Everything You Need to Know About Prostate Cancer

Table of Contents

Overview
Signs and Symptoms
Risk Factors
Screening and Prevention
When to See a Doctor
Diagnosis
Stages and Types of Prostate Cancer
Prognosis
Complications
Treatments
Living with Prostate Cancer
Outlook

Overview

Only found in males, the prostate gland produces seminal fluid, which nourishes and transports sperm. It is located below the bladder (where urine is stored) and in front of the rectum (the final portion of the large intestine).

The American Cancer Society (ACS) estimates roughly one in nine men will experience a diagnosis of prostate cancer during his lifetime. Besides skin cancer, prostate cancer is the most diagnosed cancer and the second leading cause of cancer death in American men.

Signs and Symptoms

Unfortunately, it is common for early prostate cancer to cause no symptoms, which is clinically referred to as being “asymptomatic.” As a result, most early prostate cancers are found through screening.

Due to the anatomy discussed above, the cancerous tumor often has room and time — often many years — to grow uncontrolled within the prostate gland before causing any symptoms.

Some of the signs and symptoms of prostate cancer may include:

• Trouble urinating, such as pain (dysuria), dribbling, slow or weak urinary stream, or increased frequency of urination (especially at night);
• Blood in the urine or semen;
• Trouble achieving or maintaining an erection, which is clinically referred to as erectile dysfunction;
• Low back pain, and;
• Pain with ejaculation.

In men with more advanced prostate cancer, the following signs and symptoms may develop:

• Fatigue;
• Swelling of the legs and/or feet, which is clinically referred to as edema;
• Pain in the hips, back, chest, ribs, or other areas from cancer that has spread to bones;
• Weakness or numbness in the legs or feet, and;
• Loss of bladder or bowel control, which is often caused by the cancer compressing the spinal cord; this is considered a medical emergency.

It should be kept in mind that most of these signs and symptoms problems are more likely to be caused by conditions other than prostate cancer. This includes:

• Benign prostatic hyperplasia;
• Prostatitis, or;
• A urinary tract infection (UTI).

Risk Factors

No one knows exactly what causes prostate cancer. However, the following have been established as risk factors that can increase your odds of developing prostate cancer:

• Age: Your risk for prostate cancer increases after the age of 50 with 60 percent of cases in men older than 65. On the other hand, it is rare in men younger than 40.
• Race or Ethnicity: Your risk for prostate cancer increases if you are an African American male or a Caribbean male of African ancestry, followed by being an Asian-American or Hispanic/Latino male, and lastly being a Caucasian (non-Hispanic white) male.
• Family History: Having a first-degree relative diagnosed with prostate cancer increases your risk of developing this disease by approximately two- to three-fold. Still, the majority of men diagnosed with prostate cancer are without a family history of the disease.
• Obesity: Clinically defined as a body mass index (BMI) greater than or equal to 30 kg/m². Being obese increases your chances of being diagnosed with advanced disease that may be more difficult to treat.
• Geography: According to the ACS, prostate cancer is most common in North America, northwestern Europe, Australia, and the Caribbean. Subsequently, the cancer is less common in Asia, Africa, Central America, and South America.

It’s important to keep in mind that having a risk factor — or even several — does not mean that you will develop prostate cancer or any other disease.

Screening and Prevention

Screening for any disease, including prostate cancer, is designed to find cancer in people before they have symptoms. In other words, it will probably make the diagnosis of prostate cancer at an earlier stage, rendering the cancer more treatable than if no screening were performed.

There are two methods of prostate cancer screening. They are:

1. Prostate-specific antigen (PSA) blood test, and;
2. Digital rectal examination (DRE).

It is imperative that both of these screening methods be carried out as some men with prostate cancer can have a normal PSA.

Prostate-Specific Antigen Blood Test

PSA is a protein produced by cells in the prostate gland, whether normal or cancerous. Historically, your odds of having prostate cancer increase as the PSA level increases.

Although there is no set cut-off value that can definitely tell if a man does or doesn’t have prostate cancer, many doctors use a PSA greater than or equal to four ng/mL when deciding upon the need for further testing. Most men without prostate cancer have a PSA level less than four ng/mL, although up to 15 percent of men with a PSA level less than four ng/mL will have prostate cancer upon biopsy. If your PSA level is between four and 10 ng/mL, you have a 25 percent chance of having prostate cancer. A level greater than or equal to 10 ng/mL increases your chance of having prostate cancer to more than 50 percent.

Digital Rectal Examination

During a DRE, the doctor dons gloves and inserts a lubricated finger into the rectum to feel any abnormalities in the prostate gland.

When to Begin Screening

Although early detection of prostate cancer may not reduce your chances of dying from prostate cancer, many medical societies and other medical associations have published recommendations for prostate cancer screening. It is imperative that you and your doctor have a discussion in which he/she outlines the risks and benefits of prostate cancer screening before commencing screening.

