Prostate cancer

Cancer - prostate; Biopsy - prostate; Prostate biopsy; Gleason score

Last reviewed: September 19, 2011.

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Causes, incidence, and risk factors

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

People who are at higher risk include:

• African-American men, who are also likely to develop cancer at every age
• Men who are older than 60
• Men who have a father or brother with prostate cancer

Other people at risk include:

• Men who have been around agent orange
• Men who use too much alcohol
• Farmers
• Men who eat a diet high in fat, especially animal fat
• Tire plant workers
• Painters
• Men who have been around cadmium

Prostate cancer is less common in people who do not eat meat (vegetarians).

A common problem in almost all men as they grow older is an enlarged prostate. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk of prostate cancer. However, it can increase your PSA blood test results.

Symptoms

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms.

The symptoms listed below can occur with prostate cancer, usually at a late stage. These symptoms can also be caused by other prostate problems:

• Delayed or slowed start of urinary stream
• Dribbling or leakage of urine, most often after urinating
• Slow urinary stream
• Straining when urinating, or not being able to empty out all of the urine
• Blood in the urine or semen
• Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)

Signs and tests

A biopsy is needed to tell if you have prostate cancer. A sample of tissue is removed from the prostate and sent to a lab.

Your doctor may recommend a prostate biopsy if:

• You have high PSA level
• A rectal exam shows a large prostate or a hard, uneven surface

The results are reported using what is called a Gleason grade and a Gleason score.

The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 - 5. You may have different grades of cancer in one biopsy sample. The two main grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer is to have spread past the prostate:

• Scores 2 - 5: Low-grade prostate cancer
• Scores 6 - 7: Intermediate- (or in the middle-) grade cancer. Most prostate cancers fall into this group.
• Scores 8 - 10: High-grade cancer

The following tests may be done to determine whether the cancer has spread:

• CT scan
• Bone scan

The PSA blood test will also be used to monitor your cancer after treatment. Often, PSA levels will begin to rise before there are any symptoms. An abnormal digital rectal exam may be the only sign of prostate cancer (even if the PSA is normal).

Treatment

Treatment depends on many things, including your Gleason score and your overall health. Your doctor will discuss your treatment options.

For early-stage prostate cancer, this may include:

• Surgery (radical prostatectomy)
• Radiation therapy, including brachytherapy and proton therapy

If you are older, your doctor may recommend simply monitoring the cancer with PSA tests and biopsies.

If the prostate cancer has spread, treatment may include:

• Hormone therapy (medicines to reduce testosterone levels)
• Surgery
• Chemotherapy

Surgery, radiation therapy, and hormone therapy can affect your sexual desire or performance. Problems with urine control are common after surgery and radiation therapy. Discuss your concerns with your health care provider.

After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including PSA blood tests (usually every 3 months to 1 year).

See also:

• Prostate cancer - stages
• Prostate radiation - discharge

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems. See: Support group - prostate cancer

Expectations (prognosis)

How well you do depends on whether the cancer has spread outside the prostate gland and how abnormal the cancer cells are (the Gleason score) when you are diagnosed.

Many patients can be cured if their prostate cancer has not spread. Some patients whose cancer has not spread very much outside the prostate gland can also be cured.

Hormone treatment can improve survival, even in patients who cannot be cured.

Complications

The complications of prostate cancer are mostly due to different treatments.

Calling your health care provider

Discuss the advantages and disadvantages to PSA screening with your health care provider.

Prevention

You may lower your risk of prostate cancer by eating a diet that is:

• High in omega-3 fatty acids
• Low-fat
• Similar to the traditional Japanese diet
• Vegetarian

Finasteride (Proscar, generic) and dutasteride (Avodart) are drugs used to treat prostate enlargement (benign prostatic hyperplasia, or BPH). If you do not have prostate cancer and your PSA score is 3.0 or lower, ask your health care provider about the pros and cons of taking these drugs to prevent prostate cancer.

Cancer

Carcinoma; Malignant tumor

Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.

Causes, incidence, and risk factors

Cancer grows out of normal cells in the body. Normal cells multiply when the body needs them, and die when the body doesn't need them. Cancer appears to occur when the growth of cells in the body is out of control and cells divide too quickly. It can also occur when cells forget how to die.

There are many different kinds of cancer. Cancer can develop in almost any organ or tissue, such as the lung, colon, breast, skin, bones, or nerve tissue.

There are many causes of cancer, including:

• Benzene and other chemicals
• Drinking excess alcohol
• Environmental toxins, such as certain poisonous mushrooms and a type of poison that can grow on peanut plants (aflatoxins)
• Excessive sunlight exposure
• Genetic problems
• Obesity
• Radiation
• Viruses

However, the cause of many cancers remains unknown.

The most common cause of cancer-related death is lung cancer.

