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Prostate cancer

Updated: 9/27/2023
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13y ago

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Definition

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.

Alternative Names

Cancer - prostate

Causes, incidence, and risk factors

The cause of prostate cancer is unknown. Some studies have shown a relationship between high dietary fat intake and increased testosteronelevels.

There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH).

Prostate cancer is the third most common cause of death from cancer in men of all ages and 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
  • Men who are older than 60
  • Farmers
  • Tire plant workers
  • Painters
  • Men who have been exposed to cadmium

The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).

Symptoms

Thanks to PSA testing, most prostate cancers are now found before they cause symptoms. Although most of the symptoms listed below can occur with prostate cancer, they are more likely to be associated with noncancerous conditions.

Other symptoms that may occur with this disease:

Signs and tests

A rectal exam will often show an enlarged prostate with a hard, irregular surface.

A number of tests may be done to diagnose prostate cancer:

  • PSA test (may be high, although noncancerous enlargement of the prostate can also increase PSA levels)
  • Free PSA (may help tell the difference between BPH and prostate cancer)
  • AMACR (a newer test that is more sensitive than the PSA test for determining prostate cancer)
  • Urinalysis (may show blood in the urine)
  • Urine or prostatic fluid testing (may reveal unusual cells)

Prostate biopsyis the only test that can confirm the diagnosis.

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

Health care providers use a system called staging to describe how far the cancer has grown. Tumor size, and how far the cancer has spread outside of the prostate determine the stage. Identifying the correct stage may help the doctor recommend the best treatment.

There are several different ways to stage tumors, including:

  • The TNM staging system (most common)
  • The A-B-C-D staging system, also known as the Whitmore-Jewett system

The grade of a tumor describes how aggressive a cancer might be. The more tumor cells differ from normal tissue, the faster these cells are likely to grow. The grading system for prostate cancer is called the Gleason grade or score. Higher scores are usually faster growing cancers.

Treatment

The appropriate treatment for prostate cancer is not clear. Treatment options vary based on the stage of the tumor. In the early stages, talk to your doctor about several options including surgery, radiation therapy, or, in older patients, monitoring the cancer without active treatment.

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 on either a temporary or permanent basis. Discuss your concerns with your health care provider.

SURGERY

Surgery is usually only recommended after a thorough evaluation and discussion of all treatment options. A man considering surgery should be aware of the benefits and risks of the procedure.

  • Surgery to remove the prostate gland is often recommended for treating stages A and B prostate cancers. This is a lengthy procedure and complications are possible. There are many different surgery options. See: Radical prostatectomy and Robotic surgery.
  • Orchiectomy alters hormone production and may be recommended for cancer that has spread to other areas of the body. There may be some bruising and swelling right after surgery, but this will gradually go away. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.

RADIATION THERAPY

Radiation therapy is used primarily to treat stage A, B, or C prostate cancers. Whether radiation is as good as prostate removal is unclear. The decision about which treatment to choose can be difficult. In patients whose health makes surgery too risky, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:

  • External beam radiation therapy is done in a radiation oncology center by specially trained radiation oncologists, usually on an outpatient basis. Before treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that looks like a normal x-raymachine. The treatment itself is generally painless. Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, inflamed bladder (cystitis), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.
  • Prostate brachytherapy or internal radiation involves placing radioactive seeds inside you, directly into the prostate. A surgeon inserts small needles through the skin behind your scrotum to inject the seeds. The seeds are so small that you don't feel them. They can be temporary or permanent. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues around the prostate. Prostate brachytherapy may be given for early, slow-growing prostate cancers. It also may be given with external beam radiation therapy for some patients with more advanced cancer. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.
  • Radiation is sometimes used for pain relief when cancer has spread to the bone.

MEDICATIONS

Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Because prostate tumors require testosterone to grow, reducing the testosterone level often works very well at preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. It may also be done by surgically removing the testes.

The drugs Lupron and Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, unlike surgery, it is reversible. The drugs must be given by injection, usually every 3 - 6 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and impotence.

Other medications used for hormonal therapy include androgen-blocking drugs (such as flutamide), which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.

Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include:

  • Adriamycin
  • Docetaxel
  • Estramustine
  • Mitoxantrone
  • Paclitaxel
  • Prednisone

After the first round of chemotherapy, most men receive further doses on an outpatient basis at a clinic or physician's office. Side effects depend on the drug, how often you take it, and for how long. Some of the side effects for the most commonly used prostate cancer chemotherapy drugs include:

  • Blood clots
  • Bruising
  • Dry skin
  • Fatigue
  • Fluid retention
  • Hair loss
  • Lowering of your white cells, red cells, or platelets
  • Mouth sores
  • Nausea
  • Tingling or numbness in hands and feet
  • Upset stomach
  • Weight gain

MONITORING

You will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups. Monitoring may include:

  • Serial PSA blood test (usually every 3 months to 1 year)
  • Bone scan or CT scan to check whether the cancer has spread
  • Complete blood count (CBC) to monitor for signs and symptoms of anemia
  • Monitoring for other signs and symptoms, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness
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)

The outcome varies greatly. This is mainly because the disease is found in older men, who may have a variety of other diseases or conditions such as heart or respiratory disease, or disabilities. The outcome is also affected by the stage and grade of the disease when you are diagnosed.

