Prostate cancer
Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-shaped structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.
Prostate cancer - Animation
As men get older, they have a lot of new worries to deal with, from hair loss, weight gain, perhaps even erectile dysfunction. In addition, cancer is one of the biggest concerns that older men face, especially prostate cancer, which is the leading cause of cancer death in men over 75. Younger men may not be very familiar with their prostate, the walnut-shaped gland that wraps around the urethra, the tube that carries urine out of the body. But as they get older, the prostate can start to cause problems. Men over the age of 60 are at increased risk for prostate cancer, especially if they're of African descent, they have a father or brother with the disease, or they eat a lot of burgers and processed meats in their daily diet. It can be hard to pinpoint prostate cancer symptoms, because they usually start late in the disease and they can mimic symptoms of a benign, enlarged prostate, which is also more common in older men. Symptoms like a slow urine stream, dribbling, blood in the urine, or straining while urinating can be signs of either condition. An enlarged prostate can also confuse the results of a PSA test, which is used to screen for prostate cancer. So, if your doctor thinks you might have prostate cancer, you may need a biopsy, which is a procedure that removes a small piece of prostate tissue and sends it to the lab to check for cancer. Then a scoring system called the Gleason grade is used to tell how fast your cancer might spread. Your Gleason grade will help decide what treatment you get. Early-stage prostate cancers that haven't spread are often removed with surgery, and then treated with radiation therapy to kill any remaining cancer cells. Prostate cancer surgery may affect your ability to have sex and control urine, so talk about these issues with your doctor before you have the procedure. Because prostate cancer tends to grow very slowly, your doctor may want to just monitor you with PSA tests and biopsies, and avoid treatment unless the cancer starts to spread. Prostate cancer that has spread is usually treated with surgery, chemotherapy, or hormone therapy. If your doctor discovers prostate cancer in its early stages, before it spreads, it's pretty easy to treat, and even cure. Treatments can also slow down prostate cancer that's spread, and extend your survival. Before you have to deal with a prostate cancer diagnosis, ask your doctor for ways to prevent and screen for the disease. Eating a healthy, low-fat diet that's high in healthy omega-3 fatty acids might help lower your risk. There are also drugs called finasteride and dutasteride that are used in some men to prevent prostate cancer. Talk with your doctor about the pros and cons of these drugs, as well as the possible benefits and risks of having your PSA levels tested.
Causes
Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.
People who are at high risk include:
- African American men, who are also more likely to develop this cancer at every age
- Men age 60 years and above
- Men who have a father or brother with prostate cancer
Other people at risk include:
- Men who have been exposed to Agent Orange
- Men who eat a diet high in fat, especially animal fat
- Obese men
Prostate cancer is less common in people who do not eat meat (vegetarians).
A common problem in almost all men as they grow older is an enlarged prostate that affects their urinary function. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk for prostate cancer. But, it can increase your prostate-specific antigen (PSA) blood test result.
Enlarged prostate
The prostate is a gland that produces some of the fluid that carries sperm during ejaculation. The prostate gland surrounds the urethra, the tube th...
Read Article Now Book Mark ArticleProstate-specific antigen
Prostate-specific antigen (PSA) is a protein produced by prostate cells. The PSA test is done to help screen for and monitor prostate cancer in men....
