Prostate cancer forms in tissues of the prostate gland, which is a small, walnut-sized structure that makes up part of a man's reproductive system. The prostate wraps around the urethra, the tube that carries urine out of the body and is found below the bladder and in front of the rectum.
Prostate cancer usually occurs in older men. It is the third most common cause of death from cancer in men of all ages and is the most common cancer cause of death in men over age 75. Prostate cancer is rarely found in men younger than 40.
A common problem in almost all men as they grow older is an enlarged prostate (benign prostatic hyperplasia, or BPH). This problem does not raise the risk of prostate cancer.
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; however, most of the time these symptoms are caused by other non-cancerous 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)
A prostate biopsy is the only test that can confirm the diagnosis. Tissue from the prostate is viewed underneath a microscope. Biopsy results are reported using something called a Gleason grade and a Gleason score.
The Gleason grade is how aggressive the prostate cancer might be. It grades tumors on a scale of 1 - 5, based on how different from normal tissue the cells are.
Often, more than one Gleason grade is present within the same tissue sample. The Gleason grade is therefore used to create a Gleason score by adding the two most predominant grades together (a scale of 2 - 10). The higher the Gleason score, the more likely the cancer has spread beyond the prostate gland:
- Scores 2 - 4:Low-grade cancer
- Scores 5 - 7:Intermediate- grade cancer. Most prostate cancers fall into this category.
- Scores 8 - 10:High-grade cancer (poorly-differentiated cells)
There are two reasons your doctor may perform a prostate biopsy:
- Your PSA blood test is high.
- A rectal exam may show a large prostate or a hard, irregular surface. Because of PSA testing, prostate cancer is diagnosed during a rectal exam much less often.
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).
The following tests may be done to determine whether the cancer has spread:
The best treatment for your prostate cancer may not always be clear. Sometimes, the doctor recommends one treatment because of what is known about the type of cancer and risk factors. Other times, the doctor will talk about two or more treatments that could be good.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance. Problems with urine control are common after surgery and radiation therapy. These problems may either improve over time or get worse, depending on the treatment.
SurgerySurgery is usually only recommended after a thorough evaluation and discussion of the benefits and risks of the procedure.
- Surgery to remove the prostate and some of the tissue around it is an option when the cancer has not spread beyond the prostate gland. This surgery is called radical prostatectomy. It can also be done with robotic surgery.
- Possible problems after the surgeries include difficulty controlling urine or bowel movements and erection problems.
Radiation TherapyRadiation therapy uses high-powered X-rays or radioactive seeds to kill cancer cells.
Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used for pain relief when cancer has spread to the bone.
External beam radiation therapy uses high-powered X-rays pointed at the prostate gland.
- Treatment is done as an out-patient five days a week in a radiation oncology center usually connected to a hospital. The therapy lasts for six-eight weeks.
- The radiation is delivered to the prostate gland using a device that looks like a normal X-ray machine. The treatment itself is generally painless.
- Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions, rectal burning or injury, diarrhea, bladder urgency, and blood in urine.
Prostate brachytherapy involves placing radioactive seeds inside the prostate gland.
- A surgeon inserts small needles through the skin behind the scrotum to inject the seeds. The seeds are so small that they aren’t felt. They can be temporary or permanent.
- Brachytherapy is often used for men with smaller prostate cancer that is found early and is slow-growing.
- Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.
Proton therapy is another kind of radiation used to treat prostate cancer. Doctors aim proton beams onto a tumor, so there is less damage to the surrounding tissue.
Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is any treatment that decreases the effect of testosterone on prostate cancer. These treatments can prevent further growth and spread of cancer. Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms. There are two types of drugs used for hormone therapy.
The primary type is called a luteinizing hormone-releasing hormones (LH-RH) agonist:
- These medicines block the body from making testosterone. The drugs must be given by injection, usually every 3 - 6 months.
- They include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix.
- Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, decreased muscle mass, weight gain, and impotence.
The other medications used are called androgen-blocking drugs.
- They are often given along with the above drugs.
- They include flutamide, bicalutamide, and nilutamide.
- Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
Much of the body's testosterone is made by the testes. As a result, removal of the testes (called orchiectomy) can also be used as a hormonal treatment. This surgery is not done very often. Chemotherapy and immunotherapy are used to treat prostate cancers that no longer respond to hormone treatment. An oncology specialist will usually recommend a single drug or a combination of drugs.
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 serial PSA blood tests (usually every three months to one year).
The outcome varies greatly. It is mostly affected by 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 with prostate cancer that has not spread can be cured, as well as some patients whose cancer has not spread very much outside the prostate gland.
Even for patients who cannot be cured, hormone treatment can extend their life by many years.