Prostate Cancer

Prostate cancer is cancer that occurs in a man's prostate. The prostate is a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

A man has a 1 in 7 chance of being diagnosed with prostate cancer during his lifetime. Prostate cancer occurs mainly in older men, and approximately 60% of cases are diagnosed in men aged 65 or older. It is rare before age 40. The average age at the time of diagnosis is 66 years old.

Prostate cancer is the second most common cancer in men in the United States, following only skin cancer. It is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 38 will die of prostate cancer.

Prostate cancer occurs more often in African-American men than in white men. African-American men with prostate cancer are more likely to die from the disease than white men with prostate cancer.

Prostate cancer that is detected early has a better chance of successful treatment. Treatments include watchful waiting, surgery, radiation therapy, hormone therapy, and chemotherapy.

Prostate cancer may cause no signs or symptoms in its early stages.

Prostate cancer that is more advanced may cause signs and symptoms such as:

• trouble urinating
• decreased force in the stream of urine
• blood in the semen
• discomfort in the pelvic area
• bone pain in the hips, back (spine), or chest (ribs)
• weakness or numbness in the legs or feet
• loss of bladder or bowel control
• erectile dysfunction

The cause of prostate cancer is not entirely clear. Cancer occurs when some cells in the prostate begin growing abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Some of these cells can break off and spread (metastasize) to other parts of the body.

Inherited genetic factors seems to cause about 5% to 10% of prostate cancers.

Factors that are associated with an increased risk of prostate cancer include:

• older age
• being African-American
• family history of prostate or breast cancer
• obesity

Some medical organizations recommend that men consider prostate cancer screening in their 50s, or sooner if men who have risk factors for prostate cancer. Other organizations advise against screening. Discuss your particular situation and the benefits and risks of screening with your doctor. Together, you can decide whether prostate cancer screening is right for you.

Prostate screening tests might include:

• a digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
• a prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but studies have disagreed whether these tests reduce the risk of dying of prostate cancer. For that reason, there is debate surrounding prostate cancer screening.

If an abnormality is detected on a DRE or PSA test, your doctor may recommend an ultrasound or a biopsy to analyze the prostate.

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, he or she may recommend imaging tests such as bone scan, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan.

Once testing is complete, your doctor assigns your cancer a stage. This helps determine your treatment options. The prostate cancer stages are:

• Stage I. The cancer is confined to a small area of the prostate.
• Stage II. The cancer may be small but aggressive or larger and may have grown to involve both sides of the prostate gland.
• Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
• Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

If you have or have had prostate cancer, you can take steps to manage the stress that accompanies the diagnosis:

• Learn about prostate cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.

The goal of prostate cancer treatment is to eliminate the cancer. Treatment for prostate cancer depends on the stage and location of the cancer, as well as your overall health.

For men diagnosed with very early-stage prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance, which includes regular follow-up blood tests, rectal exams, and, possibly, biopsies to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation.

Radiation therapy. Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered from outside of your body (external beam radiation) or placed inside your body (brachytherapy).

Hormone therapy. Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:

• medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and histrelin (Vantas). Other drugs sometimes used include ketoconazole and abiraterone (Zytiga). Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex), flutamide, and nilutamide (Nilandron). The drug enzalutamide (Xtandi) may be an option when other hormone therapies are no longer effective.
• surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body.

Surgery. Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. A radical prostatectomy procedure can be performed using a robot, an abdominal incision, a perineal incision, or laparoscopy.

Freezing prostate tissue. Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.

Chemotherapy. Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm or in pill form.

Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that do not respond to hormone therapy.

For prostate cancer, chemotherapy drugs are typically used one at a time. Some of the common drugs used to treat prostate cancer include:

• docetaxel (Taxotere)
• cabazitaxel (Jevtana)
• mitoxantrone (Novantrone)
• estramustine (Emcyt)
• doxorubicin (Adriamycin)
• etoposide (VP-16)
• vinblastine (Velban)
• paclitaxel (Taxol)
• carboplatin (Paraplatin)
• vinorelbine (Navelbine)

Biological therapy. Biological therapy (vaccine therapy or immunotherapy) uses your body's immune system to fight cancer cells. One type of biological therapy called sipuleucel-T (Provenge) has been developed to treat advanced, recurrent prostate cancer.