- What is the prostate?
- What is prostate cancer?
- Who is at risk for prostate cancer?
- What other prostate conditions can cause symptoms like these?
- Can prostate cancer be found before a man has symptoms?
- How reliable are the screening tests for prostate cancer?
- How is prostate cancer diagnosed?
- How is localized prostate cancer treated?
- How does a patient decide what is the best treatment option for localized prostate cancer?
- Where can a person find more information about prostate cancer and its treatment?
What is the prostate?
The prostate is a gland in the male reproductive system. The prostate makes and stores a component of semen and is located in the pelvis, under the bladder and in front of the rectum. The prostate surrounds part of the urethra, the tube that empties urine from the bladder. A healthy prostate is about the size of a walnut. Because of the prostate's location, the flow of urine can be slowed or stopped if the prostate grows too large.
What is prostate cancer?
Prostate cancer forms in the tissues of the prostate. Except for skin cancer, cancer of the prostate is the most common malignancy in American men. It is estimated that 218,890 men in the United States will be diagnosed with prostate cancer in 2007. In most men with prostate cancer, the disease grows very slowly. The majority of men with low-grade, early prostate cancer (which means that cancer cells have been found only in the prostate gland) live a long time after their diagnosis. Even without treatment, many of these men will not die of the prostate cancer, but rather will live with it until they eventually die of some other, unrelated cause. Nevertheless, it is estimated that nearly 27,000 men will die from prostate cancer in 2007.
Who is at risk for prostate cancer?
An important risk factor is age; more than 70 percent of men diagnosed with this disease are over the age of 65. African American men have a substantially higher risk of prostate cancer than white men, including Hispanic men. Dramatic differences in the incidence of prostate cancer are also seen in different populations around the world. There is some evidence that dietary factors are involved, such as vitamin E and selenium, which may have a protective effect. Genetic factors also appear to play a role, particularly for families in which the diagnosis is made in men under age 60. The risk of prostate cancer rises with the number of close relatives who have the disease.
What are the symptoms of prostate cancer?
Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include:
- Urinary problems:
- Not being able to urinate.
- Having a hard time starting or stopping the urine flow.
- Needing to urinate often, especially at night.
- Weak flow of urine.
- Urine flow that starts and stops.
- Pain or burning during urination.
- Difficulty having an erection.
- Blood in the urine or semen.
- Frequent pain in the lower back, hips, or upper thighs.
These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.
What other prostate conditions can cause symptoms like these?
As men get older, their prostate may grow bigger and block the flow of urine or interfere with sexual function. This common condition, called benign prostatic hyperplasia (BPH), is not cancer, but can cause many of the same symptoms as prostate cancer. Although BPH may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. An infection or inflammation of the prostate, called prostatitis, may also cause many of the same symptoms as prostate cancer. Again, it is important to check with a doctor.
Can prostate cancer be found before a man has symptoms?
Yes. Two tests can be used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate-specific antigen (PSA). Together, these tests can detect many "silent" prostate cancers that have not caused symptoms. Due to the widespread implementation of PSA testing in the United States, approximately 90 percent of all prostate cancers are currently diagnosed at an early stage, and, consequently, men are surviving longer after diagnosis.
At present, however, it is not known whether routine prostate screening saves lives. Screening is a term used to describe tests when they are done in individuals who are not experiencing any symptoms. The benefits of screening and local therapy (surgery or radiation) remain unclear for many patients. Because of this uncertainty, the National Cancer Institute (NCI), a part of the National Institutes of Health, is currently supporting research to learn more about screening men for prostate cancer. Currently, researchers are conducting a large study to determine whether screening men using a blood test for PSA and a DRE can help reduce the death rate from this disease. They are also assessing the risks of screening. Full results from this study, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), are expected by 2015.
IMAGESBrowse through our medical image collection to see illustrations of human anatomy and physiology See Images
How reliable are the screening tests for prostate cancer?
