Prostate Cancer

Prostate cancer is the second most common type of cancer among American men, second only to skin cancer. In the United States, more than 2 million men have had prostate cancer and more than 233,000 men are diagnosed with the disease each year.

The prostate is a walnut-sized organ that helps in the production of semen. It is located just below the bladder, in front of the rectum.

Prostate cancer occurs when cells in the prostate grow abnormally, multiplying without control and forming a mass or a tumor in the prostate gland. In most men diagnosed with prostate cancer, the tumor is only in the prostate, and has not spread to other parts of the body. There are different treatments available depending on whether the cancer is only in the prostate or if it has spread to other parts of the body. If you have been diagnosed with prostate cancer, it is important to learn as much as possible about your diagnosis and to talk with your doctor to find the treatment option that is right for you. If your cancer spreads to the bone, this is called bone metastases.

Risk Factors

There are several factors that can increase your risk of prostate cancer. Speak with your doctor if you believe you may be at risk for developing prostate cancer. Common risk factors include:

• Age - Most men with prostate cancer are over 65; the disease is rare in men under 45.
• Family History - A person is more likely to get prostate cancer if his father, brother or son had prostate cancer.
• Race - Prostate cancer is more common among black men than white or Hispanic/Latino men. It’s least common among Asian American/Pacific Islander and American Indian/Alaska Native men.
• Prostate changes - Men with high-grade Prostatic Intraepithelial Neoplasia (PIN), an abnormal cell condition, may be at increased risk of prostate cancer.

Signs and Symptoms

Men are often diagnosed with prostate cancer following a digital rectal exam (DRE) or a Prostate-Specific Antigen (PSA) Test. Early prostate cancer usually causes no symptoms. Advanced prostate cancer can cause symptoms such as:

• Weak urine stream
• Blood in urine or semen
• Swelling in the legs
• Discomfort or evidence of swollen lymph nodes in the pelvic area
• Bone pain
• Weight loss
• Tiredness

If you experience any of these symptoms, speak with your doctor right away. If your primary care doctor determines that you have prostate cancer, ask to be referred to a specialist in medical oncology, radiation oncology and/or urology for confirmation of your diagnosis and next steps.

In order to diagnose prostate cancer, your doctor will perform a physical exam, and may order additional tests including one or more of the following:

• Transrectal ultrasound - A doctor inserts a probe into the rectum. The probe uses sound waves to look for abnormal growth in the prostate.
• Biopsy - A doctor uses a needle inserted through the rectum to remove small tissue samples, called cores, from several areas of the prostate. A pathologist looks at the samples under a microscope to check for cancer cells.
• Digital rectal exam (DRE) - As part of the DRE, the doctor uses a lubricated, gloved finger inserted into the rectum to feel the prostate. This test is often performed to screen for prostate cancer or if a man has symptoms of an enlarged prostate.
• Prostate-specific antigen (PSA) blood test - This blood test checks levels of PSA (prostate-specific antigen) in the blood. The prostate makes PSA, and a high level in the blood could be caused by cancer. This blood test is often used to screen for prostate cancer and evaluate response to treatment.
• Imaging scans - Scans such as a bone scan, ultrasound, CT scan or MRI are used to determine how far the cancer has spread. There are also new PET scans that are sometimes used.

Stages of Prostate Cancer

If prostate cancer is diagnosed, the doctor needs to determine the stage, or extent, of the cancer to plan the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body.

• Stage I: The cancer cannot be felt during a digital rectal exam or seen on a sonogram. It is found through a prostate biopsy or during surgery for another reason. The cancer is only in the prostate.
• Stage II: The tumor is more advanced or a higher grade than stage I, but the tumor is only in the prostate. It may be felt during a digital rectal exam or seen on a sonogram.
• Stage III: The tumor extends beyond the prostate wall. The tumor may have invaded the seminal vesicles, which sit on top of the prostate, but cancer cells have not spread to the lymph nodes.
• Stage IV: The tumor may have invaded the bladder, rectum or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.

Grades and Scores

As part of the staging process, a pathologist will assign a score to the prostate cancer based on how the cancer cells look under a microscope. Pathologists score prostate cancer according to the Gleason grade. The Gleason score indicates how aggressive the prostate cancer appears to be. A higher number means that the cancer is more aggressive and more likely to spread. The Gleason score is determined by adding the two most common grades seen in a sample by the pathologist. Grades range from 3 (least aggressive) to 5 (most aggressive) and scores range from 6 (least aggressive) to 10 (most aggressive).

• A Gleason score of 6 is often considered low risk prostate cancer
• A Gleason score of 7 is often considered intermediate risk prostate cancer
• A Gleason score of 8-10 is often considered high risk prostate cancer

Grade Group is a score from 1 to 5 that may also be assigned based on your Gleason grade; grade group 1 is Gleason grade 3+3=6, grade group 2 is Gleason grade 3+4=7, grade group 3 is Gleason grade 4+3=7, grade group 4 is Gleason grade 4+4=8, grade group 5 is any Gleason score of 9-10.

Treatment for prostate cancer depends on the stage of the cancer, the grade of the tumor, the person’s age, the number of biopsy samples that contain cancer cells, and the person’s overall health and symptoms. It is important to talk with your doctor about treatment options before starting a treatment plan.

Treatment options include:

• Active surveillance
• Surgery
• Radiation therapy
• Hormone therapy
• Chemotherapy
• Immunotherapy
• Clinical trials
• Targeted therapy

Ask your doctor about the possible side effects of treatment before you begin so you will know what to expect. When you know more, you can work with your health care team to improve your quality of life during and after treatment.

Everyone reacts differently to treatment and experiences side effects differently. Always tell a member of your health care team about any uncomfortable problems you may be experiencing, such as erectile dysfunction, pain, nausea, fatigue, incontinence and bodily changes that affect your sense of self. These things are common and can be managed.

Follow-Up

Recovery after prostate cancer depends on the type of treatment, spread of disease and other factors. Follow-up care is important. Don’t be afraid to seek emotional support. Social workers and counselors who specialize in cancer are available to provide confidential help. Many hospitals offer free support groups, information, or connections to other men who’ve had similar experiences. Ask your doctor or nurse about resources in your area.