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 NamesCancer - prostate
Causes, incidence, and risk factorsThe 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:
The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).
SymptomsThanks 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:
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:
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 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.
TreatmentThe 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.
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:
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:
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:
MONITORING
You will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups. Monitoring may include:
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.
ComplicationsImpotence 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 providerCall for an appointment with your health care provider if you are a man over age 40 who has:
Discuss the advantages and disadvantages to PSA screening with your health care provider.
PreventionThere 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.
ReferencesAndriole 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.
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 NamesCancer - prostate; Biopsy - prostate; Prostate biopsy; Gleason score
Causes, incidence, and risk factorsProstate 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:
Other people at risk include:
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.
SymptomsThe 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:
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:
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:
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).
TreatmentTreatment 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:
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 GroupsYou 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.
ComplicationsThe complications of prostate cancer are mostly due to different treatments.
Calling your health care providerDiscuss the advantages and disadvantages to PSA screening with your health care provider.
PreventionYou may lower your risk of prostate cancer by eating a diet that is:
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.
ReferencesTheoret 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 ByReview 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.
lung cancer is in the lungs, prostate cancer is in the prostate.
The Prostate Cancer Infolink. http://www.comed.com/prostate.
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.
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.
No. Someone having an enlarged prostate does not mean they will develop cancer.
Prostate Cancer Foundation was created in 1993.
Masterbation does not cause prostate cancer.
Prostate cancer treatments will make you impotent.
PSA is just one indicator of prostate cancer. It is possible to have prostate cancer and have a normal PSA reading.
Prostate massage is only recommended for prostate health issues, such as enlarged prostate (BPH) or prostatitis (prostate inflammation). Due to the potential risk of releasing prostate cancer cells that can spread to the body, it is not recommended that men with prostate cancer perform prostate massage.
The peak incidence for prostate cancer is 67 years of age, but a man's risk of developing prostate cancer rises with age.
There is no specific threat of bladder cancer during or after prostate cancer. The prostate cancer could spread to the bladder just as easily as it could spread to any other organ.