The prostate is a gland, about the size of a walnut, found only in men. It is located just below the bladder and in front of the rectum. The tube that carries urine, the urethra, runs through the prostate. The prostate contains cells that make some of the seminal fluid, which protects and nourishes the sperm.
Most of the time, prostate cancer grows slowly. Autopsy studies show that many older men who died of other diseases also had prostate cancer that neither they nor their doctor were aware of. But sometimes prostate cancer can grow and spread quickly. Even with the latest methods, it is hard to tell which prostate cancers will grow slowly and which will grow quickly.
Some doctors believe that prostate cancer begins with very small changes in the size and shape of the prostate gland cells. These changes, known as PIN (prostatic intraepithelial neoplasia), can be either low-grade (almost normal) or high-grade (abnormal). If a patient had a prostate biopsy that showed high-grade PIN, there is a greater chance of cancer cells in the prostate. For this reason, he will be watched carefully and may need another biopsy.
Although there are several cell types in the prostate, nearly all prostate cancers start in the gland cells. This kind of cancer is known as adenocarcinoma.
African-American men have the highest prostate cancer incidence rates in the world and will account for a high proportion of new cases.
African-American men are nearly twice as likely to get prostate cancer as white men.
About 85 percent of newly diagnosed prostate tumors are discovered in local and regional stages, meaning the tumor has not spread beyond the prostate.
When the cancer is confined to the prostate, the five-year survival rate is 100 percent.
By having a healthy lifestyle and talking to your health care professional about screening, especially if you are at high risk, you may greatly reduce your risk of prostate cancer.
To help protect yourself against prostate cancer, try the following tips:
Eat a low-fat diet high in fruits and vegetables. Studies suggest that dietary fat may be linked to prostate cancer. There is preliminary evidence that suggests some chemoprotectives found in foods may help reduce risk for prostate cancer. For example, lycopene , the ingredient found in tomatoes and processed tomato products that gives them their red color, may have cancer-fighting properties. Bread, cereals, grain products, rice, pasta, and beans are also recommended. These guidelines on nutrition may also lower the risk for some other types of cancer, as well as other health problems.
Exercise regularly. It may help reduce several types of cancer and help you maintain your weight, increase energy, flexibility and strength, as well as contribute to your overall mental well being.
While 75 percent of all prostate cancer cases are diagnosed in men over the age of 65, some young men are at an increased risk for prostate cancer. You are at greater risk if you:
Have a strong family history of the disease, such as two or more affected first-degree relatives, e.g., father, brother
Are an African-American man. African-American men are twice as likely to die of the disease. Prostate cancer occurs less often in Asian men than in whites.
Consume a diet high in fat, red meat and low in fruits and vegetables: Try to eat five or more servings of vegetables and fruits each day and eat less red meat and high-fat dairy products.
In the early stages of prostate cancer, when a tumor is small and contained in the prostate, there are usually no symptoms.
However, the symptoms below are associated with prostate cancer, and are often misinterpreted as benign conditions. When a prostate tumor grows, it can press on the urethra and cause one or more of the following problems:
- Frequent urination, especially at night
- Trouble starting or stopping urine flow
- Weak or interrupted urine flow
- Inability to urinate
- Pain or burning sensation while urinating
- Blood in the urine
- Constant pain in lower back, pelvis or upper thighs
- Trouble having or keeping an erection
Regardless of your age, if any of these symptoms last for more than two weeks, schedule an appointment with your health care professional immediately.
Early detection is the key to reducing your risk of advanced prostate cancer and for diagnosis of an early stage when there is a good chance for successful treatment. If you are at an increased risk for prostate cancer, talk to you health care professional about when you should begin screening. For men at average risk, these routine screening exams should be performed:
Prostate-Specific Antigen (PSA): An annual PSA blood test is recommended beginning at age 50. Men at high risk (African-Americans and men with a strong family history of prostate cancer) may need to begin screening at an earlier age. The PSA test measures a protein that is made by prostate cells. High PSA levels are associated with the presence of prostate cancer. The test alone, however, does not definitively diagnose prostate cancer. Conditions such as non-cancerous prostate enlargement and inflammation of the prostate (prostatitis) can cause a borderline or high PSA test result in men who do not have prostate cancer.
Digital Rectal Examination (DRE) : A DRE should be offered annually to men beginning at age 50. Most prostate cancers begin in the posterior part of the gland that can be reached by a digital rectal examination. During a DRE, a physician inserts a gloved, lubricated finger into the rectum to feel for any irregular or abnormally firm area that may be cancer. A DRE should be performed by a health care professional skilled in recognizing subtle prostate abnormalities. If an abnormal finding is detected during the DRE, a transrectal ultrasound will likely be recommended for a more detailed diagnosis.
Transrectal Ultrasound (TRUS): Transrectal ultrasound uses sound waves released from a small probe placed in the rectum to create an image of the prostate on a TV screen. It is often used in conjunction with a biopsy to help guide a needle into the exact area of the prostate where a tissue sample will be taken for examination under a microscope.
After diagnosis, tests will be completed to determine if the cancer has spread beyond the prostate to other parts of the body. There are a number of tests that help to stage the disease — prostate cancers are classified from Stage 1, in which the cancer is confined to the prostate, through Stage IV, in which the cancer has spread (metastasized to lymph nodes or to other organs such as the bladder, rectum, bones, liver or lungs).
Very early cancer may never be treated. Clinicians may take a watchful waiting approach because the cancer grows so slowly. Most often surgery is performed. A prostatectomy removes the entire prostate gland and some tissue around the gland. Lymph nodes around the prostate may also be removed for study under a microscope. Sometimes the surgeon does not remove lymph nodes, if the chance for spreading is considered low. When possible, surgeon will try to spare the nerves surrounding the prostate since these control erection.
Laparoscopic radical prostateomy is being used more often; it is less invasive and involves small cuts rather than a long surgical incision.
Radiation therapy is used to kill cancer cells in cases in which the disease has not spread. This might be either external beam radiation, the use of x-rays aimed outside the body, or brachytherapy, in which radioactive materials are injected into the body. Cryosurgery is sometimes used to treat the cancer by freezing cells. Cold gases are inserted into probes placed into incisions between the anus and scrotum.
Hormone therapy lowers levels of the male hormones, such as testosterone, which help prostate cells grow.
It is used when other treatments are inappropriate or in addition to surgery in men at high-risk for recurrence of disease. Hormone therapy is not a cure for prostate cancer. Orchiectomy is surgery to remove the testicles, which are the main source of male hormones.
Chemotherapy is given in cases in which the cancer has spread outside the prostate gland and hormone therapy isn't effective. It can relieve pain and slow the growth of the tumor, but isn't not a treatment for early prostate cancer.
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