Prostate Cancer

Prostate cancer is the second most common cancer in American men, and is the second leading cause of cancer death in men. According to the American Cancer Society, more than 220,000 men are diagnosed with prostate cancer each year and approximately 1 in 7 men will be diagnosed with during their lifetime. Despite its prevalence, prostate cancer is easy to treat. Ninety-five percent of patients diagnosed with the disease are still alive fifteen years later.

What is Prostate Cancer?

Prostate cancer starts when cells in the prostate grow uncontrollably. The prostate is a walnut-sized gland located below the bladder and is unique to men. Its role is to produce fluid that protects semen and most prostate cancer begins in the cells that produce this fluid. Prostate cancer can also begin in the prostrate tubes or the flat cells covering the prostrate, but these are rare.

A majority of prostate cancers are slow-growing and low risk. Many can be safely monitored and require only minimal treatment. The risk of developing prostate cancer increases as patients get older, with 60 percent of cases occurring in men over 65.

Prostate Cancer Symptoms & Signs

Because the prostate is located at the base of the bladder, around the urethra, the most common symptom of prostate cancer is difficulty urinating. This may include:

  • An inability to start urinary flow
  • An inability to stop urinary flow
  • An inability to maintain a steady urine flow
  • A weak, dribbling urine flow
  • A need to urinate more frequently, especially at night
  • Pain or a burning sensation during urination

Men with prostate cancer may also experience problems getting an erection. They may experience pain when they ejaculate and their ejaculations may contain blood as well. Other prostate cancer signs include swelling in the legs or pelvis; pain or numbness in the legs, hips, or feet; and persistent bone pain.

Prostate Screening & Detection

Prostate cancer is one of the most difficult cancers to detect because often, in its early stages, it does not cause any symptoms. Most tumors appear inside the prostrate, away from the urethra, and it may be months or years before their effects become noticeable. Compounding this problem are medical conditions, such as prostatitis (enlarged prostate), that cause symptoms similar to prostate cancer. Urinary problems and erectile dysfunction are also a common side effect of aging, which makes identifying symptoms more difficult.

The best way to detect prostate cancer is with regular screenings designed to uncover evidence of cancer before symptoms start. Prostate-specific antigen blood tests and digital rectal exams (DRE) are the most common ways to screen for prostate cancer. Prostate MRI is also an emerging option that can aid in the detection and diagnosis of prostate cancer.

PSA Blood Test

Prostate-specific antigen (PSA) is a protein produced by the prostate gland. A PSA test measures the amount of PSA in the bloodstream using nanograms per milliliter (ng/mL). Elevated PSA levels are often associated with prostate cancer, but other conditions, such as prostate enlargement and infection, can elevate PSA levels as well.

Most doctors consider a PSA level of 4 ng/mL as normal. If a patient's levels are higher, the doctor may decide to inspect the prostate with a a transrectal ultrasound, x-rays, or cystoscopy. They may also order a urine test, to check for a urinary infection. If they still suspect prostate cancer, they’ll follow these tests with a biopsy, in order to examine the prostate's cells directly.

The American Cancer Society recommends men consider PSA screening at age 40, depending on their personal risk factors, such as age, race, or family history. 

Digital Rectal Exam

Digital rectal exams are used to check for problems in the pelvis and lower abdomen. Though they’re primary used to check the prostate, doctors occasionally perform DRE’s on women as well, to check their uterus and ovaries. During a DRE, a physician wearing a lubricated glove inserts one or two fingers into the rectum to manually inspects the prostate for bumps, hard spots, and other abnormalities. Doctors perform this test to not only check for cancer, but other potential prostrate problems as well, such as a tumor or prostate enlargement. For most men, a DRE is a part of their routine physical examinations.

Prostate MRI

During a prostate MRI, radiologists use magnetic fields, radio waves, and computers to create a detailed image of the prostate gland. The image can be used to search for cancer or diagnose a wide range of medical conditions, including congenital abnormalities, infections, or abscess.

Doctors recommend men age 40-70 receive regular prostate cancer screenings. Men over 70 may choose to continue screening, but some may feel that it is unnecessary due to the slow-growing nature of the disease. All men should discuss prostate cancer screenings with their doctors, especially if they’re high-risk based on their family history or other factors, such as age, genes, and diet. 

Prostate Cancer Staging

Doctors use a 4-part staging system to determine how far the cancer has spread and how aggressively it is growing. The system developed by the American Joint Committee on Cancer is the most widely used. It evaluates prostate cancer based using five factors:

  • The extent of tumor and how far it has spread within or beyond the prostate
  • Whether cancer cells have spread to surrounding lymph nodes
  • Whether cancer cells have spread to distant parts of the body
  • Levels of prostate specific-antigen, a protein developed by the prostate
  • The patient's Gleason Score, which determines how much the cancer cells resemble normal prostate cells under a microscope

Stage I prostate cancer cannot be detected using a physical exam or imaging technology. At this stage, the cancer is very small and growing very slowly. Stage II prostate cancer is still too small to be detected with a DRE or imaging, but the cells have a higher Gleason score and are dividing rapidly. In stage III, the cancer has spread beyond the outer layer of the prostate and may have infected the seminal vesicles or the lymph nodes.  In stage IV, the cancer has spread to other organs, such as the bladder, rectum, or liver.

Prostate Cancer Treatments

Patients with prostate cancer can sometimes live for many years without being affected by their disease, which makes treatment decisions difficult and highly personal. Factors that patients and their physicians should consider include:

  • Age
  • Overall health
  • Stage and grade
  • Personal values and lifestyle choices
  • Potential treatment outcomes and side effects

A growing number of treatment and disease management options are available to men with prostate cancer. These include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy.