Know the risk. Beat the odds.
What is the prostate?
The prostate, found only in men, is a walnut-sized gland located in front of the rectum, at the outlet of the bladder. It contains gland cells that produce some of the seminal fluid, which protects and nourishes sperm cells in semen. Just behind the prostate gland are the seminal vesicles that produce most of the fluid for semen. The prostate surrounds the first part of the urethra, the tube that carries urine and semen through the penis.
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What is cancer?
Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells.
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What is prostate cancer?
Prostate cancer is an abnormal growth of cells in the prostate gland. Most of the time, prostate cancer grows very slowly. However, some types of prostate cancer 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. Although the only way to know for sure is with a biopsy, the first step in detection is screening.
Cancer cells often travel to other parts of the body, where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells get into the bloodstream or lymph vessels of our body. When cells from a cancer such as prostate cancer spread to another organ, the cancer is still called prostate cancer.
In addition to prostate cancer, other conditions of the prostate can cause trouble. One is Benign Prostatic Hyperplasia or BPH, which is an enlarged prostate and generally a condition of aging. It can cause frequent, slow urination. One-third of all men experiencing BPH will need treatment that may include medication or surgery. Another is prostatitis, or inflammation of the prostate, which, depending on the cause, may be treated with antibiotics or anti-inflammatories.
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What are the statistics?
Prostate cancer is the most common cancer, excluding skin cancers, in American men. The Arkansas Central Cancer Registry estimates that in 2008, 1,980 new cases of prostate cancer will be diagnosed in Arkansas, and 360 will die of the disease. One man in six will be diagnosed with prostate cancer during his lifetime. African-American men are more likely both to have prostate cancer and to die from it than are Caucasian or Asian men.
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Am I at risk?
Although we do not yet completely understand the causes of prostate cancer, researchers have identified several factors that increase the risk of developing this disease:
- Age: The chance of having prostate cancer increases rapidly after age 50. More than 70% of all prostate cancers are diagnosed in men over the age of 65.
- Ethnicity: Prostate cancer occurs almost 70% more often in African-American men than it does in Caucasian men. Compared with men of other races, African-American men are more likely to be diagnosed at an advanced stage. African-American men are twice as likely to die of prostate cancer as Caucasian men are.
- Family history: If a close relative has prostate cancer, a man’s risk of the disease more than doubles. With two relatives, his risk increases five times. With three close relatives, his risk is about 97%.
- Diet: Men who eat a lot of red meat and have a great deal of fat in their diet appear to have a greater chance of developing prostate cancer. These men also tend to eat fewer fruits and vegetables and more dairy products. Doctors are not sure which of these factors is responsible for increasing risk. Therefore, proper diet and exercise are important.
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Can I reduce my risk of prostate cancer?
Current information on prostate cancer risk factors suggests that some cases might be prevented. One possible risk factor that can be changed is diet. You may be able to reduce your risk of prostate cancer by eating a diet low in fat and high in vegetables, fruits and grains.
The American Cancer Society recommends eating a variety of healthful foods, with an emphasis on plant sources, and limiting your intake of red meats. Eat five or more servings of fruits and vegetables each day. 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.
Tomatoes (raw, cooked or tomato-based products such as sauces or ketchup), grapefruit and watermelon are rich in lycopenes. These vitamin-like substances are antioxidants that help prevent damage to DNA and may help lower prostate cancer risk.
Taking vitamin or mineral supplements may reduce your prostate cancer risk. Some studies suggest that taking 50 milligrams (or 400 International Units) of vitamin E daily can lower risk. Although other studies found vitamin E to be of no benefit, reasonable doses of this vitamin have no significant side effects and are not expensive. Selenium, a mineral, may also lower risk.
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What are the symptoms of prostate cancer?
In most cases of early prostate cancer, there are NO symptoms or warning signs. Some advanced prostate cancers can slow or weaken your urinary stream or make you need to urinate more often. However,
benign diseases of the prostate such as an enlarged prostate or infection can also cause these symptoms.
If the prostate cancer is advanced, you might also develop
hematuria,
impotence, painful ejaculation or pain in your pelvic bone, spine, hips or ribs. Keep in mind that other conditions can also cause these same symptoms.
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How is prostate cancer found?
Screening involves looking for cancer before a person has any symptoms. This can help detect cancer at an early stage. When doctors find abnormal tissue or cancer early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.
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Are there risks of prostate cancer screening?