The three most common cancers in men in the United States are:

• Prostate cancer
• Lung cancer
• Colon cancer

In women in the United States, the three most common cancers are:

• Breast cancer
• Colon cancer
• Lung cancer

Some cancers are more common in certain parts of the world. For example, in Japan, there are many cases ofstomach cancer, but in the United States, this type of cancer is unusual. Differences in diet or environmental factors may play a role.

Some other types of cancers include:

• Brain cancer
• Cervical cancer
• Hodgkin's lymphoma
• Kidney cancer
• Leukemia
• Liver cancer
• Non-Hodgkin's lymphoma
• Ovarian cancer
• Skin cancer
• Testicular cancer
• Thyroid cancer
• Uterine cancer

Symptoms

Symptoms of cancer depend on the type and location of the cancer. For example, lung cancer can causecoughing, shortness of breath, or chest pain. Colon cancer often causes diarrhea, constipation, and blood in the stool.

Some cancers may not have any symptoms at all. In certain cancers, such as pancreatic cancer, symptoms often do not start until the disease has reached an advanced stage.

The following symptoms can occur with most cancers:

• Chills
• Fatigue
• Fever
• Loss of appetite
• Malaise
• Night sweats
• Weight loss

Signs and tests

Like symptoms, the signs of cancer vary based on the type and location of the tumor. Common tests include the following:

• Biopsy of the tumor
• Blood tests (which look for chemicals such as tumor markers)
• Bone marrow biopsy (for lymphoma or leukemia)
• Chest x-ray
• Complete blood count (CBC)
• CT scan
• Liver function tests
• MRI scan

Most cancers are diagnosed by biopsy. Depending on the location of the tumor, the biopsy may be a simple procedure or a serious operation. Most patients with cancer have CT scans to determine the exact location and size of the tumor or tumors.

A cancer diagnosis is difficult to cope with. It is important, however, that you discuss the type, size, and location of the cancer with your doctor when you are diagnosed. You also will want to ask about treatment options, along with their benefits and risks.

It's a good idea to have someone with you at the doctor's office to help you get through the diagnosis. If you have trouble asking questions after hearing about your diagnosis, the person you bring with you can ask them for you.

Treatment

Treatment varies based on the type of cancer and its stage. The stage of a cancer refers to how much it has grown and whether the tumor has spread from its original location.

• If the cancer is confined to one location and has not spread, the most common treatment approach is surgery to cure the cancer. This is often the case with skin cancers, as well as cancers of the lung, breast, and colon.
• If the tumor has spread to local lymph nodes only, sometimes these can be removed.
• If surgery cannot remove all of the cancer, the options for treatment include radiation, chemotherapy, or both. Some cancers require a combination of surgery, radiation, and chemotherapy.
• Lymphoma, or cancer of the lymph glands, is rarely treated with surgery. Chemotherapy and radiation therapy are most often used to treat lymphoma.

Although treatment for cancer can be difficult, there are many ways to keep up your strength.

If you have radiation treatment, know that:

• Radiation treatment is painless.
• Treatment is usually scheduled every weekday.
• You should allow 30 minutes for each treatment session, although the treatment itself usually takes only a few minutes.
• You should get plenty of rest and eat a well-balanced diet during the course of your radiation therapy.
• Skin in the treated area may become sensitive and easily irritated.
• Side effects of radiation treatment are usually temporary. They vary depending on the area of the body that is being treated.

If you are going through chemotherapy, you should eat right. Chemotherapy causes your immune system to weaken, so you should avoid people with colds or the flu. You should also get plenty of rest, and don't feel as though you have to accomplish tasks all at once.

It will help you to talk with family, friends, or a support group about your feelings. Work with your health care providers throughout your treatment. Helping yourself can make you feel more in control.

Support Groups

The diagnosis and treatment of cancer often causes a lot of anxiety and can affect a person's entire life. There are many resources for cancer patients.

See: Cancer resources

Expectations (prognosis)

The outlook depends on the type of cancer and the stage of the cancerr when diagnosed.  

Some cancers can be cured. Other cancers that are not curable can still be treated effectively. Some patients can live for many years with cancer. Other tumors are quickly life threatening.

Complications

Complications depend on the type and stage of cancer. The cancer may spread.

Calling your health care provider

Contact your health care provider if you develop symptoms of cancer.

Prevention

You can reduce the risk of getting a cancerous (malignant) tumor by:

• Eating a healthy diet
• Exercising regularly
• Limiting alcohol
• Maintaining a healthy weight
• Minimizing your exposure to radiation and toxic chemicals
• Not smoking or chewing tobacco
• Reducing sun exposure, especially if you burn easily

Cancer screenings, such as mammography and breast examination for breast cancer and colonoscopy for colon cancer, may help catch these cancers at their early stages when they are most treatable. Some people at high risk for developing certain cancers can take medication to reduce their risk.