PROSTATE CANCER

Overview

Prostate cancer is the most common cancer in American men after lung cancer. According to the American Cancer Society, men aged 50 and older, and those over the age of 45 who are in high-risk groups, such as African-American men and men with a family history of prostate cancer, should have a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) once every year.

The prostate is a gland of the male reproductive system. Located below the bladder and in front of the rectum, the gland helps regulate both bladder control and normal sexual functioning. Normally, the prostate is quite small—it is nearly the same size and shape as a wallnut.

Risk Factors

Age: A man's risk of developing prostate cancer increases with age. The disease can occur at any age, but it is most often found in men older than 50, and more than 75 percent of tumors are found in men over age 65. The incidence of prostate cancer has nearly doubled over the past 20 years, possibly because deaths from heart disease have declined in recent decades. More men are living longer, into the decades when prostate cancer risk is highest.

Family History: A family history of prostate cancer may also increase a man's risk of developing the disease, particularly if he has a number of close relatives who were diagnosed with prostate tumors, or if any relatives were younger than 60 at the time of diagnosis. Such inherited predispositions might be responsible for about 5 to 10 percent of all prostate cancers, according to recent genetic studies.

Race: Any man can develop prostate cancer, but for reasons that are not clearly understood, African-American men are twice as likely as white men to develop the disease. Incidence rates are lower among Asian and American Indian men.

Diet: Diets high in animal fat may increase the risk of prostate cancer, and a diet high in fruits and vegetables particularly cruciferous vegetables (broccoli, cabbage, cauliflower, kale, collard and mustard greens, horseradish, kohlrabi, Brussels sprouts, broccoli rabe, radishes, turnips, rutabagas, and watercress) may decrease the risk.

Lifestyle: tobacco smoking, stress, lack of physical exercise, obesity can provoke cancer or make the treatment more difficult. New studies show that obese men with prostate cancer are more likely to have aggressive tumors and to experience cancer recurrence after surgery compared to men of normal weight.

Symptoms

Many men with prostate cancer experience no symptoms; the first indication that they may have the disease is often an abnormal finding on a routine screening exam.

However, as the tumor grows, it may spread from the prostate to surrounding areas. Others may notice one or more of the following symptoms:

• Frequent urination
• Inability to urinate
• Painful or burning urination
• Trouble starting or holding back urine flow
• Pain in the lower back
• Painful ejaculation or trouble having an erection
• Blood in urine or semen

Some of these symptoms could also be a sign of a common, noncancerous condition. It is important to get a medical consultation if you have any of these symptoms to ensure proper diagnosis and treatment.

Screening:

Until science is able to prevent prostate cancer, our goal is to detect the disease at its earliest stages, while the tumor is small and curable.

We routinely use two examinations to screen men for prostate cancer:  

• Digital rectal examination (DRE) – an examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities.
• PSA blood test – a test, detecting the amount of prostate-specific antigen (PSA) circulating in the blood.

Both tests are NOT painful.

If a man's PSA level is elevated and digital rectal exam is abnormal, his physician is likely to suggest a biopsy, which can provide more detailed information and is required before a diagnosis is made.

What is a Biopsy?

Biopsy is a procedure where tissue samples are removed from the prostate to be examined by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. Using a transrectal ultrasound (TRUS) probe, a physician can see the prostate and precisely place the biopsy needles to remove tissue from several different spots in the gland. During a standard biopsy, a physician removes six tissue samples. The whole procedure takes about 20 minutes and is essentially painless as tiny needles are inserted for only a fraction of a second into the prostate.  

If the result of the biopsy is positive and indicates that you do have prostate cancer, your physician will continue gathering information to further characterize the cancer, it’s aggressiveness and stage. It’s essential for the doctor to have the most detailed information to determine the best way of treatment.

What is a Gleason score?

Gleason score is a system of grading prostate cancer cells based on how they look under a microscope. Gleason scores range from 2 to 10 and indicate how likely it is that a tumor will spread. A low Gleason score means the cancer cells are similar to normal prostate cells and are less likely to spread; a high Gleason score means the cancer cells are very different from normal and are more likely to spread.

In other words, physicians characterize the aggressiveness of prostate cancer using the Gleason grading system, which provides an estimate of the cancer's potential to grow and spread to other parts of the body.