Prostate Cancer

About Prostate cancer

The fear of having prostate cancer can be devastating to men. However, it is most successfully treated when found early. Consider these statistics from the American Cancer Society (ACS):

• Ninety-one percent of all prostate cancers are discovered while they are either localized (confined to the prostate) or regional (nearby). The five-year survival rate for men diagnosed with prostate tumors discovered at these stages is 99 percent.
• In the past 20 years, the five-year survival rate for all stages combined has increased from 67 percent to 99 percent.
• Prostate cancer is the most common cancer among men, excluding skin cancer.
• American Cancer Society (ACS) estimates for 2008 include 186,320 new cases of prostate cancer in the US.
• Year 2008 estimates include 28,660 deaths occurring from prostate cancer in the US alone, making it the second leading cause of cancer death in men.

What are the symptoms of prostate cancer?

Early prostate cancer may not present any symptoms and can only be found with regular prostate examinations by your physician. Do not let fear and anxiety keep you from having the tests you need. These tests can often detect, or help rule out, prostate cancer.

Follow-up visits with your physician are extremely important if you have had an unusual DRE (digital rectal exam), or if your PSA (prostate-specific antigen) level is high. Your physician may order additional tests or suggest repeating the PSA tests.

The following are the most common symptoms of prostate cancer, when present. However, each individual may experience symptoms differently. Symptoms may include:

• weak or interrupted flow of urine
• urinating often (especially at night)
• difficulty urinating or holding back urine
• inability to urinate
• pain or burning when urinating
• blood in the urine or semen
• nagging pain in the back, hips, or pelvis
• difficulty having an erection

It is important to understand that these symptoms may have other, less serious causes, including benign prostatic hyperplasia (BPH) or an infection, and should be evaluated by a physician. The symptoms of prostate cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Risk Factors

What is grading of prostate cancer?

Another step in the diagnostic process is grading the cancer cells - taking a measurement of how fast the tumor is likely to grow and spread. Grading is done in the laboratory with cells taken from the prostate gland during biopsy. The cancer cells are measured by how closely they look like normal cells.

Gleason System for grading cancer

According to the National Comprehensive Cancer Network (NCCN), one way of grading prostate cancer is the Gleason System. This grading system is based on a number range from 2 to 10. The lower the number, the lower the grade, and the slower the cancer is growing. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly than low-grade tumors, and are more likely to spread to other parts of the body.

• Grades under 6 mean that the cancer cells look similar to your normal cells, and the cancer is likely to be less aggressive.
• Grade 7 is in the intermediate range. This means that the cancer cells do not look like normal cells, and are more likely to be aggressive and grow faster.
• Grades 8 to 10 indicate that the cancer cells are more likely to be very aggressive in growth.

Find out more about grading of prostate cancer »

How is prostate cancer diagnosed?

Diagnosing prostate cancer is often a multi-step process. In addition to a complete medical history and physical examination, diagnostic procedures for prostate cancer may include the following:

• DRE (digital rectal examinations)
  As recommended by your physician, DREs are usually conducted annually for men over the age of 50. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer, should consult their physicians about being tested at age 45.
• PSA (prostate-specific antigen) and PAP (prostatic acid phosphatase)
  As recommended by your physician, PSA and PAP tests are usually conducted annually for men over the age of 50. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer, should consult their physicians about being tested at age 45.

What are some other prostate cancer evaluation procedures?

If the DRE or PSA are unusual, your physician may repeat the tests or request an ultrasound and other procedures. These evaluation tools may include:

• transrectal ultrasound (TRUS) - a test using sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions such as gland enlargement, nodules, penetration of tumor through capsule of the gland, and/or invasion of seminal vesicles; may also be used for guidance of needle biopsies of the prostate gland and/or guiding the nitrogen probes in cryosurgery.
• computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• radionuclide bone scan - a nuclear imaging method that helps to show whether the cancer has spread from the prostate gland to the bones. The procedure involves an injection of radioactive material that helps to locate diseased bone cells throughout the entire body, suggesting possible metastatic cancer.
• lymph node and/or prostate biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

Treatment Options

Hormone Therapy For Prostate Cancer

Produced mainly in the testicles, the male hormone testosterone causes prostate cancer cells to grow. Reducing testosterone levels can make the prostate cancer shrink and become less active.

The goal of hormone therapy is to lower the level of male hormones in the body, particularly testosterone. Hormone therapy does not cure the cancer and is often used to treat persons whose cancer has spread or recurred after treatment. Most studies show that hormone therapy works better if it is started early.

Find out more about hormone therapy for prostate cancer »

What Are Clinical Trials?

Clinical trials are studies, managed by government agencies, educational institutions, private not-for-profit organizations, or commercial businesses, to develop, produce, and evaluate the effectiveness of new treatments and therapies for diseases.

What are the risks and benefits of participating in a clinical trial?

Individuals who participate in research studies are given the opportunity to benefit from treatments that are not currently available to the general public, but have shown promise in previous research.

Risks from participating in a clinical trial vary depending on the study. It is important to understand that not all new treatments produce the desired effect.

Find out more about clinical trials »

Additional Resources

Listed below you will find some additional information regarding prostate cancer. If you cannot find the information in which you are interested, please visit the Health Library for additional information.

Coping With Prostate Cancer

For Family Members Coping With Prostate Cancer

Prostate Cancer Statistics

Getting Back to Health after Cancer

Coping with Cancer