Articles on Prostate Cancer
What does prostate cancer feel like?
Difficulty with urination – frequency, weak stream, trouble getting started, etc. – is usually a first sign of prostate cancer. But the early symptoms can also come from benign prostate conditions, so diagnostic testing is important.
The prostate is the gland in a man’s pelvis that wraps around the urethra and secretes the fluid part of semen. A working prostate is crucial for ejaculation and sexual intercourse.
What are the signs and symptoms of prostate cancer?
A patient with early prostate cancer is usually asymptomatic. However, prostate cancer symptoms associated with enlargement of the prostate due to prostate cancer, which may occur with early and late-stage/advanced-stage disease, include the following:
- Frequent urination, during the day and/or at night
- Difficulty in starting (hesitancy), maintaining, or stopping the urine stream
- A weak or interrupted urine stream
- Straining to urinate
- Inability to urinate (urinary retention)
- Loss of control of urination
- Difficulty urinating when standing, requiring sitting during urination
- Pain with urination or ejaculation
- Blood in the urine or in the semen
- Abnormal rectal examination
Many symptoms of early prostate cancer can also be attributed to benign (noncancerous) conditions of the prostate, including
Signs and symptoms of advanced prostate cancer (late-stage prostate cancer) that has already spread from the prostate gland to elsewhere in the body (called metastatic prostate cancer) include
- a new dull, then progressively severe, pain in the bones, especially the low back;
- unexplained weight loss;
- increasing shortness of breath while doing activities previously well-tolerated;
- low-impact fracture of bone(s) without a lot of trauma (or broken bone[s] from minor trauma); and
- swelling of the legs related to obstruction of the lymph tissue by prostate cancer.
It is always best to find and diagnose prostate cancer at an early stage and hopefully still confined to its site of origin. At that point, treatments can cure it. When prostate cancer is widespread or metastatic, it can be treated, but it cannot be cured.
What causes prostate cancer?
The exact causes of prostate cancer are not known. Several risk factors for developing prostate cancer have been identified, but which of these risk factors cause a prostate cell to become cancerous is not fully known.
For cancer to develop, changes must occur in the chemicals that make up the DNA, which makes up the genes in the cell. The genes control how the cell works, for example, how quickly the cell grows, divides into new cells, and dies, as well as correcting any mistakes that occur in the DNA of the cell to keep the cell working normally.
- Cancer occurs when certain genes that either control the growth or death of the cell are affected, which results in abnormal cell growth and/or death.
- Genes are inherited (passed on from parents to their children) and thus some changes in the genes (gene mutations) that increase the risk of developing cancer may be inherited.
For prostate cancer, approximately 5%-10% of prostate cancers are due to inherited gene changes. Several inherited genes have been identified that increase the risk of prostate cancer, including
- BRCA 1, and BRCA 2,
- DNA mismatch genes,
- HPC1, and
Kote-Jarai and colleagues identified that men who carry a hereditary mutation in homeobox 13 (HoxB13) have a higher than average risk of developing prostate cancer. In a systematic review and meta-analysis the investigators noted that in these men with the HoxB13 mutation, the risk of prostate cancer is also affected by a family history of prostate cancer and the year of their birth.
Gene changes may also be acquired (develop during the course of your life). These changes are not passed on to children. Such changes may occur when a cell normally undergoes growth and division. It is thought that at times during normal cell growth, risk factors may affect the DNA of the cell.
What are the risk factors for prostate cancer?
Certain risk factors may predispose a person to prostate cancer. These include the following:
- Age: Sixty percent of cases of prostate cancer arise in men over 65 years of age. The disease is rare in men under 40.
- Race or ethnicity: African-American men and Jamaican men of African ancestry are diagnosed with prostate cancer more often than are men of other races and ethnicities. Asian and Hispanic men are less likely to develop prostate cancer than are non-Hispanic white males.
- Family history: Prostate cancer can run in families. A man whose father or brother (first-degree relative) has or had prostate cancer is twice as likely to develop the disease. The younger the family member is when he is diagnosed with prostate cancer, the higher the risk is for male relatives to develop prostate cancer. The risk of developing prostate cancer also increases with the number of relatives affected.
- Nationality: Prostate cancer is more common in North America, Europe (especially northwestern countries in Europe), the Caribbean, and Australia. It is less common in Asia, Africa, and South and Central America. Multiple factors, such as diet and lifestyle, may account for this.
- Genetic factors: Mutations in a portion of the DNA called the BRCA2 gene can increase a man's risk of getting prostate cancer, as well as other cancers. This same mutation in female family members may increase their risk of developing breast or ovarian cancer. However, very few cases of prostate cancer can be directly attributed to presently identifiable genetic changes. Other inherited genes associated with an increased risk of prostate cancer include RNASEL, BRCA 1, DNA mismatch genes, HPC1, and HoxB13.
- Other factors: High-fat diets (fatty foods) and diets high in red meats and fatty foods and low in fruits and vegetables appear to be associated with a higher risk of developing prostate cancer. Obesity is also linked to a higher risk of the disease. Increased calcium intake and dairy foods may increase the risk of prostate cancer.