The ACS recommends prostate cancer screening commence at age:

• 50 for men who are asymptomatic and at average risk;
• 45 for African American men or men with a first-degree relative diagnosed before the age of 65, and;
• 40 for men at high-risk.

On the other hand, the American Urological Association recommends:

• No screening for men younger than 40;
• No screening for men ages 40 to 54 who are at average risk;
• Routine screening every two years for men ages 55 to 69, and;
• Suspension of screening for men older than 70.

Other Ways of Prevention

Currently, there is no evidence that prostate cancer can be prevented. Despite many of the risk factors being uncontrollable, there are some measures you can take that might lower your risk of prostate cancer.

There is some evidence that a diet rich in whole grains and high in vegetables and fruits with minimal intake of red meat may lower your risk of prostate cancer.

You may lower your risk by engaging in regular exercise. Regular exercise is defined as at least 30 minutes, four to five times per week.

Lastly, maintaining a healthy body weight — usually defined as a BMI of between 18.5 kg/m² and 24.9 kg/m² — may lower your risk of developing prostate cancer.

When to See a Doctor

It’s important to see your doctor for an evaluation if you experience any of the aforementioned symptoms — no matter how mild.

Additionally, regular prostate cancer screenings are important, particularly if you have a family history of the disease. Prostate cancer screening is also particularly important for African American males, who are 76 percent more likely to develop prostate cancer and 2.2 times more likely to die from this cancer as compared to Caucasian males.

In general, the earlier the diagnosis of prostate cancer is made, the more amenable this cancer is to treat.

Diagnosis

If you have symptoms that may be indicative of prostate cancer, your doctor is going to investigate. This investigation starts with a medical history and physical examination.

Medical History

As part of the medical history, your doctor will ask you several questions regarding your personal medical history and symptoms, such as:

• When did you first notice symptoms?
• Have your symptoms been intermittent or constant?
• What is the intensity of your symptoms?
• What seems to relieve your symptoms?
• What seems to aggravate your symptoms?

Physical Examination

The physical examination should include a DRE performed by your doctor. The DRE may reveal asymmetry or any unusual lumps or bumps in your prostate gland. In addition to the DRE, your doctor may order blood and urine tests to help further delineate the cause of your symptoms.

Based on these results, your doctor may pursue further diagnosis with additional tests and/or procedures, such as the PCA3 test, transrectal ultrasound, and biopsy. As with the great majority of cancers, a biopsy is the only method that can definitively diagnose prostate cancer.

Biopsy

A biopsy is a procedure in which very small pieces of the prostate are removed and then looked at under a microscope. The procedure is usually performed by a urologist, typically with guidance from imaging studies. A thin, hollow needle is inserted into the prostate gland by the urologist to gather samples — most often 12 from various regions of the gland — which is referred to clinically as a core needle biopsy.

The biopsy can be performed through the wall of the rectum or through the skin between the scrotum and anus. The prostate biopsy can be carried out in about 10 minutes. It is commonly performed in your doctor’s office without general anesthesia or great risk for complications.

PSA Test

The PSA blood test can be useful outside of screening, especially if you have already been diagnosed with prostate cancer.

The PSA level, along with a physical exam and staging of the tumor, can help determine your prostate cancer treatment options. Surgery and/or radiation are not always likely to be helpful treatments, especially if you have been diagnosed with advanced prostate cancer.

The PSA level can also be helpful to gauge the success of treatment, as levels typically fall with the death or removal of cancerous prostate cells. So, if you have been previously diagnosed and treated only to see your PSA levels on the rise again, this could be a sign that your prostate cancer has come back.

Stages and Types of Prostate Cancer

The stage of your prostate cancer is one of the main determinants of the best treatment course chosen by your doctor. The staging of prostate cancer utilizes the American Joint Committee on Cancer TNM (which stands for tumor, node, metastasis) system. The TNM system is based on five fundamental pieces of information:

1. The extent of the main tumor (T);
2. Spread to lymph nodes (N);
3. Spread to distant parts of the body (M);
4. PSA level at diagnosis, and;
5. Grade group.

In general, there are five stages of prostate cancer, including:

1. Stage 0: This is referred to as prostate carcinoma in situ. This stage is characterized by the presence of abnormal cells that may or may not develop into cancer.
2. Stage I: Cancers at this stage are typically small and confined within the prostate gland.
3. Stage II: Cancers at this stage are typically larger but still confined to the prostate gland.
4. Stage III: At this stage, the cancer has grown outside of the prostate gland, but has not spread to the lymph nodes or distant organs.
5. Stage IV: These cancers have spread to the lymph nodes and/or distant organs, such as the bone and lung.

In yet another staging system, the disease can be categorized as:

• Localized (Stage I prostate cancer);
• Regional (Stages II and III prostate cancer), and;
• Distant (Stage IV prostate cancer).