Neither of the screening tests for prostate cancer is perfect. Most men with mildly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the DRE can miss many prostate cancers. The DRE and PSA test together are better than either test alone in detecting prostate cancer.
A recent study examining the PSA histories of men enrolled in the Baltimore Longitudinal Study of Aging (BLSA) suggests that PSA velocity may be a better indicator of potentially life-threatening cancer than PSA level. PSA velocity is the rate at which serum PSA levels change over time. The study found that men who had a PSA velocity above 0.35 ng/ml per year had a higher relative risk of dying from prostate cancer than men who had a PSA velocity less than 0.35 ng/ml per year. More studies are needed to determine if PSA velocity more accurately detects potentially life-threatening prostate cancer early.
The NCI Early Detection Research Network (EDRN) has a Prostate Collaborative Group, which is applying a variety of strategies to find better ways to detect prostate cancer early. In addition, the NCI's prostate cancer Specialized Program of Research Excellence (SPORE) program is funding projects to identify new biomarkers to detect prostate cancer.
How is prostate cancer diagnosed?
The diagnosis of prostate cancer can be confirmed only by a biopsy. During a biopsy, a urologist (a doctor who specializes in diseases of urinary and sex organs in men, and urinary organs in women) removes tissue samples, usually with a needle. This is generally done in the doctor's office with local anesthesia. Then a pathologist (a doctor who identifies diseases by studying tissues under a microscope) checks for cancer cells.
Men may have blood tests to see if the cancer has spread. Some men also may need the following imaging tests:
- Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. Doctors often use CT scans to see the pelvis or abdomen.
- MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside the body.
Prostate cancer is described by both grade and stage.
- Grade describes how closely the tumor resembles normal prostate tissue. Based on the microscopic appearance of tumor tissue, pathologists may describe it as low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. In both systems, the higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.
- Stage refers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland and may be in the seminal vesicles. Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to other tissues or organs.
Latest Cancer News
How is localized prostate cancer treated?
Three treatment options are generally accepted for men with localized prostate cancer: radical prostatectomy, radiation therapy (with or without hormonal therapy), and surveillance (also called watchful waiting).
- Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection. However, nerve-sparing surgery is not always possible.
- Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered in a technique known as brachytherapy, which involves implanting radioactive seeds in the prostate using a needle. Patients with high-risk prostate cancer are candidates for adding hormonal therapy to standard radiation therapy.
- Active surveillance (watchful waiting) may be an option recommended for patients with early-stage prostate cancer, particularly those who have low-grade tumors with only a small amount of cancer seen in the biopsy specimen. These patients have regular examinations, PSA testing, and sometimes scheduled biopsies. If there is evidence of cancer growth, active treatment may be recommended. Older patients and those with serious medical problems may also be good candidates for active surveillance.
How does a patient decide what is the best treatment option for localized prostate cancer?
Choosing a treatment option involves the patient, his family,
and one or more doctors. They will need to consider the grade and stage of the
cancer, the man's age and health, and his values and feelings about the
potential benefits and harm of each treatment option. Since both surgery and
radiation therapy are options for localized disease, consultation with both a
urologist and a radiation oncologist is recommended. Often it is useful to seek
Where can a person find more information about prostate cancer and its treatment?
The NCI has several other resources that readers may find helpful, including the following:
- The Prostate Cancer home page provides links to NCI resources about
prevention, screening, treatment, clinical trials, and supportive care for this
type of cancer. This page can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/
types/prostate on the Internet.
- Prostate Cancer (PDQ®): Treatment includes information about prostate cancer treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. This summary of information from PDQ, the NCI's comprehensive cancer information database, is available at http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient/ on the Internet.
- Treatment Choices for Men With Early-Stage Prostate Cancer describes the treatment choices available to men diagnosed with early-stage prostate cancer and examines the pros and cons of each treatment. This NCI fact sheet is available at http://www.cancer.gov/cancertopics/prostate-cancer-treatment-choices on the Internet.
Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2004. Bethesda, MD: National Cancer Institute, 2007.
Carter HB, Ferrucci L, Kettermann A, et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. Journal of the National Cancer Institute 2006; 98(21):1521-1527.
Source: U.S. National Institutes of Health, National Cancer Institute, http://www.cancer.gov
Health Solutions From Our Sponsors
Top Prostate Cancer Related Articles
Enlarged Prostate (BPH, Benign Prostatic Hyperplasia)Benign prostatic hyperplasia (BPH or enlarged prostate) is very common in men over 50 years of age. Half of all men over the age of 50 develop symptoms of BPH, but few need medical treatment. This noncancerous enlargement of the prostate can impede urine flow, slow the flow of urine, create the urge to urinate frequently and cause other symptoms like complete blockage of urine and urinary tract infections. More serious symptoms are urinary tract infections (UTIs) and complete blockage of the urethra, which may be a medical emergency. BPH is not cancer. Not all men with the condition need treatment, and usually is closely monitored if no symptoms are present. Treatment measures usually are reserved for men with significant symptoms, and can include medications, surgery, microwave therapy, and laser procedures. Men can prevent prostate problems by having regular medical checkups that include a prostate exam.
Blood in Urine (Causes, Pain, and Treatment in Men and Women)
Blood in the urine is termed hematuria. Hematuria, whether it be gross or microscopic, is abnormal and should be further investigated.
Cancer Risk FactorsThough it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Screening Tests for CancerCancer detection are methods used to find cancer in persons who may or may not have symptoms. Symptoms of cancer are abnormal sensations or conditions that persons can notice that are a result of the cancer. It is important to your doctor for regular checkups and not wait for problems to occur.
Cancer-Fighting FoodsExperts have praised certain foods for their ability to reduce cancer risks. Learn which foods and eating strategies may help reduce your risk of developing cancer.
CT Scan (Computerized Tomography)A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Clinical TrialsClinical trials are a form of clinical research that follow a defined protocol that has been carefully developed to evaluate a clinical question. Clinical research is a type of study of clinical or biomedical questions through the use of human subjects. Clinical trials are divided into five types:
- Treatment trials
- Prevention trials
- Diagnostic trials
- Screening trials
- Quality of life trials
Erectile Dysfunction (ED, Impotence)Erectile dysfunction (ED, impotence) is the failure to achieve or maintain an erection. There are many potential underlying causes of erectile dysfunction, including stress and emotional problems, brain dysfunction, problems with blood supply to the penis, and structural problems with the penis.
Men's Cancer SymptomsSee pictures of which 15 cancer symptoms men ignore such as skin changes, difficulty swallowing, rapid weight loss, a breast mass, and more. Learn possible clues to finding and detecting cancer early.
19 Health Problems in Men: Snoring, Hair Loss, and MoreWhat are the biggest body health issues that plague men? Most men struggle with belly fat, back hair, sweating, erectile dysfunction, hair loss, body odor, or bad breath at some point. Get tips on dealing with male body problems and the prevention of common issues in men's health.
Men's Screening TestsGetting the right screening test at the right time is one of the most important things a man can do for his health. Learn at what age men should be screened for prostate cancer, high blood pressure, cholesterol and other health risks.
ObesityObesity is the state of being well above one's normal weight. A person has traditionally been considered to be obese if they are more than 20% over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.
Prostate Cancer QuizIs prostate cancer the most common cancer in men? Take this quiz to find out and learn the causes, symptoms and treatments of this disease.
Illustrations of ProstateSide View of the Prostate. The prostate is a walnut-sized gland located between the bladder and the penis. See a picture of the Prostate and learn more about the health topic.
Questions To Ask Before SurgerySurgery is the branch of medicine that employs operations in the treatment of disease or injury. Prior to surgery you might consider asking your surgeon questions about the operation (procedure).
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
- heart valve irregularities,
- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
- diseases of the male reproductive organs.