Prostate Cancer

The prostate is a small gland that produces fluid that makes up semen (seminal fluid). It is located below the bladder in men, in front of the rectum. Prostate cancer is the abnormal growth of cells in the prostate gland.

What are the causes?

The exact cause of this condition is not known.

What increases the risk?

You are more likely to develop this condition if:

• You are 65 years of age or older.
• You have a family history of prostate cancer.
• You have a family history of breast and ovarian cancer.
• You have genes that are passed from parent to child (inherited), such as BRCA1 and BRCA2.
• You have Lynch syndrome.

African American men and men of African descent are diagnosed with prostate cancer at higher rates than other men. The reasons for this are not well understood and are likely due to a combination of genetic and environmental factors.

What are the signs or symptoms?

Symptoms of this condition include:

• Problems with urination. This may include:
  • A weak or interrupted flow of urine.
  • Trouble starting or stopping urination.
  • Trouble emptying the bladder all the way.
  • The need to urinate more often, especially at night.
• Blood in urine or semen.
• Persistent pain or discomfort in the lower back, lower abdomen, or hips.
• Trouble getting an erection.
• Weakness or numbness in the legs or feet.

How is this diagnosed?

This condition can be diagnosed with:

• A digital rectal exam. For this exam, a health care provider inserts a gloved finger into the rectum to feel the prostate gland.
• A blood test called a prostate-specific antigen (PSA) test.
• A procedure in which a sample of tissue is taken from the prostate and checked under a microscope (prostate biopsy).
• An imaging test called transrectal ultrasonography.

Once the condition is diagnosed, tests will be done to determine how far the cancer has spread. This is called staging the cancer. Staging may involve imaging tests, such as a bone scan, CT scan, PET scan, or MRI.

Stages of prostate cancer

The stages of prostate cancer are as follows:

• Stage 1 (I). At this stage, the cancer is found in the prostate only. The cancer is not visible on imaging tests, and it is usually found by accident, such as during prostate surgery.
• Stage 2 (II). At this stage, the cancer is more advanced than it is in stage 1, but the cancer has not spread outside the prostate.
• Stage 3 (III). At this stage, the cancer has spread beyond the outer layer of the prostate to nearby tissues. The cancer may be found in the seminal vesicles, which are near the bladder and the prostate.
• Stage 4 (IV). At this stage, the cancer has spread to other parts of the body, such as the lymph nodes, bones, bladder, rectum, liver, or lungs.

Prostate cancer grading

Prostate cancer is also graded according to how the cancer cells look under a microscope. This is called the Gleason score and the total score can range from 6–10, indicating how likely it is that the cancer will spread (metastasize) to other parts of the body. The higher the score, the greater the likelihood that the cancer will spread.

• Gleason 6 or lower: This indicates that the cancer cells look similar to normal prostate cells (well differentiated).
• Gleason 7: This indicates that the cancer cells look somewhat similar to normal prostate cells (moderately differentiated).
• Gleason 8, 9, or 10: This indicates that the cancer cells look very different than normal prostate cells (poorly differentiated).

How is this treated?

Treatment for this condition depends on several factors, including the stage of the cancer, your age, personal preferences, and your overall health. Talk with your health care provider about treatment options that are recommended for you. Common treatments include:

• Observation for early stage prostate cancer (active surveillance). This involves having exams, blood tests, and in some cases, more biopsies. For some men, this is the only treatment needed.
• Surgery. Types of surgeries include:
  • Open surgery (radical prostatectomy). In this surgery, a larger incision is made to remove the prostate.
  • A laparoscopic radical prostatectomy. This is a surgery to remove the prostate and lymph nodes through several small incisions. It is often referred to as a minimally invasive surgery.
  • A robotic radical prostatectomy. This is laparoscopic surgery to remove the prostate and lymph nodes with the help of robotic arms that are controlled by the surgeon.
  • Cryoablation. This is surgery to freeze and destroy cancer cells.
• Radiation treatment. Types of radiation treatment include:
  • External beam radiation. This type aims beams of radiation from outside the body at the prostate to destroy cancerous cells.
  • Brachytherapy. This type uses radioactive needles, seeds, wires, or tubes that are implanted into the prostate gland. Like external beam radiation, brachytherapy destroys cancerous cells. An advantage is that this type of radiation limits the damage to surrounding tissue and has fewer side effects.
• Chemotherapy. This treatment kills cancer cells or stops them from multiplying. It kills both cancer cells and normal cells.
• Targeted therapy. This treatment uses medicines to kill cancer cells without damaging normal cells.
• Hormone treatment. This treatment involves taking medicines that act on testosterone, one of the male hormones, by:
  • Stopping your body from producing testosterone.
  • Blocking testosterone from reaching cancer cells.

Follow these instructions at home:

Lifestyle

• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Eat a healthy diet. To do this:
  • Eat foods that are high in fiber. These include beans, whole grains, and fresh fruits and vegetables.
  • Limit foods that are high in fat and sugar. These include fried or sweet foods.
• Treatment for prostate cancer may affect sexual function. If you have a partner, continue to have intimate moments. This may include touching, holding, hugging, and caressing your partner.
• Get plenty of sleep.
• Consider joining a support group for men who have prostate cancer. Meeting with a support group may help you learn to manage the stress of having cancer.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you have to go to the hospital, notify your cancer specialist (oncologist).
• Keep all follow-up visits. This is important.

Where to find more information

• American Cancer Society: www.cancer.org
• American Society of Clinical Oncology: www.cancer.net
• National Cancer Institute: www.cancer.gov

Contact a health care provider if:

• You have new or increasing trouble urinating.
• You have new or increasing blood in your urine.
• You have new or increasing pain in your hips, back, or chest.

Get help right away if:

• You have weakness or numbness in your legs.
• You cannot control urination or your bowel movements (incontinence).
• You have chills or a fever.

Summary

• The prostate is a small gland that is involved in the production of semen. It is located below a man's bladder, in front of the rectum.
• Prostate cancer is the abnormal growth of cells in the prostate gland.
• Treatment for this condition depends on the stage of the cancer, your age, personal preferences, and your overall health. Talk with your health care provider about treatment options that are recommended for you.
• Consider joining a support group for men who have prostate cancer. Meeting with a support group may help you learn to manage the stress of having cancer.