Read Article Now Book Mark ArticleEnlarged prostate - Animation
Not every man will have to deal with age-related issues like balding or weight gain. Whether you have these problems really depends on your health, and luck. But one problem just about every man will have to face, if he lives long enough, is an enlarged prostate. Let's talk about an enlarged prostate, also known as benign prostatic hyperplasia, or BPH. The prostate gland is part of your reproductive system, and its job is to add fluid to the sperm before ejaculation. The prostate is pretty small when you're young, but as you get older it grows and grows. Keep in mind, this growth isn't cancerous. But by design, the prostate is wrapped around the urethra, the tube that carries urine from your bladder out of your body. So as the prostate grows, it can begin to squeeze or pinch the urethra which often can make it harder for men with an enlarged prostate to urinate. If you have an enlarged prostate, the first notice that you're having trouble urinating. Instead of having a strong even flow, the urine only dribbles out like a leaky faucet; drip, drip, dribble, drip. Because you're not emptying your bladder fully each time, you keep feeling the urge to use the bathroom, even in the middle of the night. To check your prostate, your doctor or urologist will check your prostate gland by inserting a lubricated, gloved finger and feeling for any growth. Other tests may check your urine flow, and how much urine is left in your bladder after you go, as well as look for signs of an infection or prostate cancer. How is an enlarged prostate treated? Treatment often depends on how you feel. If you're not having any symptoms, your doctor may suggest just watching it, that's called watchful waiting. If you've got bothersome symptoms, medications can reduce the size of the prostate gland, and relax your bladder and prostate so you don't constantly feel the urge to go. For more serious symptoms, surgery can remove the extra prostate tissue. To help relieve the symptoms of an enlarged prostate, watch how much fluid you drink, especially before bedtime, or before going out. Minimize alcohol and caffeine, as well as over-the-counter decongestants and antihistamines. They can make your symptoms worse. Double voiding can help. After you've emptied your bladder, wait a moment and try to go again without straining or pushing. Some people take herbs like saw palmetto for an enlarged prostate. Although there's some evidence that these herbs can relieve BPH symptoms, many studies haven't found a benefit. Talk to your doctor before taking any herbal remedy, because they can cause side effects. Prostate enlargement isn't usually serious, but it can have a serious impact on your way of life, especially when you're always going to the bathroom. Remember that BPH is treatable. Work with your doctor to find the treatment that works best for you. If you've been caring for your symptoms for 2 months and not finding any relief, or you're having more serious symptoms like you're not urinating at all, or you have a fever or pain in your back or abdomen, call your doctor as soon as possible.
Symptoms
With early prostate cancer, there are often no symptoms.
The PSA blood test may be done to screen men for prostate cancer. Often, the PSA level rises before there are any symptoms.
The symptoms listed below can occur with prostate cancer as it grows larger in the prostate. These symptoms can also be caused by other prostate problems:
- Delayed or slowed start of urinary stream
Slowed start of urinary stream
Difficulty starting or maintaining a urine stream is called urinary hesitancy.
Read Article Now Book Mark Article - Dribbling or leakage of urine, most often after urinating
- Slow urinary stream
- Straining when urinating, or not being able to empty all of the urine
- Blood in the urine or semen
When the cancer has spread, there may be bone pain or tenderness, most often in the lower back and pelvic bones.
Exams and Tests
An abnormal prostate gland felt during a digital rectal exam may be the only sign of prostate cancer.
Digital rectal exam
A digital rectal exam is an exam of the lower rectum. Your health care provider uses a gloved, lubricated finger to check for any abnormal findings....
Read Article Now Book Mark ArticleA biopsy is needed to tell if you have prostate cancer. A biopsy is a procedure to remove a sample of tissue from the prostate. The sample is sent to a lab for examination. It will be done in your doctor's office.
Biopsy
A prostate biopsy is the removal of tiny samples of prostate tissue to examine it for signs of prostate cancer. The prostate is a small, walnut-sized...
Read Article Now Book Mark ArticleYour doctor may recommend a biopsy if:
- You have a high PSA level
- A digital rectal exam reveals that your prostate is hard or has an uneven surface
The biopsy result is reported using what is called a Gleason grade and a Gleason score.
The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 through 5. You may have different grades of cancer in one biopsy sample. The two most common grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer can spread beyond the prostate:
- Scores 2 through 6: Low-grade prostate cancer.
- Score 7: Intermediate- (or in the middle) grade cancer. Most prostate cancers fall into this group.
- Scores 8 through 10: High-grade cancer.
Another grading system, the 5 Grade Group System does a better job of describing how a cancer will behave and respond to treatment:
- Grade group 1: Gleason score 6 or lower (low-grade cancer)
- Grade group 2: Gleason score 3 + 4 = 7 (medium-grade cancer)
- Grade group 3: Gleason score 4 + 3 = 7 (medium-grade cancer)
- Grade group 4: Gleason score 8 (high-grade cancer)
- Grade group 5: Gleason score 9 to 10 (high-grade cancer)
A lower group indicates a better chance for successful treatment than a higher group. A higher group means that more of the cancer cells look different from normal cells. A higher group also means that it is more likely that the tumor will spread aggressively.
The following tests may be done to determine whether the cancer has spread:
- CT scan
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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Bone scan
A bone scan is an imaging test used to diagnose bone diseases and find out how severe they are.
