Prostate Cancer Overview

Cancer spares no organ or tissue, but some body parts are more vulnerable than others. The prostate is one such organ. This tiny gland, part of the male reproductive system, is a prominent cancer site. After skin cancer, it is the most common cancer in men in the U.S. However, it's usually a slow-growing cancer and may never require treatment if it doesn't cause symptoms.

Risk of prostate cancer increases with age. African American men and those with a family history of this type of cancer are also at greater risk.

Treatments include radiation, surgery, and hormone therapy, which can pose side effects such as erectile dysfunction or incontinence. Some men may choose to monitor the problem for signs that things are getting worse before pursuing more aggressive treatment options. Everyone's situation is different, which is why it's important to discuss the risks and benefits of treatment with a physician.

What Is it?

To understand prostate cancer, it helps to know a little bit about the prostate. This walnut-size gland in men helps produce seminal fluid. The gland itself is located in the abdomen, behind the base of the penis and in front of the rectum. The prostate surrounds the urethra, which is the channel that ferries urine and semen through the penis.

Cancer of the prostate occurs when normal prostate cells mutate and grow uncontrollably, forming a mass of tissue known as a tumor. These cell changes can occur decades before symptoms arise. A cancer that grows slowly and remains confined to the prostate may not require treatment at all. In fact, many men have prostate cancer and never know it because they don't develop symptoms. Other cancers are more aggressive. Prostate cancer cells can spread beyond the prostate gland to other body parts.

Types

The vast majority of prostate cancers are adenocarcinomas. Adenocarcinoma is a type of cancer that forms in the cells of glandular tissue.

That said, there are rare types of prostate cancer too. These include small cell carcinoma and neuroendocrine prostate cancer, which tend to be more aggressive. They may spread outside of the prostate gland more quickly.

Symptoms

Prostate cancer often lurks under the radar. Early in the disease, a man or person assigned male at birth may not have any symptoms. But as time goes on and the cancer progresses, signs and symptoms can develop, such as:

• Frequent urge to urinate.
• Weak urine stream.
• Blood in the urine or semen.
• Pain or burning with urination.
• Difficulty achieving an erection.
• Pain with ejaculation.
• Bone pain, particularly in the back, pelvis, hips, or ribs. (Usually a sign of advanced cancer.)

An enlarged prostate can cause similar urinary symptoms. This condition, called benign prostatic hyperplasia, or BPH, is very common—but it's not cancer and it won't affect a person's risk for prostate cancer.

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Causes

No one knows why cells in the prostate go rogue. But there are a number of variables that can boost the risk of developing this cancer:

Older age. It's much more common in men over 50. A majority of men are diagnosed at age 65 and older.

Family history. A male who has a brother or father with prostate cancer is at least twice as likely to develop this cancer than the general population. The risk rises with the number of first-degree relatives affected.

Genetic mutations. The risk of prostate cancer may also be higher in families with a history of breast cancer or breast cancer-related BRCA1 or BRCA2 mutations.

Race/ethnicity. African American men are more likely to get prostate cancer and to die from it.

Diet. There's some evidence that consuming a high-fat diet may boost the risk of prostate cancer. People who are obese or severely overweight can have worse outcomes.

Diagnosis

What triggers a diagnosis of prostate cancer? Usually, it's an abnormal finding on a prostate-specific antigen (PSA) blood test. This common screening test for prostate cancer may help catch early-stage disease, but it cannot tell you definitively whether you have this cancer. Sometimes bothersome symptoms are the reason for seeking a diagnosis, especially if the cancer is more advanced. Common diagnostic tests include:

• A digital rectal exam. The doctor inserts a gloved, lubricated finger inside the rectum to feel for any abnormalities.
• PSA test.
• Imaging tests, such as a transrectal ultrasound or MRI.
• Prostate biopsy.

Once prostate cancer has been detected, it's sized up based on its:

1. Grade, or how the cancer cells behave under the microscope. A higher-grade cancer is more aggressive.

2. Stage, or how the cancer is spreading. Staging factors in your PSA results, the cancer's aggressiveness, where it's located, and how far it has spread.

Treatment

Prostate cancer treatment is highly individualized. The type of treatment can depend on the grade and stage of the cancer, a person's age and overall health, and personal preferences. Treatment options range from no treatment at all to surgical removal of the prostate and surrounding tissue.

Common treatment options:

Observation (aka watchful waiting). This means monitoring changes in symptoms.

Active surveillance. Monitoring the prostate tumor for any changes that may occur. This may involve PSA testing, digital rectal exams, prostate biopsies, and imaging tests.

Radiation. This treatment may be delivered externally or internally.

Surgery. So-called radical prostatectomy involves removal of the entire prostate gland, surrounding tissue, and possibly nearby lymph nodes.

Hormone therapy. This category includes injections or pills to stop testosterone production or to block this male hormone from fueling cancer-cell growth. Surgical castration (removal of the testicles) is also considered a type of hormone therapy.

Chemotherapy. Delivering anti-cancer drugs by mouth or intravenously.

Immunotherapy. Coaxing the body's immune system to target and destroy cancer cells.

Targeted therapy. Using drugs to disrupt cancer-cell growth.

Prevention

There's no proven strategy for preventing prostate cancer, and researchers are still trying to figure out how to slow the progression of early-stage cancers. But that doesn't mean do nothing. Making healthy diet and lifestyle choices and minimizing risk factors may be beneficial. They may include:

• Losing weight if you're overweight and maintaining a healthy weight.
• Becoming and staying physically active.
• Adopting and adhering to a diet rich in vegetables, fruits, and whole grains.
• Quitting smoking.

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