factors, including a patient's age, the cancer's stage, and other factors:
- Watchful waiting (active surveillance)
- Radiation therapy
- Hormone Therapy
- Biologic Therapy
Watchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change.
Among the surgeries available for treatment of prostate cancer are pelvic lymphadenectomy, which removes lymph nodes in the pelvis; if cancer is spotted in the lymph nodes, the doctor will not remove the prostate and then recommend further treatment. Radical prostatectomy is a surgical procedure which removes the prostate, seminal vesticals, and surrounding tissues. One other surgery, transurethral resection of the prostate, involves removing tumors from the prostate using a resectoscope (a lighted tube with a cutting tool) that is inserted through the urethra. Oftentimes, this procedure is done to relieve symptoms that are caused by the tumor before actual cancer treatment is administered.
Radiation therapy uses powerful X-rays (and other types of radiation) to kill cancer cells and keep them from growing. Hormone therapy aims to remove hormones or blocks their action and prevents cancer cells from growing. Chemotherapy utilizes drugs to stop the growth of cancer cells. Finally, biologic therapy uses a cancer patient's immune system to fight the cancer.
Three new types of cancer treatment are currently being developed:
- High-intensity focused ultrasound
- Proton beam radiation therapy
Getting Additional Help
If you have been diagnosed with cancer, the most important thing you can do is to read and ask questions of your doctor in order to fully understand your options. Second opinions are not only covered under many health plans, but they are important for you. The Prostate Cancer Research Institute as well as the American Cancer Society provides resources, and support. Do not make any decision before you feel ready. It may not be necessary to treat the cancer or it may be your preference to treat the cancer in a specific way.