Prostate Cancer Overview

How prevalent is prostate cancer?

Cancer of the prostate is the most common type of cancer and the second leading cause of cancer deaths among American men. It is estimated that one of every 10 American men will develop prostate cancer before age 85.

The risk of developing prostate cancer greatly increases with age. It rarely occurs in men younger than 50. The average age is 72. Black American men are at greater risk than white American men, but the reason for this is not known. The cause of prostate cancer is also unknown.

What is the function of the prostate gland?

The prostate is a male gland normally about the size of a chestnut. It secretes a milky fluid that is part of the semen needed for ejaculation. The prostate gland lies at the base of the penis, just below the urinary bladder and in front of the rectum. It surrounds the first inch of the urethra, the tube that carries urine from the bladder. Its location allows that part of the gland where most tumors occur to be felt through the rectum.

What is cancer?

Cancer is really a number of diseases caused by the abnormal growth of cells. Normally, the cells that make up the body divide and reproduce in an orderly manner so that we can grow, replace wornout tissue and repair any injuries. Sometimes, however, cells get out of control. They divide too aggressively and form masses known as tumors. Some tumors may interfere with body functions and require surgical removal, but they do not spread to other parts of the body. These are known as benign tumors. Malignant -- or cancerous -- tumors not only invade or destroy normal tissue, but by a process known as metastasis, cells break away from the original tumor and migrate to other parts of the body. There they may form more malignant tumors.

The rates of growth and spread of prostate cancer vary widely. Some tumors grow rapidly; others grow so slowly they do not even produce symptoms during a man's lifetime.

What are the risk factors for prostate cancer?

The cause of prostate cancer remains unknown. Several factors associated with a higher rate of prostate cancer, however, have been identified. The risk of developing prostate cancer increases as a man ages. Almost all patients with prostate cancer are older than 50 years old and 80 percent are over age 65. For reasons not currently known, black Americans have the highest incidence rate in the world. A family history of prostate cancer in a brother or father also doubles one's chances of getting prostate cancer. There is no convincing evidence to date that diet and nutrition play a role in developing prostate cancer.

What are the signs and symptoms of prostate cancer?

In the very early stages of prostate cancer there usually are no symptoms. When symptoms do develop, they vary according to the size and location of the tumor, and are often the same as those for benign prostate conditions. In fact, it is more likely that any of these symptoms would indicate prostate enlargement (known as benign prostatic hypertrophy), infection or other conditions rather than cancer. Still, a physician should check any symptom. Only a physician conducting the proper tests can determine for sure whether the condition is cancerous or benign. Symptoms of prostate problems include:

  • Weak or interrupted urine flow
  • Inability to urinate
  • Difficulty in starting or stopping urination
  • Need to urinate frequently, especially at night
  • Blood in the urine
  • Painful or burning urination
  • Continuing pain in lower back, pelvis or upper thighs

How can prostate cancer be detected early?

Every man over the age of 40 should have a digital rectal examination as part of his regular annual physical checkup. A gloved, lubricated finger is inserted into the rectum to feel any irregular or abnormally firm area that may indicate the presence of a tumor. Almost all prostate cancers begin in the part of the prostate gland that can be felt during a rectal examination. This exam also helps detect early rectal cancers.

In addition, the American Cancer Society recommends that men aged 50 and older have an annual prostate specific antigen blood test (PSA). If there is a family history (father or brother), screening should begin at age 40. If either digital rectal examination or the prostate specific blood test is abnormal, further evaluation should be considered. See the American Cancer Society's information on prostate cancer.

Men over the age of 40 should also stay alert to any of the urinary problems and painful conditions that could be symptoms of prostate cancer. If any of these symptoms are noticed, call our office immediately.

How is prostate cancer definitively diagnosed?

Removal of a small tissue sample and its examination under a microscope (a procedure known as a biopsy) is the ONLY way to determine conclusively if a growth is cancerous. For prostate cancer, tissue samples are usually obtained by inserting an ultrasound probe into the rectum to visualize the prostate on a TV monitor. A thin needle is placed through the probe into the prostate. This procedure is known as needle biopsy. No anesthesia is needed for a needle biopsy of the prostate. It is an outpatient procedure usually done in our office.

What are the stages of prostate cancer?

If prostate cancer is found, we will need more information about the extent of the cancer. That is, has the cancer spread farther than the prostate? The treatment of prostate cancer and the expected outcome depend greatly on the stage, or extent, of disease. Although there are several staging systems, newly diagnosed cases can generally be considered to be in one of these stages:

VERY EARLY: Stage A or Stage I

In this stage the cancer is confined to the prostate gland and cannot be felt during a rectal examination. Rather, a case such as this is detected in a patient initially having surgery for what was thought to be benign prostate disease, but whose biopsy reveals cancer. This also applies to those patients with a normal prostate exam but who are found to have cancer on an ultrasound guided biopsy. In many cases, patients with very early cancers receive no additional treatment at that time but are advised to return for follow-up exams at regular intervals.

LOCALIZED: Stage B or Stage II

These cancers are still confined to the prostate gland but are large enough to be felt during a rectal examination.

REGIONALIZED: Stage C or Stage III

These tumors have spread into the tissues immediately surrounding the prostate gland.

ADVANCED: Stage D or Stage IV

In this stage, tumors have spread to lymph nodes in the pelvis or beyond, or to other body structures, usually the bones.