Complications

Impotence is a potential complication after prostate removal or radiation therapy. Recent improvements in surgical procedures have made this complication less common. Urinary incontinence is another possible complication. Medications can have side effects, including hot flashes and loss of sexual desire.

Calling your health care provider

Call for an appointment with your health care provider if you are a man over age 40 who has:

  • Never been screened for prostate cancer (by rectal exam and PSA level)
  • Not had regular, annual exams
  • A family history of prostate cancer

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

Prevention

There is no known way to prevent prostate cancer. Following a vegetarian, low-fat diet or one that is similar to the traditional Japanese diet may lower your risk. Early identification (as opposed to prevention) is now possible by screening men over age 40 each year with a digital rectal examination (DRE) and PSA blood test.

There is a debate, however, as to whether PSA testing should be done in all men. There are several potential downsides to PSA testing. The first is that a high PSA level does not always mean that a patient has prostate cancer. The second is that health care providers are detecting and treating some very early-stage prostate cancers that may never have caused the patient any harm. The decision about whether to use a PSA testing to screen for prostate cancer should be based on a discussion between the patient and his health care provider.

References

Andriole GL, Crawford ED, Grubb RI 3rd, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319.

Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol. 2008;180:1993-2004.

NCCN Clinical Practice Guidelines in Oncology: Prostate cancer. V.2.2009. Accessed June 2009.

Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-1328.

Walsh PC, DeWeese TL, et al. Clinical practice: localized prostate cancer. N Engl J Med. 2007;357(26):2696-2705.

Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148(6):435-448.

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11y ago
Definition

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.

Alternative Names

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

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:

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:

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:

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.

References

Theoret MR, Ning YM, Zhang JJ, et al. The risks and benefits of 5a-reductase inhibitors for prostate-cancer prevention. N Engl J Med. 2011 Jun 15.

Antonarakis ES, Eisenberger MA. Expanding treatment options for metastatic prostate cancer. N Engl J Med. 2011 May 26;364:2055-2058.

Andriole GL, Crawford ED, Grubb RI 3rd, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319.

Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol. 2008;180:1993-2004.

Schrader FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-1328.

Walsh PC. Chemoprevention of prostate cancer. N Engl J Med. 2010 Apr 1;362(13):1237-8.

Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148(6):435-448.

Reviewed By

Review Date: 09/19/2011

Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Can prostate cancer be atributed to colon cancer?

Prostate cancer and colon cancer are two distinct types of cancer that affect different organs within the body. While they can occur concurrently in the same individual, one is not directly attributed to the other in terms of causality. However, there are some factors that may increase the risk of developing both prostate and colon cancer: Genetic Factors: Some hereditary cancer syndromes, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer, HNPCC), can predispose individuals to both colon and prostate cancer. In these cases, specific genetic mutations increase the likelihood of developing various types of cancer, including those affecting the colon and prostate. Age: Both prostate cancer and colon cancer are more common in older individuals. As age increases, the risk of developing these cancers also rises. Lifestyle Factors: Certain lifestyle habits, such as a diet high in red and processed meats, low intake of fruits and vegetables, lack of physical activity, smoking, and excessive alcohol consumption, are associated with an increased risk of both prostate and colon cancer. Inflammation: Chronic inflammation in the body may contribute to the development of various cancers, including prostate and colon cancer. Conditions such as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, have been linked to an increased risk of colon cancer. Inflammation of the prostate gland, such as in cases of chronic prostatitis, may also play a role in the development of prostate cancer. While these factors may overlap and increase the risk of developing both prostate and colon cancer, it's essential to understand that each cancer has its unique risk factors, causes, and mechanisms of development. Additionally, early detection through screening and prompt medical intervention are crucial for managing both prostate and colon cancer effectively. If you have concerns about your risk of developing these cancers, it's recommended to discuss them with a healthcare professional who can provide personalized guidance based on your medical history and risk factors.


What is the contact information for The Prostate Cancer Infolink?

The Prostate Cancer Infolink. http://www.comed.com/prostate.


Where can I learn about prostate health?

The Prostate Cancer Foundation, the U.S. Army's Prostate Cancer Research Program, the Institute for Prostate Cancer Research, the National Cancer Institute, and the Centers for Disease Control and Prevention all provide information on the latest research on prostate cancer.


When was Prostate Cancer Foundation created?

Prostate Cancer Foundation was created in 1993.


Is musturbration causes prostate cancer in male?

Masterbation does not cause prostate cancer.


How can prostate cancer a ffect your penis?

Prostate cancer treatments will make you impotent.


What different treatments are there to cure prostate cancer?

Procedures to treat prostate cancer and chemotherapy, radiation therapy or surgery. Surgery can include removal of cancer from the prostate, or removal of prostate gland.


Is there a correlation between prostate cancer and prostate hypertrophy?

No. Someone having an enlarged prostate does not mean they will develop cancer.


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PSA is just one indicator of prostate cancer. It is possible to have prostate cancer and have a normal PSA reading.


Is prostate massage a positive thing again prostate cancer?

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