About Prostate Cancer

Prostate cancer is the most common cancer in men. It is the 2nd leading cancer killer of men, behind lung cancer. It is generally very slow growing and most men die with prostate cancer (meaning that they die of some other cause) rather than from it.  There are almost 2.8 million men living with prostate cancer in the USA.

Still, it kills about 30,000 men each year. But detected early, prostate cancer can be treated.

While no one knows how to prevent prostate cancer, there may be ways to reduce your risk. It is thought that these help reduce the risk for most forms of cancer.

  • Eat healthy – and choose a low-fat diet
  • Eat plenty of fruits, vegetables, and whole grains
  • Maintain a healthy weight
  • Stay physically active
  • Don’t use tobacco
  • Get regular checkups

 

Risk Factors For Prostate Cancer

The following factors could put you at risk for prostate cancer:

  • Age – men who are 40 or over with a family history of prostate cancer and African Americans are at risk. For other men without a family history, men 50 and over are at risk. Most prostate cancers are diagnosed in men over 65, but it is becoming more common in men 55-65.
  • Family history – Your risk of developing prostate cancer is double if your father, brother, or close male blood relative has or had the disease. Also, men with the breast cancer gene, BRCA1 and BRCA2, have a higher risk of developing prostate cancer.
  • Race – African American men have the highest rate of prostate cancer in the world, at least twice as high as other men.
  • Diet – Eating a diet that’s low in fiber, and high in fat and red meat, may increase the risk for prostate cancer.

Family history – Your risk of developing prostate cancer is double if your father, brother, or close male blood relative has or had the disease. Also, men with the breast cancer gene, BRCA1 and BRCA2, have a higher risk of developing prostate cancer.

 

Symptoms of Prostate Cancer

In its early stages, prostate cancer usually doesn’t cause symptoms.

As the disease progresses, symptoms may develop that can be similar to the symptoms for BPH and/or prostatitis (see the BPH and prostatitis sections on this website for more information).

Symptoms can include:

  • Chronic pain in the hips, thighs, or lower back
  • Difficulty urinating
  • Painful / burning urination
  • Blood in the urine / semen
  • Trouble getting an erection

Since prostate cancer doesn’t have early symptoms, and the symptoms that may show can be the same as for other non-cancerous conditions, prostate cancer is very hard to diagnose.

That’s why it’s very important to speak to your healthcare provider about regular screening.

 

How Prostate Cancer is Diagnosed

If you don’t have any symptoms of prostate cancer, signs of cancer are often found during a regularly scheduled checkup with a DRE (digital rectal exam) and a PSA (prostate specific antigen) test.

A DRE is a test where the doctor puts a gloved finger in the rectum to feel the prostate. A PSA test is a blood test that can find a prostate related problem. An abnormal PSA test may mean that you need more testing.

More testing may include:

  • Genomic Testing – The activity of sets of related genes is measured in a tumor biopsy or blood sample. Genomic tools can provide information that helps men and their doctors better understand their individual prostate cancer; this information can help answer questions such as how aggressive the tumor may be.
  • Genetic Testing – The presence of a particular gene or genes is assessed using a blood or other tissue sample.  Some genes are associated with an increased risk of cancer or other diseases; screening for these genes provides information that helps men and their doctors estimate their personal risk of these cancers/diseases.
  • Urinalysis – A urine sample is analyzed. It is often used to rule out BPH or prostatitis.
  • Imaging – An ultrasound uses sound waves to produce an image of the prostate. MRI and CT scans use computers to produce images. Also, bone scanning can look for prostate cancer that might have spread to the bones.
  • Biopsy – Small pieces of prostate tissue are taken using a transrectal biopsy and examined under a microscope.
  • Lymph node biopsy – Small samples of tissue from the lymph nodes are examined to determine whether the prostate cancer has spread to other parts of the body.
  • Transrectal ultrasound – This test uses sound wave echoes to create an image, a sonogram, of the prostate gland to see whether there are abnormal tissues.

There are various stages of prostate cancer. The stages are I, II, III, and IV. Stage I is early-stage cancer and Stage IV is advanced (also known as metastatic prostate cancer). During metastatic prostate cancer, the cancer has spread to other parts of the body, such as the bones and soft tissue.

 

Treatments For Prostate Cancer

The main approaches to treating early-stage prostate cancer are:

Active Surveillance

This can be a good option if your doctor believes your cancer is growing slowly and won’t spread to other parts of the body. The advantages are that you avoid all the risks associated with the various treatment options below. Disadvantages are that you’ll need regular monitoring if something changes for the worse. This is also called “watchful waiting.”Genetic testing may be an option to consider during active surveillance. Genetic testing is a method of testing where DNA is analyzed to detect any mutations in genes that can detect the rate at which prostate cancer can spread.

Prostatectomy

This is surgical removal of the prostate. Side effects may include urinary incontinence (bladder control problems) that can last for weeks, and erectile dysfunction.The surgery options include:

  • Nerve-sparing retropubic radical prostatectomy (NS-RRP)
  • Radical perineal prostatectomy (RPP)
  • Robotic and/or laparoscopic prostatectomy
  • Nonnerve sparing wide excision RP

Radiation Therapy

There are two options:

  • High-powered x-rays – These x-rays are used to kill the cancer cell. Side effects include reduced sexual function, urinary troubles, intestinal difficulty, loss of appetite and hair.
  • Radioactive seeds – Your doctor will use a special needle to implant 80 – 120 pellets the size of a grain of rice directly into the prostate. There are fewer sexual side effects but more urinary ones, and there can be damage to the rectum and lower intestines.

Radiation therapy can have various side effects, such as diarrhea, rectal bleeding, mucus discharge, or fistulas, and can cause damage to the tissues around the prostate, such as the rectum.

SpaceOAR® is a liquid gel that is placed between the rectum and the prostate. Once it is applied, the liquid expands and hardens, creating a space between the rectum and prostate. During radiation therapy, this distance between the rectum and prostate limits radiation damage to the rectal wall. Once radiation therapy is complete, SpaceOAR® is absorbed into the body after 6 months.

Hormone therapy

The male sex hormone, testosterone, stimulates cancer cells to grow. You can take drugs to block the body from making testosterone. Hormone therapy is usually not a cure; it’s just a way of stopping the tumor from growing. Side effects include breast enlargement reduced sex drive, weight gain, and reduction in muscle mass.

Cryosurgery / Cryotherapy

This involves freezing the prostate gland in order to destroy the cancer within it. Cryosurgery is an FDA-approved treatment for localized and locally recurrent prostate cancer. It may cause more sexual side effects than other local therapies, but if you’re interested, ask your doctor for more information.

Radium-223

An injection for the treatment of bone metastases which has shown an anti-tumor effect.

For more information on these treatments and how they can affect sexual health, click here to visit the Men’s Health Resource Center.

It is important to know that some men with prostate cancer may not need to have treatments.