Everything You Need To Know About Prostate Cancer

Prostate cancer is cancer that originates in the prostate gland, a male genital gland about the size of a walnut that is located in front of the rectum, behind the base of the penis, and under the bladder.

The prostate gland surrounds the upper part of the urethra, the tube that carries urine and semen out of the penis. Because of its location, a physician can directly examine the part of the gland where most tumors occur.

In most cases, prostate cancer grows slowly. Some prostate cancers are aggressive, spreading rapidly to other organs and the bones.

Who Gets Prostate Cancer?
Cancer of the prostate is the most common type of cancer (excluding skin cancer) among American men. The number of cases that have been found during the past decade has increased dramatically, largely due to improved detection.

Now that there is a blood test (the prostate -specific antigen, or PSA, test) that is widely used to screen for prostate cancer, it is expected that even more cases will be found.

Prostate cancer affects thousands of lives. An estimated 184,500 new cases will be diagnosed in the United States this year, and about one of every five American men will develop the disease in his lifetime. The highest incidence of prostate cancer is in North America and northwestern Europe. It is rare in Asia, Africa, Central America, and South America.

The way that prostate cancer is distributed among these populations suggests that diet may play a role in the development of this disease, especially if diet affects the level of hormones in men.

Prostate Cancer in African Americans
For reasons that have not yet been identified, the highest incidence rates of prostate cancer in the world are among African American men. Once diagnosed, African Americans have poorer survival rates for prostate cancer than white Americans. This may be because more prostate cancers in African Americans are diagnosed in advanced stages compared with cancers in Caucasian Americans.

Researchers have suggested several possible reasons for late diagnosis of prostate cancer in African Americans. One is a lack of awareness of the importance of early detection.

As an example, in 1987 researchers asked a group of people over age 40 if they had ever heard of a digital rectal exam, one of the tests a physician uses to detect prostate cancer in its early stages. Nearly twice as many black men as white men said they had never heard of the exam. Because of their greater risk of getting this disease and poorer survival after diagnosis, African American men are more than twice as likely to die of prostate cancer than are white American men.

Risk Factors
The risk of developing prostate cancer increases greatly with age. More than 75% of all prostate cancers are diagnosed in men over the age of 65. Apart from age, little is understood about what puts a man at risk for prostate cancer or what puts African Americans at higher risk of developing the disease.

Also at higher risk are men who have a history of prostate cancer in close family members, for example, a brother or father. Research is under way to study the genetic basis of racial and familial differences in prostate cancer risk.

A high-fat diet is associated with an increased risk of developing prostate cancer. Some research has suggested that vasectomy (surgery that makes a man infertile) might increase the risk of prostate cancer, but so far this link has not been proven.

Prevention
Since so little is known about what causes prostate cancer, it is not possible to say how to prevent it. Reducing fat intake, however, especially saturated fat from red meat and dairy products, is a smart move for every man to make. A low-fat, high-fiber diet that includes plenty of fruits and vegetables is recommended to lower the risk for many types of cancer, and can reduce the risk of heart disease, stroke, and diabetes as well.

The Best Defense--Early Detection
The earlier prostate cancer is discovered, the better the chances are that it can be treated effectively. If the tumor has not spread outside of the prostate gland to other areas of the body, the chances are good for long-term survival, that is, living for many years with a good quality of life.

Once the tumor has begun to spread, it is more difficult to treat. There are two tests commonly used to detect prostate cancer, the PSA blood test (PSA stands for prostate-specific antigen) and the digital rectal exam (DRE) of the prostate gland. For the DRE, the health care professional inserts a gloved, lubricated finger into the rectum to feel any irregular or abnormally firm area, which may indicate that a tumor is present.

Most prostate cancers begin in the part of the prostate gland that can be reached by a DRE. This exam also helps to detect early rectal tumors. The procedure may be a bit uncomfortable, but it only takes a short time. Talk with your health care professional about when to begin these tests.

If either the PSA blood test or the DRE has an abnormal finding, further medical evaluation is needed. For more information about the early detection of prostate cancer, call the American Cancer Society at 1-800-ACS-2345.

Signs and Symptoms of Prostate Cancer
When prostate cancer is in its earliest stages (still confined to the prostate gland), it usually causes no pain or other symptoms. Occasionally, men with early prostate cancer experience difficulty when urinating. However, this symptom is far more likely to indicate a condition called benign prostatic hyperplasia (BPH), which is not a cancer. Any urinary symptom should be evaluated by a physician.

Confirming the Diagnosis of Prostate Cancer
If the results of a PSA blood test or a digital rectal examination suggest the possibility of prostate cancer, your doctor may refer you for further testing. A diagnosis of prostate cancer is usually confirmed by a biopsy of the prostate gland. A biopsy is a surgical procedure in which small samples of prostate tissue are removed and examined under a microscope.

The procedure can be done in the physician's office. Actual biopsies take seconds, although the whole procedure from beginning to end will take a little less than half an hour. Most of this time is spent on getting the individual ready for the procedure.

If cancer is detected, additional tests to determine the stage of the disease will be done. The stage of the cancer indicates if the tumor is still confined to the prostate gland or if it has spread to other parts of the body.

The grade of the cancer is also important. Grade helps determine whether it is likely to be aggressive (fast growing with a tendency to spread) or slow growing.

Staging
Staging is a system used to determine how far the cancer has spread. It is very important to know the stage in order to select the appropriate treatment. Staging is done through additional tests that may include a bone scan, computed tomography (sometimes called a CT scan or a CAT scan), magnetic resonance imaging (MRI), and a biopsy of the lymph nodes.