With regard to the types of prostate cancer, the great majority (93.75 percent) of this cancer are adenocarcinomas (develop in mucus-secreting glands). Other much rarer types of prostate cancer include:

• Sarcomas;
• Transitional cell carcinomas;
• Neuroendocrine tumors, and;
• Small cell carcinomas.

Prognosis

Most men diagnosed with prostate cancer do not succumb to the disease. In fact, there are currently more than 3.1 million survivors of prostate cancer still alive today in the United States.

The ACS utilizes information from the Surveillance, Epidemiology, and End Results database to provide five-year relative survival rates for prostate cancer. The prognosis for prostate cancer with treatment is excellent with an overall five-year relative survival rate of 98 percent. The survival rate is 100 percent for both localized and regional disease. However, it dips to around 30 percent for distant disease.

These results attest to the effective treatments available for this cancer, which are magnified when the diagnosis of the cancer is made early.

Complications

The most dreaded complication of prostate cancer — and all cancers as a whole — is metastasis or spread of cancer to other parts of the body. The most common site of metastasis for prostate cancer is bone. This can lead to broken bones and accompanying pain.

In the case of prostate cancer, metastasis may still respond to therapy, which should control, but not cure, the disease. In general, metastasis may also limit — sometimes severely — the treatment options for cancer. Some patients may be referred for hospice and/or palliative care, as this represents advanced disease with lower survival rates.

Other common complications of prostate cancer may occur both due to the disease and its treatment. These complications include:

• Urinary incontinence;
• Erectile dysfunction (ED), and;
• Depression.

These complications of prostate cancer are often treatable. For example, ED can be treated with medications, surgery, and vacuum erection devices, while incontinence can be treated with medications, catheters, and surgery.

Treatments

There are various options that can be utilized for the treatment of prostate cancer. You and your doctor will decide on the treatment option that’s best for you. This is dependent on several factors, including:

• The trajectory of cancer growth;
• Metastasis;
• Your overall level of health, and;
• Potential benefits or side effects of a particular treatment.

One of the major determinants of treatment is whether the prostate cancer is early-stage or advanced.

Treatment options for early-stage prostate cancer include:

• Watchful Waiting: Also known as “active surveillance”. Close monitoring of the cancer with periodic PSA levels, DREs, and prostate biopsies. The initiation of treatment only happens if the cancer grows or becomes symptomatic.
• Surgery: The most commonly performed surgery is a prostatectomy or removal of the prostate gland with or without the surrounding. It can be done openly with a long abdominal incision via laparoscopy, or robot-assisted.
• Radiation Therapy: This treatment option utilizes high-energy beams to kill prostate cancer cells. It can be applied externally with a machine or internally with radioactive seeds or pellets.

Treatment options for advanced prostate cancer include:

• Chemotherapy: This treatment option utilizes chemicals/drugs to kill or shrink cancer cells. It can be administered by mouth or via your veins.
• Hormone Therapy: This treatment option prevents the production or blocks the actions of the male hormone testosterone, as the growth of prostate cancer is dependent upon this hormone.

Newer treatment options for prostate cancer include:

• Cryotherapy: Freezes and kills cancer cells.
• Biologics or Immunotherapy: Stimulates your immune system to effectively detect and kill cancer cells
• High-Intensity Focused Ultrasound: Uses sound waves to kill cancer cells.

Living with Prostate Cancer

Some general recommendations for men living with prostate cancer include:

• At least 30 minutes of exercise most days of the week;
• A healthy diet with plenty of fresh fruits and vegetables, whole grains, poultry, and fish;
• Cut back on the intake of both red and processed meat and high-fat dairy products;
• Maintenance of a healthy weight, which is typically defined as a BMI between 18.5 and 24.9 kg/m², and;
• Seven to nine hours of rest per night.

Mental health while living with prostate cancer deserves special mention, as depression is a common complication of prostate cancer.

Therefore, it’s important to maintain close contact with family and friends, as they can provide much-needed support. Connecting with others who have been diagnosed with prostate cancer through support groups, whether in person or online, can also provide support.

Lastly, there has been a recent uptick in interest in supplements in the treatment of prostate cancer. However, keep in mind that vitamins, herbs, and other complementary nutritional supplements cannot prolong your life. Supplements may even shorten your life, which is why you should discuss them with your doctor before their initiation.

Outlook

Today, most prostate cancers continue to be diagnosed through routine screening at yearly checkups. Although DRE is less effective than the PSA blood test at detecting prostate cancer, it can still be helpful in finding cancers in men with normal PSA levels.

Because prostate cancer grows slowly, asymptomatic men who do not have a life expectancy of 10 or more years should not be offered screenings, as they are unlikely to receive any benefit. Still, early diagnosis of prostate cancer gives the best chances for a cure.