Prostate Cancer:

Prostate Anatomy

The prostate gland, approximately the size of a large walnut, is located behind the base of the penis, above the rectum and below the bladder. Its purpose is to secrete components of semen.

Although prostate cancer is the second leading cause of death in men, if caught in the early stages, the 5-year survival rate is extremely good. As a result, significant research has been done into new and more innovative ways to treat this disease.

Things to know

Prostate cancer means that cancer cells form in the tissues of the prostate. It is the most common cancer in American men after skin cancer.

Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread ( metastasize ) throughout the body. By the time symptoms appear, the cancer may be more advanced.

By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancerous cells are present. More than half of all American men have some cancer in their prostate glands by the age of 80.

Most of these cancers never pose a problem. They either give no signs or symptoms or never become a serious threat to health.

A much smaller percentage of men are actually treated for prostate cancer. Most men with prostate cancer do not die from this disease.

  • About 16 percent of American men are diagnosed with prostate cancer at some point in their lives.

  • Eight percent have serious symptoms.

  • Three percent die of the disease.

Symptoms

Prostate cancer can sit quietly for years. That means most men with the disease have no obvious symptoms. When symptoms finally appear, they may be a lot like the symptoms of BPH.

Prostate Cancer Symptoms

• Trouble passing urine
• Frequent urge to pass urine, especially at night
• Weak or interrupted urine stream
• Pain or burning when passing urine
• Blood in the urine or semen
• Painful ejaculation
• Nagging pain in the back, hips, or pelvis

Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be another symptom.

Risk factors

There are some risk factors linked to prostate cancer. A risk factor is something that can raise your chances of having a problem or disease. Having one or more risk factors doesn't mean that you will get prostate cancer. It just means that your risk of disease is greater.

  • Age. Being 50 or older increases risk of prostate cancer.

  • Race . African-American men are at highest risk of prostate cancer—it tends to start at younger ages and grows faster than in men of other races. After African-American men, it is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer. Aside from race, all men can have other prostate cancer risk factors (aging, family history, and diet). See the For More Information section to request the booklet about African-American men and prostate cancer screening

  • Family history. Prostate cancer risk is 2 to 3 times higher for men whose fathers or brothers have had the disease. For example, risk is about 10 times higher for a man who has 3 immediate family members with prostate cancer. The younger a man is when he has prostate cancer, the greater the risk for his male family members. Prostate cancer risk also appears to be slightly higher for men whose mothers or sisters have had breast cancer.

  • Diet. The risk of prostate cancer seems to be higher for men eating high-fat diets with few fruits and vegetables

Prostate Cancer Staging

Prostate cancer tumors are staged to determine how far the cancer has spread.

Stage T1 is prostate cancer in its earliest stage. Cancer is confined to the prostate gland and the patient rarely experiences any symptoms of disease.

At stage T2, cancer is still localized in the prostate gland and is usually in the form of a small to large, hard nodule.

A stage T3 tumor has spread outside the gland to surrounding tissues, including the seminal vesicles.

Stage T4 prostate cancer has spread outside the gland to other tissues and perhaps other organs, such as the bladder or even the lungs, liver or bone

PSA Testing

A PSA (Prostate Specific Antigen) test is an important diagnostic tool for detecting a chemical which could signify the presence of prostate cancer. When the PSA result is elevated or abnormally high, a patient typically undergoes a prostate biopsy under ultrasound to establish a definitive diagnosis.

PSA RESULT

0 -4

Normal

4 -10

Slightly Elevated

10+

Abnormally Elevated

In men younger than 5O, a PSA greater than 2.5 is considered elevated.

Gleason Scores

The Gleason test is a grading scale that helps the physician determine how aggressive a patient's cancer is. Tissue removed from the prostate during biopsy is examined microscopically and graded. The higher the Gleason score, the more aggressive the cancer.

Gleason

Grade

2 -4

Low Aggressiveness

5 - 6

Moderate Aggressiveness

7 - 10

High Aggressiveness

Current Treatment Options

Brachytherapy

Also known as "interstitial radiation," brachytherapy is the permanent implanting of radioactive "seeds" into the prostate gland. Brachytherapy delivers a prescribed dose of radiation directly to the cancer cells while decreasing the risk of radiating surrounding tissues or organs. The seeds are usually permanently implanted, where the radiation dissipates over time. Brachytherapy may be done alone or in combination with external beam radiation and/or hormonal therapy. Generally, it is an outpatient procedure. Some patients experience irritative voiding symptoms for a few days or months after implantation.

X-ray of the pelvis after Palladium -103 implant

X-ray of the pelvis after Palladium -103 implant

Surgery

Radical prostatectomy is the surgical removal of the prostate gland, and unlike brachytherapy, which is an outpatient procedure, surgery typically involves a hospital stay of several days. The two most common side effects of this surgery are loss of bladder control (incontinence) and the inability to maintain an erection (impotence).

External Radiation

This treatment involves the use of high-energy X-rays directed at the prostate gland, and normally requires treatment 5 days per week for 6 to 8 weeks. Side effects may include complications such as problems with urination and impotence, as well as radiation injury to the bowel.

Hormone Therapy

The purpose of this treatment is to lower the levels of testosterone (male hormone) which slows the growth of cancerous cells over a period of time. Under certain circumstances, hormones may be used in combination with brachytherapy to shrink the prostate and the tumor.

Watchful Waiting

Since many prostate cancers are slow-growing, a physician may recommend close observation for a period of time without any active treatment, during which the tumor's progress is carefully monitored.

Prostate Cancer Screening

Screening means testing for cancer before you have any symptoms. A screening test can often help find cancer at an early stage. When found early, cancer is less likely to have spread and may be easier to treat. By the time symptoms appear, the cancer may have started to spread. Remember, even if your doctor suggests prostate cancer screening, this doesn't necessarily mean that you have cancer.

Screening tests are most useful when they have been proven to find cancer early and lower a person's chance of dying from cancer. For prostate cancer, doctors don't yet know these answers and more research is being done.

  • Large research studies, with thousands of men, are going on now to study prostate cancer screening. The National Cancer Institute is studying the combination of PSA testing and DRE as a way to get more accurate results

  • Some cancers never cause symptoms or become life- threatening. If they are found by a screening test, the cancer may then be treated. For prostate cancer in its early stages, it isn't known whether treatment would help you live longer than if no treatment were given when a screening test detects prostate cancer.

Talk with your doctor about your risk of prostate cancer and your need for screening tests.

Can prostate cancer be prevented?

National research studies are looking at how prostate cancer can be prevented. There is some proof that the drug finasteride lowers your risk of getting prostate cancer, but whether it decreases the risk of dying of prostate cancer is still unclear.

Support Groups

US TOO International, Inc.
930 N. York Rd., Suite 50
Hinsdale, IL 60521
Telephone: 630/323-1002; Fax: 630/323-1003
Toll-Free Hotline: 800/80-US-TOO
(800-808-7866)

Man-To-Man
Contact your local American Cancer Society Office or call 1-800-ACS-2345 for more information about this program.

Web Sites

The American Cancer Society
www.cancer.org

National Cancer Institute
www.nci.nih.gov

University of Pennsylvania
www.oncolink.upenn.edu

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