Prostate Cancer

Breast Cancer | Lung Cancer | Lymphoma | Prostate Cancer

• The risk of prostate cancer increases as men age
• Symptoms, such as difficulty urinating, a need to urinate frequently and urgently, and blood in the urine, usually occur only after the cancer is advanced
• The cancer can spread, usually to the bone, kidneys, brain, or spinal cord
• A digital rectal examination and a blood test may be done to check for prostate cancer in men without symptoms
• If cancer is suspected, ultrasonography and a biopsy of prostate tissue are done.

Among men in the United States, prostate cancer is the most common cancer and one of the most common causes of cancer death. The chance of developing prostate cancer increases with age and is greater for:

• Men who are black or Hispanic
• Men whose close relatives had the disease
• Possibly men receiving testosterone treatment

Prostate cancer usually grows very slowly and may take decades to produce symptoms. Thus, particularly because it occurs more often in elderly men, far more men have prostate cancer than die from it. Many men with prostate cancer die from other causes without ever knowing that the cancer was present.

Prostate cancer begins as a small bump in the gland. Most prostate cancers grow very slowly and never cause symptoms. Some, however, grow rapidly or spread outside the prostate. The cause of prostate cancer is not known.

Symptoms

Prostate cancer usually causes no symptoms until it reaches an advanced stage. Sometimes, symptoms similar to those of benign prostatic hyperplasia (BPH) develop, including difficulty urinating and a need to urinate frequently or urgently. However, these symptoms do not develop until after the cancer grows large enough to compress the urethra and partially block the flow of urine. Later, prostate cancer symptoms may cause bloody urine or a sudden inability to urinate.

In some men, symptoms of prostate cancer develop only after it spreads (metastasizes). The areas most often affected by cancer spread are bone (typically the pelvis, ribs, or vertebrae) and the kidneys. Bone cancer tends to be painful and may weaken the bone enough for it to easily fracture. Prostate cancer can also spread to the brain, which eventually causes seizures, confusion, headaches, weakness, or other neurologic symptoms. Spread to the spinal cord, which is also common, can cause pain, numbness, weakness, or urinary incontinence. After the cancer spreads, anemia is common.

Diagnosis

Doctors may suspect prostate cancer based on the symptoms, the results of a digital rectal examination, or the results of screening blood tests. The screening blood test is a measurement of prostate-specific antigen (PSA) levels. PSA is a substance produced only by prostate gland tissue.

If results of these tests suggest cancer, ultrasound scanning is usually done. In men with prostate cancer, ultrasound scans may or may not reveal the cancer but are used to guide biopsy of the prostate.

If the results of a digital rectal examination or PSA test suggest prostate cancer, tissue samples from the prostate are taken and analyzed (biopsy). When doing a biopsy, doctors usually first obtain images of the prostate by inserting an ultrasound probe (transducer) into the rectum (transrectal ultrasound). Doctors then insert a needle through the probe and use the needle to obtain tissue samples several times. Usually, 5 or 6 samples are taken from each side of the prostate to increase the likelihood of finding a small cancer. This procedure takes only a few minutes, and men are given local anesthesia.

Grading and staging help doctors determine the likely course and the best treatment of the cancer:

Grading

The Gleason scoring system is the most common way to grade prostate cancer. Based on the microscopic examination of tissues obtained from the biopsy, a number between 1 and 5 is assigned based on how distorted the cells appear. Because cancer cells often vary in their appearance, the number score for the most common abnormal cells is added to the number for the next most common abnormal cells to give a total score from 2 to 10. Scores between 6 and 7 are most common. The higher the number (high grade), the more aggressive the cancer is and the more likely it is that the cancer will spread.

Staging

Prostate cancers are staged according to three criteria:

• How far the cancer has spread within the prostate
• Whether the cancer has spread to lymph nodes in areas near the prostate
• Whether the cancer has spread to organs far from the prostate (metastatic cancer)

Testing to stage the cancer is often done when cancer is diagnosed. However, such testing may not be necessary when the likelihood of spread beyond the prostate is extremely low. Likelihood of spread is low when cancers have a Gleason score of 7 or less, the PSA level is less than 10 ng/mL, and the cancer has not penetrated the surface of the gland. Results of the digital rectal examination, ultrasound scan, and biopsy reveal how far the cancer has spread within the prostate.

AIf likelihood of spread is not low, doctors usually do a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis. Sometimes the MRI is done using a special coil inserted in the rectum. A bone scan may be done in people who have pain in their bones or who have a very high PSA level.

If spread to the brain or spinal cord is suspected, CT or MRI of those organs is done.

Screening

Because prostate cancer is common, many doctors check for it in men with no symptoms (screening). However, because screening tests are positive in many men who do not have cancer and because some men who do have cancer may not require treatment, experts disagree about whether and when screening is helpful. Screening is considered in men older than 50 and in those older than 40 who have risk factors, such as being black or having a family history of prostate cancer. Benefits of screening may decrease with age. For example, one professional organization recommends against screening men who are older than 75 or who are not expected to live at least 10 more years. Screening, once begun, is usually repeated yearly.

To screen for prostate cancer, doctors do a digital rectal examination and a blood test to measure PSA levels. If the prostate gland is hard, irregularly enlarged, or has a lump, or the PSA level is elevated, prostate cancer is more likely. However, PSA levels can be misleading. The PSA level can be normal when prostate cancer is present and can be elevated for reasons other than prostate cancer. PSA levels normally increase with age and with disorders such as BPH and prostatitis. Men with an elevated PSA level then require a transrectal prostate biopsy to identify those who have cancer. Because most men who have elevated PSA levels on screening tests do not have prostate cancer, many biopsies have negative results.

ISome prostate cancers are aggressive and potentially fatal but may not cause symptoms until they are too advanced to be cured. Screening offers the advantage of finding such cancers early—when they might be cured. However, because many prostate cancers grow slowly and often never cause symptoms or death, screening may find cancers that would probably not hurt or kill a man even if they were never detected. The side effects of treating such a cancer can be more damaging than leaving the cancer untreated. Thus, it is not clear whether the benefits of screening outweigh the discomfort, stress, and possible harm from unnecessary testing and treatment.

Prognosis

Prognosis for most men with prostate cancer is very good. Most elderly men with prostate cancer tend to live as long as other men their age who have similar general health and do not have prostate cancer. For many men, long-term remission or even cure is possible. The prognosis depends upon the cancer's grade and stage. High-grade cancers have a poor prognosis unless treated very early. Cancers that have spread to surrounding tissues also have a poorer prognosis. Metastatic prostate cancer has no cure. Most men with metastatic cancer live about 1 to 3 years after diagnosis, but some live for many years.

Treatment

Individual prostate cancer treatment may vary depending upon the cancer patient and their desire to receive tradition prostate treatment, alternative cancer treatment, or integrative cancer treatment. It is vital that persons diagnosed with, or suspected of having prostate cancer consult with their health care provider to assure proper evaluation, treatment and interpretation of information contained on this site.

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