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American Cancer Society (ACS). <http://www.cancer.org/cancer/prostatecancer/index>.
American Urological Association. "Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline." 2017. <http://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)>.
Byrd, E.S., et al. AJCC Cancer Staging Manual, 7th Ed. New York, NY: Springer, 2009.
The James Buchanan Brady Urological Institute. Johns Hopkins Medicine.
Lu-Yao, G.L., P.C. Albertson, D.F. Moore, et al. "Fifteen-year outcomes following conservative management among men aged 65 years or older with localized prostate cancer." Eur Urol 68.5 (2015): 805-811.
Mottet, Nicolas, et al. "Updated Guidelines for Metastatic Hormone-Sensitive Prostate Cancer: Abiraterone Acetate Combined With Castration Is Another Standard." European Urology 73 (2018): 316-321.
National Comprehensive Cancer Network
"Prostate Cancer." Memorial Sloan Kettering Cancer Center.
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Early-Stage Prostate Cancer Treatment
If prostate cancer is detected early and appears to be slow-growing, invasive procedures, chemotherapy, radiation and other approaches can sometimes do more harm than good. Many prostate cancer treatments come with side effects, like incontinence or impotence, so it’s in the patient’s interest to put off invasive treatments as long as is medically safe. Active surveillance is where doctors "watch and wait" for changes that could prompt medical intervention.
How Is Prostate Cancer Diagnosed?
Prostate cancer is largely a disease of men over 40, so it’s around this age doctors recommend the first prostate screening. The first exam is a blood test to determine if there are abnormal prostate specific antigen (PSA) levels in your blood – PSA is produced by the prostate. If the PSA is high, your doctor will perform a digital rectal exam, during which the doctor feels your prostate from inside your rectum with a gloved finger. Other diagnostic tests include an endoscopic biopsy of tumor tissue for analysis in a lab.
Prostate cancer is the most common cancer in men after skin cancer. Risk factors include age, family history, ethnicity, and diet. Prostate cancer is diagnosed by digital rectal exam, prostate specific antigen (PSA) test, and prostate biopsy.
Symptoms may include frequent need to urinate, incontinence, pain, blood in the urine, fatigue, and more. Prognosis and treatment depend on cancer staging. Watchful waiting, surgery, radiation, cryotherapy, and other management strategies are available. Research and clinical trials strive to find new and better treatments for prostate cancer.
Prostate Cancer Treatment: Chemotherapy, Bone-Targeted and Immune Therapy
Doctors may introduce chemotherapy and immune therapy if other measures fail to cure a case of prostate cancer. However, unlike with other forms of cancer, chemotherapy isn’t the first choice for early prostate cancer. Immune therapy uses the body's own immune system to attack the prostate tumor, while bone-targeted therapy aims to preserve bone and prevent metastasis.
Prostate Cancer Facts
Prostate cancer is a leading cause of cancer and cancer death in males; in some men, identifying it early may prevent or delay metastasis and death from prostate cancer. The prostate is a walnut-shaped gland that is a part of the male reproductive system that wraps around the male urethra at it exits the bladder. Prostate cancer is common in men over 50 years of age, with the risk of developing prostate cancer increases with aging.
Prostate Cancer Treatment: Focal Therapy and Other Experimental Treatments
Several new and experimental treatments for prostate cancer are under study, including treatments that use ultrasound, lasers, tissue-freezing gas, and new ways of administering radiation. These new methods are types of focal therapy, that is, treatment focused on the cancer cells in the prostate, rather than systemic therapy that administers medications or other treatments to the whole body with the aim of treating the prostate.
Prostate Cancer Treatment: Radiation, Brachytherapy and Radiopharmaceuticals
Radiation treatment for prostate cancer is a powerful tool at doctors’ disposal. Using radiation vs. surgery or other invasive treatments to kill cancer cells may still cause side effects, but ideally they are less severe. Radiation therapy can be performed via external beam therapy (EBRT) or the placement of radioactive seeds into the prostate (prostate brachytherapy) or using radioactive drugs (radiopharmaceuticals).
Prostate Cancer Treatment: Radical Prostatectomy Surgery
Radical prostatectomy, or surgical removal of the entire prostate gland, isn’t typically the first choice in prostate cancer treatment. Sometimes a radical approach is necessary to keep the cancer from metastasizing, however. Some cases are too severe or diagnosed too late for drugs or radiation to have much effect. In these cases, treatment teams may opt for a radical prostatectomy, despite potential side effects like impotence and incontinence.
Prostate Cancer Staging and Prognosis
The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations. The patient's PSA score at diagnosis, as well as their Gleason score (the grading system used to determine the aggressiveness of prostate cancer) determines the prognosis and final stage designation. Prostate cancer has a high survival rate in general, but your chances depend on the stage of the cancer.
Prostate Cancer Treatment: Hormonal Therapy
Prostate cancer is highly sensitive to, and dependent on, the level of the male hormone testosterone, which drives the growth of prostate cancer cells. Testosterone belongs to a family of hormones called androgens, and today front-line hormonal therapy for advanced and metastatic prostate cancer is called androgen deprivation therapy (ADT).