Prostate cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 23, 2016
StartDiseasesProstate cancer

Prostate cancer is a disease which affects men and is the second leading cause of death for them in the United States. A great deal is known about this cancer, its treatments and its outcome. Knowing the facts about prostate cancer enables a man to understand what to look for and get tested and treated early, and this early intervention can be the key to curing this disease.

Contents

Definition & Facts

Prostate cancer is a cancer of the prostate gland, a small gland in men that, along with the testicles and seminal vesicles, is classified as a major sexual gland. The walnut-sized prostate is located behind the bladder and surrounds the urethra which transports semen and urine through the penis and then out of the body.

When irregular cells develop and become malignant in the prostate, they grow into a tumor in the gland, and then cells can break off and travel to other parts of the body carrying the malignant cells with them. Prostate cancer is usually a slow-growing disease, which is why most elderly men diagnosed with it will die from some other cause. But it can also be aggressive, especially in younger males. North America and Oceania have the highest rate of prostate cancer, while Africa and Asia have the lowest.

Symptoms & Complaints

Because this cancer can be slow-growing, many cases are asymptomatic until the disease has developed and already caused noticeable physical problems for a man. A man may notice that he is urinating more frequently than usual, and is urinating not in one stream, but in starts and stops. Many men also report that they wake up often during the night with a feeling of urgency, but very little urine actually comes out. There may also be pain while urinating.

This cancer can interfere with sexual activity and make the man unable to ejaculate; if he is able to ejaculate, it may be painful. Other symptoms include bone pain or pain in the thighs, pain in the lower back area and pain in the hips. Changes in the testicles like a lump or an unusual feeling of heaviness can be symptoms, as can blood in urine or blood in stool.

Causes

Age is a leading risk factor for prostate cancer, since the likelihood of prostate cancer cases developing increases greatly as a man ages. Most cases of this cancer are diagnosed in men who are 70 or older, and the mean age of diagnosis is 65.

Genetics play a role as a risk factor, because men who have a family history of prostate cancer, especially in a father or brother, are at twice the average risk of developing it. If a man has two close relatives who have had it, the risk of developing prostate cancer is anywhere between five and eleven times more likely.

Ethnicity is also a risk factor although it is not yet known why. And while African American men are more likely than Caucasians to develop this type of cancer and to die from it, Asian Americans are less likely to develop it than either African Americans or Caucasians.

There is some evidence that being obese can contribute to the risk of developing this cancer; obesity may also contribute to the cancer being a more aggressive type. Recent studies suggest that men who have had sexually transmitted diseases in the past have a greater chance of developing this cancer than members of the population who have been STD-free. Men who have been exposed to cadmium are at higher risk, and men with high testosterone levels are also suspected of being at higher risk.

Diagnosis & Tests

Prostate cancer may be noticed during a regular physical exam that includes blood tests and a physical work-up. If the prostate-specific antigen (PSA) count is higher than normal, this is an indicator that something is wrong and further tests should be performed.

The physician will usually perform a rectal exam, since the largest number of prostate tumors occur in the back region of the gland which is next to the rectum, and abnormalities can often be felt. The rectal ultrasound small probe is a test in which a probe is inserted into the rectum in order to examine sound waves which differentiate between prostate tumors and normal tissue, since the two do not emit the same kind of sound waves.

If any of these tests indicate the possibility of cancer, a prostate biopsy done with a needle (a needle biopsy) will be used to remove enough tissue and confirm or dismiss the diagnosis. If it is confirmed, the physician may also order a chest X-ray, CT scan, MRI or a bone scan to determine if the cancer has metastasized or spread anywhere else in the body.

Treatment & Therapy

There are several different treatment options available, and the stage or severity of the cancer along with the patient's medical history and current physical condition will determine which will be most effective for that individual. If the cancer is localized (contained in the gland), the doctor may initially want to simply monitor the patient closely and repeat some of the tests regularly, including the PSA count to see if the cancer has grown or metastasized.

Localized cancer can be treated with radiation therapy, a radical prostatectomy, which involves removing the entire gland and some of the tissue surrounding it with high intensity focused ultrasound (HIFU) or with cryotherapy, which freezes the prostate tissue and causes the cancerous cells to die. When prostate cancer is at a more advanced stage, it may be treated with hormonal therapy or chemotherapy.

Prevention & Prophylaxis

There is no guaranteed way to prevent prostate cancer, but there are sensible steps to take in terms of a healthy lifestyle overall. A healthy diet low in animal fats and high in fruits and vegetables is advised, as is maintaining a healthy weight; if the patient needs to lose weight to get to that goal, the low fat diet and an increase in exercise are encouraged. The patient should talk frankly to his physician about his concerns, so the doctor can help evaluate any risk factors.