Prostate Cancer: The Basics
The prostate is a gland found only in men between the bladder and the penis. It secretes the fluid in semen. Prostate cancer is caused by prostate cells growing out of control. As the number of cells grow, they form into a tumor. It is often a slow-growing cancer, but if it grows quickly it can spread to the nearby lymph nodes and metastasize (spread) to other parts of the body, most often the bones. Prostate cancer that has spread from the prostate to another part of the body is called metastatic cancer.
Risk factors for developing prostate cancer include:
- Age over 60 (although men of any age can be diagnosed).
- African American ethnicity and Carribbean ethnicity with African ancestry.
- Eating a diet high in animal fat.
- Family history of prostate cancer.
- A digital rectal exam consists of a provider inserting a gloved, lubricated finger into a man’s anus to feel the prostate and check for any abnormalities.
- A prostate specific antigen test is a blood test that measures for a protein made by the prostate. The PSA level becomes elevated when prostate cancer is present. However, this protein can be elevated for other health reasons or not elevated in some cases of prostate cancer.
Men who wish to have screening should do so after talking with their healthcare provider about the risks and benefits of screening. Men at average risk for prostate cancer should have this talk starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 45. Men who have more than one relative (father and brother) with prostate cancer should talk with their healthcare provider beginning at age 40.
Signs & Symptoms of Prostate Cancer
The early stages of prostate cancer are most often found with PSA tests or digital rectal exams before they cause any symptoms. Some more advanced prostate cancers can cause symptoms such as:
- Trouble starting to urinate.
- Urinating more frequently than usual.
- The feeling that you can’t release all of your urine.
- Pain with urination or ejaculation.
- Blood in the urine or semen.
- Bone Pain.
Many of these symptoms can be caused by things other than prostate cancer, so having them doesn't always mean you have prostate cancer. If you have any of these symptoms, you should call your provider right away.
Diagnosis of Prostate Cancer
If your provider thinks you have prostate cancer, they will order tests including:
- Digital rectal exam.
- If your provider feels any abnormalities during a digital rectal exam and/or if your PSA level is elevated, you will need to have a biopsy of the prostate. This is done using a trans-rectal ultrasound. During this test, a thin ultrasound probe is put into the rectum and used to view the prostate. Any areas that look suspicious are sampled and sent to a lab to be examined by a pathologist.
The pathologist assigns a Gleason score, the scale used to grade prostate cancers. A pathology report summarizes these results and is sent to your healthcare provider, typically 5-10 days after the biopsy. This report is an important part of planning your treatment. You can request a copy of your report for your records.
Staging Prostate Cancer
To guide treatment, prostate cancer is "staged." The stages are based on:
- Size and location of the tumor.
- Whether cancer cells are found in the lymph nodes.
- Whether cancer cells are found in other areas of the body.
- PSA and histologic grade (G).
This information is combined to give a stage from 0-IV, with IV being the most advanced.
Prostate cancer can be treated in a number of ways. A second opinion can help you to learn more about your options. In many cases, you may have several good options for treatment. In that case, it is important to weigh the side effects and decide what option is best for you.
- Active Surveillance (Watchful Waiting): This is when a patient chooses to not receive active therapy, but is closely watched to see if the cancer grows.
- Surgery: Removal the entire prostate. The two surgical procedures are radical prostatectomy and robot-assisted radical prostatectomy. Surgery can also be used to relieve symptoms in advanced stage prostate cancers.
- Radiation: May be used in both early stage (to cure the cancer) and more advanced stage prostate cancer (to relieve symptoms). Both external beam therapy and brachytherapy may be used. External beam therapy can be done in two forms: x-ray and proton.
- Hormonal Deprivation Therapy: The hormone testosterone helps prostate cancer grow. By removing testosterone from the body, the cancer may shrink and/or grow more slowly. This can be done with medication or removal of one or both testicles.
- Chemotherapy: The use of chemotherapy is used for more advanced stages of prostate cancer that are no longer responsive to hormonal therapy.
- Targeted therapy: A type of treatment that attacks cancer cells, while largely leaving normal cells alone. Targeted therapies change how cancer cells grow and divide, and how they act within the body. Examples of targeted therapies for prostate cancer are Rucaparib and Olaparib. Both of these medications work when there is a mutation in either your BRCA1 or BRCA2 gene. Your provider will test you for this before treatment with these medications.
- Immunotherapy: Immunotherapy uses the immune system to fight cancer. Sipuleucel-T (Provenge) is a cancer vaccine immunotherapy used to treat metastatic prostate cancer that is no longer responding to hormonal treatments. Pembrolizumab is used to treat some prostate cancers.
This article is a basic guide to prostate cancer. You can learn more about prostate cancer and treatment by using the links below.