Read Article Now Book Mark Article - MRI scan
MRI scan
A pelvis MRI (magnetic resonance imaging) scan is an imaging test that uses a machine with powerful magnets and radio waves to create pictures of the...
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The PSA blood test will also be used to monitor your cancer after treatment.
Treatment
Treatment depends on many things, including your Gleason score and your overall health. Your doctor will discuss your treatment options with you.
Prostate cancer
Treatment of prostate cancer varies depending on the stage of the cancer (i.e., spread) and may include surgical removal, radiation, chemotherapy, hormonal manipulation or a combination of these treatments.
If the cancer has not spread outside the prostate gland, common treatments include:
Treatments
Treatment for your prostate cancer is chosen after a thorough evaluation. Your health care provider will discuss the benefits and risks of each trea...
Read Article Now Book Mark Article- Surgery (radical prostatectomy)
Radical prostatectomy
Radical prostatectomy (prostate removal) is surgery to remove all of the prostate gland and some of the tissue around it. It is done to treat prosta...
Read Article Now Book Mark Article - Radiation therapy, including brachytherapy, external beam therapy, and proton therapy
Radiation therapy
Radiation therapy uses high-powered radiation (such as x-rays or gamma rays), particles, or radioactive seeds to kill cancer cells.
Read Article Now Book Mark ArticleBrachytherapy
Brachytherapy is a procedure to implant radioactive seeds (pellets) into the prostate gland to kill prostate cancer cells. The seeds may give off hi...
Read Article Now Book Mark ArticleProton therapy
Proton therapy is a kind of radiation used to treat cancer. Like other types of radiation, proton therapy kills cancer cells and stops them from gro...
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If you are older, your doctor may recommend simply monitoring the cancer with PSA tests and biopsies. This is called active surveillance.
Hormone therapy is mainly used for cancer that has spread beyond the prostate. It helps relieve symptoms and prevents further growth and spread of the cancer. But it does not cure the cancer.
If prostate cancer spreads even after hormone therapy, surgery, or radiation has been tried, treatment may include:
- Chemotherapy
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
Read Article Now Book Mark Article - Immunotherapy (medicine to trigger the immune system to attack and kill cancer cells)
Immunotherapy
Immunotherapy is a type of cancer treatment that relies on the body's infection-fighting system (immune system). It uses substances made by the body...
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Surgery, radiation therapy, and hormone therapy can affect your sexual performance. Problems with urine control are possible after surgery and radiation therapy. Discuss your concerns with your health care provider.
After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine checkups, including PSA blood tests (usually every 3 months to 1 year).
Support Groups
You can ease the stress of illness by joining a prostate cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.
Prostate cancer support group
The following organizations are good resources for information on prostate cancer:American Cancer Society -- www. cancer. org/cancer/prostate-cancer....
Read Article Now Book Mark ArticleOutlook (Prognosis)
How well you do depends on whether the cancer has spread outside the prostate gland and how abnormal the cancer cells are (the Gleason score) when you are diagnosed.
A cure is possible if the cancer has not spread. Hormone treatment can improve survival, even if a cure is not possible.
When to Contact a Medical Professional
Discuss the advantages and disadvantages of PSA screening with your provider.
Prevention
Talk with your provider about possible ways to lower your risk for prostate cancer. These may include lifestyle measures, such as diet and exercise.
There are no medicines approved by the FDA for preventing prostate cancer.
Reviewed By
Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
National Cancer Institute website. Prostate cancer treatment (PDQ) health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated February 13, 2023. Accessed July 17, 2023.
National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): Prostate cancer. Version 4.2023. www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Updated September 7, 2023. Accessed October 6, 2023.
Nelson WG, Antonarakis ES, Carter HB, De Marzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 81.
Stephenson AJ, Abouassaly R, Klein EA. Epidemiology, etiology, and prevention of prostate cancer. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 148.
US Preventive Services Task Force; Grossman DC, Curry SJ, et al. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901-1913. PMID: 29801017 pubmed.ncbi.nlm.nih.gov/29801017/.
Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part I: prostate cancer screening. J Urol. 2023;210(1):45-53. www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines.
Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part II: considerations for a prostate biopsy. J Urol. 2023;210(1):54-63. www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines.