An Overview of Prostate Cancer

Prostate cancer is a slow-growing cancer of the prostate gland. Prostate cancer is actually a wide spectrum of diseases, with some tumors being aggressive and others that act more benign. What causes it is uncertain, though there are known risk factors, such as age. Urination issues are symptoms most associated with the disease, though most cases are first suspected because of screening tests, such as a PSA. A formal diagnosis can only be made with tests such as an ultrasound-guided or MRI-targeted biopsy. Treatment options range from watchful waiting to radiation to surgery and depend on your case.

There are more than 3 million new cases of prostate cancer in the United States each year and the disease is the second leading cause of cancer-related deaths in men.

The Prostate Gland

The prostate gland is a small gland responsible for making seminal fluid. It completely surrounds the urethra, the tube from the bladder to the urethral opening in the penis. The gland lies directly in front of the rectum.

Early on, prostate cancer is contained completely within the prostate gland. At these stages, it can cause a narrowing of the urethra, and hence, urinary symptoms. As it grows to later stages—stages 3 and 4—it can invade the seminal vesicles, bladder, and rectum. The prostate gland can also spread, either through the lymphatic vessels or through the bloodstream. The most common sites to which prostate cancer spreads include the bones, liver, or lungs.

Symptoms

It's important for men to be familiar with the symptoms of prostate cancer, even though the disease is often diagnosed with screening tests before any signs develop. Understanding the anatomy described above is helpful, as most of the symptoms occur secondary to the growth of a tumor and its effect on adjacent structures. 

Common symptoms include:

  • Frequency of urination
  • Urgency with urination
  • The need to urinate at night (nocturia)
  • Difficulty starting the stream of urine
  • Decreased force of urination

Less common symptoms may include:

  • The sudden onset of erectile dysfunction
  • Blood in urine or semen
  • Loss of bladder control
  • Pain in the back, hips, or ribs (due to the spread of the cancer to bone)
  • Unintentional weight loss

Complications of the disease may also give rise to symptoms, such as urinary retention, pelvic pain, incontinence, or fractures related to bone metastases from prostate cancer.

Signs and Symptoms of Prostate Cancer

Causes and Risk Factors

What exactly causes the disease is unknown, but several risk factors for prostate cancer have been identified. Prostate cancer increases with age, with most men being diagnosed after the age of 50.

The disease is more common in blacks than in whites, and is less common in Asians and Hispanics. There are significant geographical differences in the incidence of prostate cancer, with the disease being more common in North America, Europe, and Australia than other continents.

A family history of prostate cancer is an important risk factor, especially in first-degree relatives (father, brother, or son). Several gene mutations (such as BRCA gene mutations) have been linked with a higher risk of the disease, but even without any known mutations, men with a family history have a greater risk. Having a brother with the disease carries more risk than having a father who was diagnosed, which suggests that a combination of genetic and environmental factors may be at play.

A diet high in red meats and dairy products is associated with an elevated risk, while conversely, a diet rich in fruits and vegetables is linked with a lower risk. Possible risk factors also include exposures to some herbicides (such as Agent Orange) and pesticides.

At one time, it was thought that more frequent sexual activity increased the risk of prostate cancer, but now it appears that men who have a greater number of ejaculations per month actually have a lower risk of the disease. Likewise, the vasectomy procedure was once thought to increase risk, while more recent research has not found a link.

Causes and Risk Factors of Prostate Cancer

Diagnosis

The diagnosing of prostate cancer includes several steps. Most prostate cancers are detected by prostate-specific antigen (PSA) tests and digital rectal exams, screening tests, before any symptoms occur. There has been significant controversy over the use of screening tests in recent years, however, with critics citing that the effect on survival is uncertain and that positive results can lead to unnecessary additional testing (with possible related complications) and over-treatment.

Generally, an abnormal PSA is just as likely to be due to a benign cause (such as prostatitis) as it is to be due to cancer. Similarly, men with prostate cancer can have a normal PSA. To make the diagnosis, a biopsy (using ultrasound and/or MRI for guidance) needs to be done.

Once a prostate cancer is diagnosed, grading and staging is done. A Gleason score is assigned, with 6 indicating low risk of growing and spreading, 7 indicating intermediate risk, and 8 to 10 indicating high risk. Additional tests, such as a bone scan or PET scan, may be done if there's a thought that the cancer has spread.

How Prostate Cancer Is Diagnosed

Treatment

The treatment options for prostate cancer vary depending on the stage of the tumor. For early, non-aggressive tumors (such as Gleason 6 tumors), active surveillance (watch and wait)—simply monitoring the cancer and only treating it if it begins to progress—may be the treatment of choice.

Curative options for prostate cancer include surgery (prostatectomy) or radiation therapy. Surgery can either be done manually or via robots (robotic surgery). Radiation therapy can be given either externally, internally (brachytherapy) via implantation of radioactive "seeds," or both.

For prostate cancers that are more advanced or have spread, systemic therapy (treatments that reach cancer cells anywhere they are in the body) is often used. Options include:

  • Hormonal therapy (androgen deprivation therapy): Testosterone drives the growth of prostate cancer cells, and medications may either block production of the hormone or its ability to act on cancer cells.
  • Chemotherapy: The chemotherapy medication Taxotere (docetaxel) is usually used first when chemotherapy is indicated.
  • Immunotherapy: Provenge (sipuleucel-T) is a cancer vaccine that trains a man's own immune system to recognize prostate cancer cells as abnormal so it can fight them.
  • Clinical trials: There are a number of clinical trials in place using combinations of the above treatments, as well as newer treatments such as other immunotherapy drugs, targeted therapy, and PARP inhibitors to treat prostate cancer.
Treatments Used for Prostate Cancer

Coping

Coping well with prostate cancer means much more than choosing the best treatment options.

Physical and sexual side effects related to treatment are one of the greatest concerns for many men, and problems such as erectile dysfunction are common. Newer approaches to prostate cancer treatment are focused much more on preserving the function of nerves in the region in the first place, but there are options for dealing with these concerns even if they do arise. Know, too, that while many men develop erectile dysfunction following surgery or radiation, most men retain the ability to have orgasms following treatment. Being aware of all of this can help ease anxiety.

A prostate cancer diagnosis can also introduce social challenges, such as who to tell about your diagnosis. Choosing who to share your news with can alleviate some of the disappointments that are far too common among people living with cancer; not everyone knows how to react or can handle the diagnosis of cancer in a friend or loved one.

Ways to Cope With Prostate Cancer

A Word From Verywell

Being diagnosed with prostate cancer can undoubtedly be unsettling, but it's helpful to understand that the disease behaves quite differently than many cancers. When found early, it is very curable, and even when advanced, men may live many years if not decades with the disease.

For these reasons, it's extremely important to learn about the natural history of prostate cancer and the treatments available. Unlike many cancers in which the goal may be to aggressively treat the cancer so that it doesn't return, the goal with prostate cancer is often to treat the cancer, but do so in a way that preserves the best quality of life possible. 

What Are the Signs and Symptoms of Prostate Cancer?
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