Because the type of treatment chosen depends on the cancer's stage, men should ask their health care professionals to carefully explain what their stage of disease means so that they can make fully informed choices about treatment. A full description and information on staging and diagnosis techniques for prostate cancer is available by calling the American Cancer Society's toll-free number, 1(800) ACS-2345.

Treatment of Prostate Cancer
The treatment of prostate cancer depends on the general health of an individual, the stage and grade of the disease, age, expected lifespan, the anticipated effects of the treatment, and personal preferences.

For instance, older men might choose not to have a treatment that could cause unpleasant side effects and is not likely to increase their lifespan.

Expectant Management (Watchful Waiting)
For some patients with prostate cancer, a "watch and wait" approach may be recommended. The cancer is carefully observed and monitored with no specific treatment given unless the prostate cancer begins to show signs of advancing or causes symptoms.

Physicians sometimes recommend this option for older patients who have early prostate cancer that is confined to one area of the prostate and is not causing any symptoms or other problems. Because prostate cancer cells often spread very slowly, many older men who have the disease may never need active treatment.

Surgery
For many patients with prostate cancer, surgery may be recommended to remove the tumor. Several types of operations are currently done:

• Radical prostatectomy (surgical removal of the prostate gland) is used to treat cancer that is confined to the prostate. During the operation, the entire prostate gland, along with some tissue around it, is removed.
• Transurethral resection is an operation that surgically removes part of the prostate gland using a tool with a small wire loop on the end. The tool is inserted through the urethra up to the prostate gland. The procedure is used for men who, because of age or other illness, cannot have a radical prostatectomy to relieve urinary obstructions caused by the tumor.
• Cryosurgery is a promising new surgical technique that is currently being evaluated for its effectiveness as a treatment for prostate cancer. This surgery involves inserting a metal probe directly into the tumor tissue and destroying the tumor by freezing.

Radiation Therapy
Radiation therapy is another way to treat prostate cancer. In this treatment, high energy x-rays kill or shrink cancer cells. Radiation therapy is used to treat prostate cancer that is still confined to the prostate gland or has spread only to nearby tissue. The goal of radiation is to destroy cancer cells by decreasing their ability to divide. If the disease is advanced, radiation may be used to reduce the size of the tumor and provide relief from symptoms.

Radiation therapy often can eliminate the need for surgery. Two types of radiation therapy are used to treat prostate cancer External beam radiation is much like getting an x-ray, but for a longer time. It is usually performed in an outpatient center. For external radiation therapy, one treatment per day will likely be given on 5 days each week over a period of 6 or 7 weeks. Each treatment lasts only a few minutes.

Internal radiation therapy uses small radioactive pellets (each about the size of a grain of rice) that are implanted directly into the cancerous cells of the prostate. This procedure is known as brachytherapy. These pellets, sometimes called seeds, give off small amounts of radiation for weeks or months. Because the pellets used for internal radiation therapy are so small, their presence causes no discomfort, and they are simply left in place.

Hormone Therapy
This treatment is often used for patients whose prostate cancer has metastasized (spread to other parts of the body) or has recurred after treatment. Most evidence shows that hormone therapy works better if it is started as early as possible after the cancer has reached an advanced stage. The goal of hormone therapy is to lower levels of the male hormone, testosterone.

Testosterone is produced mainly in the testicles and causes prostate cancer cells to grow. Reduced testosterone levels can make the prostate cancer shrink or grow slower. However, hormone therapy does not cure the cancer. There are several methods used for hormone therapy:

• Orchiectomy: This procedure involves surgical removal of the testicles. It is considered a routine operation which causes few complications.
• Luteinizing Hormone-Releasing Hormone (LHRH) analogs: These drugs decrease the amount of testosterone produced by a man's body. LHRH analogs are injected monthly or every three months at the physician's office or at the oncology center.
  Research shows that these drugs can lower the level of testosterone as effectively as surgical removal of the testicles.
• Anti-androgens: Recent studies have shown that even after orchiectomy, a small amount of testosterone is still produced in the body by the adrenal glands.
  Antiandrogens block the body's ability to use testosterone. Anti-androgens are usually used in combination with orchiectomy or LHRH analogs.

Chemotherapy
Chemotherapy uses powerful anti-cancer drugs that are given to patients either intravenously (injected into a vein) or by mouth. Chemotherapy can be done in a doctor's office, an outpatient clinic, or even at home in some cases.

Although not commonly used to treat prostate cancer, chemotherapy may be used for patients whose prostate cancer has spread outside of the prostate gland and for whom hormone therapy has failed. It has shown only limited success in treating advanced disease, but it may slow tumor growth and reduce pain. Chemotherapy is not recommended for the treatment of early prostate cancer.

Surviving Prostate Cancer
The average age of men diagnosed with prostate cancer is 72 years, so many patients with prostate cancer, especially those whose disease is confined to the prostate gland, may die of other illnesses or old age without ever having suffered significant disability from their cancer.

Survival rates for all stages of prostate cancer have steadily improved over the past 50 years. This means that today, more than three-quarters of men who have prostate cancer can expect to live at least five years from the time the cancer was diagnosed. For men with prostate cancer that has not spread beyond the prostate gland, the 5-year survival rate climbs to 99%.

For Further Information The American Cancer Society offers comprehensive information on all aspects of cancer-prevention, detection, diagnosis, treatment, and services for cancer patients and their families.

For more information on prostate cancer and on our programs and services, including the following publications, call our toll-free number, 1-800-ACS-2345 or visit www.cancer.org.