Prostate cancer is among the most common and survivable forms of cancer diagnosed in men. In 2016, more than 180,000 new cases will be diagnosed in the US, and about 26,000 men will die from it. While it’s a serious disease, it’s not fatal in most cases. More than 2.9 million men who’ve been diagnosed with it are still alive today.
What Is Prostate Cancer?
The prostate gland is part of the male reproductive system. It’s about the size of a walnut and sits at the base of the bladder. Its job is to produce and excrete fluids contained in semen. Prostate muscle fibers help control the flow of urination.
Prostate cancer happens when cells located within the prostate gland grow abnormally. It’s a very slow-progressing cancer that’s diagnosed most often in men over age 65. The American Cancer Society (ACS) says there are several types of prostate cancer, but most cases are adenocarcinomas that start in the glandular cells that make seminal fluid.
As cancer cells divide, they can enlarge the prostate, interfere with urination, cause discomfort and eventually spread to other parts of the body. It grows so slowly, however, that many men live with it for years, die from other age-related conditions, and never know they had it.
Who’s at Risk for Prostate Cancer?
Age is the biggest risk factor; it’s rarely diagnosed in men under 40. African American men are at higher risk than Caucasian men, while Hispanic and Asian men are at lower risk. The ACS says it’s most commonly diagnosed in North America, northwestern Europe and Australia, and less common in Asia, Africa, Central America and South America. That may be because there are fewer cancer-screening resources in those countries.
However, other factors like diet and lifestyle may play a role as well. Research shows that men who eat a lot of red meat and high-fat dairy foods, and few fruits and veggies, are at increased risk for getting prostate cancer. While smoking is implicated in other cancers, there’s currently no link between tobacco and prostate cancer.
What Are the Symptoms of Prostate Cancer?
Most men with prostate cancer have no symptoms. Some have trouble with urination or erectile dysfunction. They might see blood in their urine or semen and, if the cancer has spread, they might have pain, weakness or numbness in their back, hips, chest or other areas.
How Is Prostate Cancer Diagnosed?
Most men are diagnosed as part of a routine screening exam that includes a blood test and rectal exam. Blood tests look for prostate-specific antigens (PSA), and rectal exams check for enlargement of the prostate gland.
Most healthy men have PSAs under 4 ng/ml. Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, that chance is over 50%.
A high PSA test does not mean the person has prostate cancer, but indicates further tests are needed. Those tests might include a rectal ultrasound to evaluate the size and condition of the prostate gland, and a biopsy to remove small parts of the prostate gland. Sometimes, biopsies indicate abnormal cells that are not cancerous, but are worth keeping an eye on.
Once prostate cancer is diagnosed, the next step is to grade it using a Gleason score. This assigns a number based on how abnormal the cancer cells look in comparison to normal tissue. If a sample looks mostly normal, it gets a grade of 1. The ACS says most cancers are at least a six, but Gleason scores can be as high as ten.
The next step is determining whether the cancer has spread to other parts of the body. That may require a bone scan to look for metastasis to the bones, a CT scan or MRI to look for cancer in other organs, and a lymph node dissection to determine if it has entered the lymphatic system.
How Is Prostate Cancer Treated?
Treatment for prostate cancer may include surgery to remove the prostate gland, radiation, hormonal therapy and chemotherapy. Physicians used to treat even low-grade prostate cancers aggressively, but treatments can have significant side effects, including the ones most men worry about most — urinary incontinence and impotence.
That’s why there’s a growing acceptance among physicians and patients to take a wait-and-see approach to treatment. If cancer doesn’t become aggressive or life threatening, further treatment may not be needed. If a patient does not have low-grade disease, however, treatment is essential.
How Do You Decide What to Do About Prostate Cancer?
Do your homework. Talk with your physician and family about your treatment options, goals and expectations. To learn more about prostate cancer, visit cancer.org.