Although timely diagnosis and treatment of prostate cancer may help some men live longer, it may not affect the life span of other men. A prostate cancer screening may not improve your health or help you live longer if you have advanced prostate cancer or if it has already spread to other places in your body. Men with a life expectancy of less than 10 years do not need an early diagnosis of prostate cancer, because some prostate cancers never cause symptoms or become life-threatening.
There may be side effects of prostate cancer treatments that affect a man’s quality of life, including problems of major surgery,
incontinence, and
impotence. There are many factors to consider when making treatment decisions.
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Can false-negative and false-positive test results occur?
Sometimes,
PSA screening test results may appear to be normal even though prostate cancer is present. A man who receives a false-negative test result may delay seeking medical care even if he has symptoms.
PSA screening test results may also appear to be abnormal even though no cancer is present. A false-positive test result can result in anxiety and additional diagnostic tests.
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Should I be screened?
Since the use of early-detection tests for prostate cancer became relatively common (about 1990), the prostate cancer death rate has dropped. However, it has not been proven that this is a direct result of screening. Studies are under way to try to prove that early-detection tests for prostate cancer in large groups of men will lower the prostate cancer death rate. Until that information is available, whether or not you have the test is something for you and your doctor to decide. Things to consider are your
age and health. If you are young and develop prostate cancer, it will probably shorten your life if it is not caught early. If you are older or in poor health, then prostate cancer may never become a major problem because it is generally a slow-growing cancer.
Although medical experts disagree on the benefits of screening, they all agree that every man needs balanced information on the pros and cons of prostate cancer screening.
Some, such as the American College of Physicians, the Canadian Task Force on Preventive Health Care, and the U.S. Preventive Services Task Force, do not recommend regular screening. They believe that some of these cancers may never affect a man’s health and treating them could cause temporary or long-lasting side effects such as
impotence and
incontinence. Since they believe it is unclear if the potential benefits of screening outweigh the known side effects of treatment, they recommend giving all men information on the pros and cons of screening before making their own screening decision. They want more evidence that finding early-stage prostate cancer, and treating it, saves lives.
The American Urological Association, American College of Radiology, and College of American Pathologists believe current scientific evidence shows that finding and treating prostate cancer early, when treatment might be more effective, may save lives. They recommend that all men who have a life expectance of at least 10 years should be offered the PSA and the DRE annually. They also recommend offering screening tests earlier to African-American men and men who have a father or brother with prostate cancer.
The National Comprehensive Cancer Network (NCCN), made up of world-class cancer treatment centers, concludes that the rate of increase in the prostate specific antigen blood test (PSA) is even more important than the actual score in finding aggressive prostate cancer. This is known as PSA velocity, or PSAV. The NCCN and the Arkansas Prostate Cancer Foundation Medical Advisory Committee recommend establishing a baseline score at age 40.
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What is grading?
Almost all pathologists grade prostate cancers according to the Gleason system. This system assigns a Gleason grade from 1 to 5 based on how much the arrangement of cells in the cancerous tissue looks like normal prostate tissue.
If the cancerous tissue closely resembles normal prostate tissue, a grade of 1 is assigned. If the cancer lacks these features and its cells seem to spread haphazardly through the prostate, it is called a grade 5 tumor. Grades 2 through 4 have intermediate features.
Because prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added together to yield the Gleason score (also called the Gleason sum) between 2 and 10. The higher your Gleason score, the more likely it is that your cancer will grow and spread rapidly. Scores of 2 through 4 are often grouped together as low, 5 and 6 are called intermediate, and scores of 7 to 10 are considered high.
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What is staging?
A staging system is a standardized way in which the cancer care team describes the extent to which a cancer has spread. While there are several different staging systems for prostate cancer, the most widely used system in the United States is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer (AJCC).
The TNM System describes the extent of the primary tumor (T stage), whether or not the cancer has spread to nearby lymph nodes (N stage), and the absence or presence of distant metastasis (M stage).
There are 4 categories for describing the prostate tumor’s (T) stage, ranging from T1 to T4.
- T1: Your doctor cannot feel the tumor or see it with imaging such as transrectal ultrasound.
- T2: Your doctor can feel the cancer when a digital rectal exam (DRE) is done, but it still appears to be confined to the prostate gland.
- T3: The cancer has begun to spread outside your prostate and may involve the seminal vesicles.
- T4: The cancer has spread to tissues next to your prostate (other than the seminal vesicles), such as your bladder's sphincter (muscles that help control urination), your rectum, and/or the wall of your pelvis.
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