Basics & Overview
Prostate cancer is a type of cancer that starts in the prostate gland. This is one of the most common forms of cancer in men and is the most common cause of death by cancer in men over age 75, as noted by PubMed Health. Some forms of this cancer may stay confined to the prostate while other cases may be more aggressive and spread throughout the body.
Types of Prostate Cancer
The prostate gland is a small walnut-shaped gland that is part of a man’s reproductive system. This gland wraps around the urethra and produces seminal fluid that transports and nourishes sperm.
There are several different types of cells in the prostate gland, but almost all of the cancers involving the prostate develop from the gland cells and are adenocarcinomas.
- Adenocarcinomas: This cancer is typically slow-growing, but can still spread beyond the prostate gland. Since most prostate cancers are adenocarcinomas, the information in this article appears mainly to this type.
- Small cell carcinoma: This rare cancer forms from specialized cells in the prostate. These cancers may be difficult to detect in the early stages.
- Other rare forms: There are other forms of prostate cancer that are exceptionally rare. To manage those, you may need a consultation with a specialist.
Many men develop benign prostatic hypertrophy (BPH) as they age with the initial sign being problems passing urine. It is important to know that BPH is not cancer and does not develop into cancer. It can be a serious medical problem, but it is not life-threatening.
Prostate cancer may not have symptoms in the early stages. More advanced disease may have symptoms such as:
- Difficulty urinating
- Blood in the urine
- Blood in the semen
- Decreased force of urine stream
- Pelvic discomfort
- Bone pain (advanced disease)
If you notice any of these symptoms, you should discuss it with your physician.
Risks & Causes
There are certain risk factors that increase your risk of developing prostate cancer.
- Age: Prostate cancer rarely occurs in men who are younger than 40. Two out of every three prostate cancers occur in men over the age of 65, according to the American Cancer Society.
- Race: Prostate cancer is more common in African American men and is also more likely to be advanced or aggressive in these men.
- Family History: If you have a family history of prostate cancer, your risk may be increased as well.
- Diet: Men who eat a diet high in animal fat are also at higher risk. The disease is more common in countries that consume more animal and dairy products.
Other factors that may play a role include:
- Exposure to agent orange
- Increased alcohol consumption
- Exposure to cadmium
- Being a painter or farmer
- Being a tire plant worker
Diagnosis & Tests
Your doctor can screen for prostate cancer. This can be controversial because different medical organizations don’t agree on how and when to do it or if screening is of enough benefit. You can discuss your specific situation with your physician.
Screening may consist of:
- Prostate-specific antigen (PSA) test: In this test, your blood is tested for prostate-specific antigen levels. If a large amount of this antigen is found in your blood, it could be a sign of infection, inflammation, enlargement or cancer.
- Digital rectal exam (DRE): During a doctor’s examination, your doctor may insert a gloved finger into your rectum to feel your prostate. If there are any abnormalities in the texture, your doctor may order further testing.
If abnormalities are detected in either of the screening tests, your doctor may order:
- Ultrasound: Your physician may order a transrectal ultrasound which uses sound waves to take a picture of your prostate.
- Prostate biopsy: In this procedure, a few cells from your prostate are removed so they can be examined under a microscope. It can usually be done in a doctor’s office.
When the biopsy is positive for cancer cells, the next step is to grade the aggressiveness of the cancer. The most common grading scale is the Gleason score. This score adds two grades and can range from a two, which is a nonaggressive cancer, to a 10 which is very aggressive.
Once the diagnosis is made, your doctor will then assess the grade of the cancer to see how far it has spread. Tests that might be used to may this determination are:
- Bone scan
- CT scan
- ProstaScint scan: This test uses low-level radioactive material to find prostate tissue in other places in the body.
- Lymph node biopsy
Stage I cancer is confined to the prostate while Stage IV has gone on to invade other organs or bone.
Treatment & Management
Treatment of prostate cancer does depend on the stage and aggressiveness of the disease.
Early Prostate Cancer
- Watchful waiting: For some men who have very early disease, the doctors may monitor the cancer with regular examinations, blood tests and possible biopsies and use “watchful waiting”. If the condition advances, other options may be considered.
- Surgery: This would involve a radical prostatectomy where the entire prostate is removed. Adverse results from this surgery include urinary and bowel problems and difficulties with erections.
- Radiation therapy: This treatment uses high-powered energy to kill cells. This radiation can be administered from a machine outside the body or through brachytherapy where small radioactive pieces are placed inside your prostate tissue. This may cause problems with urination and erectile dysfunction.
Advanced Prostate Cancer
- Hormone therapy: Hormone therapy stops the body from producing testosterone or block testosterone that is there and may cause the cancer cells to die or to stop growing. These treatments may affect sexual performance. Types of hormone therapy include:
- Medications that stop production: Medications like luteinizing hormone-releasing hormone (LH-RH) prevents the testicles from creating more testosterone. Examples of these medications include histrelin (Vantas), leuprolide (Lupron, Eligard), goserelin (Zoladex), and triptorelin (Trelstar).
- Medications that block testosterone: Anti-androgens block testosterone from getting to the cells. Examples of these medications include flutamide, bicalutamide (Casodex), and nilutamide (Nilandron). You usually take these drugs typically along with an LH-RH agonist or before taking an LH-RH agonist.
- Surgery: You may opt for surgery to remove your testicles (orchiectomy) which also lowers your testosterone levels as well.
- Chemotherapy: Drugs to kill the cancer cells can be used to treat prostate cancer that has spread. This is often reserved for patients who have not responded to hormone therapy but also can be used for men who have disease in other parts of their bodies.
- Cryotherapy: Men who have not been helped by radiation therapy may be candidates for cryotherapy where the prostate cancer cells are frozen. The tissue is then reheated; this process kills cancer cells – as well as some healthy tissue. Advances in this procedure have made it easier for patients to tolerate.
- Vaccine Therapy: This treatment may be used for patients who are no longer responding to hormone therapy. Sipuleucel-T (Provenge®) is an individually made vaccine that will boost the immune system to help fight cancer cells. This treatment may cause fever, chills, nausea and headache.
No complimentary or alternative therapies will cure prostate cancer; however, alternative therapies may help you deal with the side effects of the diagnosis and conventional therapy. Exercise, relaxation techniques and meditation may all be of benefit.
Because the exact cause of prostate cancer is not known, it is difficult to know how to prevent the disease in most people. There are some factors you can modify to lower your risk of the disease.
- Stay at a healthy weight
- Eat a diet full of fruits and vegetables
Some doctors believe that taking a medication beforehand may lower the risk of developing prostate cancer. Drugs called 5-alpha reductase inhibitors block the enzyme that changes testosterone into dihydrotestosterone (DHT) and research has suggested that this prevents the formation of DHT which keeps the prostate from growing. The research is ongoing, but in some cases, these drugs (Finasteride (Proscar®); Dutasteride (Avodart®)) may increase the risk of high-grade prostate cancer. Therefore, the use of these agents in this situation is controversial so you should talk to your physician about your options.
Managing Prostate Cancer
You may not be able to prevent all cases of prostate cancer; however, if you are diagnosed, it is important to learn to deal with the diagnosis and treatment. You may need support from your family and friends and close communication with your physician team. It is also important to remember that you are still a sexual being although your expression of that may be different. In addition, talking to other prostate cancer survivors for support can help you have a positive outlook.