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.

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.