What is Prostate Cancer?
Prostate cancer is cancer that occurs in the prostate, a small walnut-shaped gland in male reproductive system that produces the seminal fluid. In the United States, prostate cancer is the most common non-skin cancer affecting 1 in 9 men in their lifetime. When detected early, many prostate cancers can be treated successfully.
Cancer is multifactorial, meaning there is no singular cause for the development of cancer in an individual. Prostate cancer begins when some cells in the prostate become abnormal and divide and grow more rapidly than normal cells. While normal cells continue to grow, divide, and die on a regular schedule, these abnormal cells do not die off and instead create growths or tumors. Although some growths and tumors can be benign and not lead to the development of cancer while other malignant tumors and growths can be cancerous.
There is no known cause for why some cells begin to grow abnormally and result in prostate cancer in any given man, however risk factors such as increasing age, race, family history of prostate cancer, genetic mutations, diet risk, and a sedentary lifestyle can increase one’s likelihood for developing prostate cancer.
What are the symptoms?
In early stages, prostate cancer may cause no signs or symptoms. In more advanced stages,
prostate cancer may cause some of the following symptoms:
- Changes in urination including:
- Difficulty starting or holding back urination
- Weak, dribbling, or interrupted flow of urine
- A need to urinate frequently, especially at night, some- times urgently
- Blood in the urine or semen
- Painful or burning urination
- Difficulty in having or maintaining an erection
- A decrease in the amount of fluid ejaculated
- Painful ejaculation
- Pain or stiffness in the lower back, hips, pelvis, or thighs
- Pressure or pain in the rectum
While for some these symptoms may be indicative of prostate cancer, many of these symptoms are also associated with non-cancerous conditions such as benign prostatic hyperplasia (BPH), a non-cancerous growth of the prostate. If you have any signs or symptoms that worry you, it’s important to talk to your health care provider so that the cause can be found and treated if needed.
What are the risk factors?
Age: All men are at risk of developing prostate cancer but that risk significantly increases as men age.
- The older a man is, the greater the chance he has of getting prostate cancer
- While only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 39 for men ages 40 to 59
- That rate increases to 1 in 14 for ages 60 to 69
- 40% of all prostate cancers are diagnosed in men under the age of 65
Race: While all men are at risk for developing prostate cancer, African American men are disproportionately affected by prostate cancer.
- 1 in 6 African American men will be diagnosed with prostate cancer (vs. 1 in 9 overall)
- African American men are more often diagnosed with deadlier forms of the disease and at a younger age compared to white men
- It is recommended that African American men begin screening for prostate cancer at 40
Genetics and Family History: Cancer is a family disease as genes can play a role in predisposing someone to developing cancer.
- Many of the same gene changes (mutations) that cause prostate cancer can also cause breast, ovarian, colon, and other cancers, so it is important to talk with both the men and women on both your mother’s and father’s sides of the family to understand prostate cancer risk
- Researchers have identified at least 60 genes associated with inherited cancer risk, and about 20 that are associated with prostate cancer risk
- If your family history suggests a pattern of heritable cancers, you may want to talk with your doctor about consulting a genetic counselor for further testing
- Having a father or brother with prostate cancer more than doubles a man’s risk of developing prostate cancer himself
- Men who have two or more relatives that have a history of prostate cancer are nearly 4 times as likely to be diagnosed with prostate cancer
Lifestyle Factors: Although genetics might play a leading role in influencing why one man might be at higher risk than another, improvements in diet and exercise are among the most commonly accepted strategies for prevention of prostate cancer.
- While being overweight does not appear to increase a man’s overall risk of developing prostate cancer, several studies have found that obese men may be at greater risk for having more advanced prostate cancer and of dying from prostate cancer
- Research has shown that PSA test results in obese men can be lower despite the presence of disease, potentially leading to a delay in diagnosis and treatment and that recovery from surgery tends to be longer and more difficult for men who are obese
- Studies show that men who exercise the equivalent of one to three hours of walking each week have an 86% lower risk of aggressive prostate cancer
- Three or more hours of vigorous exercise was found to lower the risk of prostate cancer death by 61%
- A heart-healthy, anti-inflammatory diet with caloric control may help prevent many cancers, including prostate cancer
- Smoking increases the risk of developing aggressive prostate cancer and dying from prostate cancer. Continuing to smoke after your treatment for prostate cancer increases the risk of prostate cancer recurrence and death
- Research has shown that stopping smoking returns the risk of dying of prostate cancer to that of someone who has never smoked
- Reduce stress
- Studies have shown that men who are overweight and who have high insulin levels when they are diagnosed with prostate cancer may be more likely to die from the disease
When should I be screened?
- In early stages, prostate cancer may cause no signs or symptoms so you do not need to wait until you notice any changes to get screened
- Since risk factors such as race and family history play such important roles in the development of prostate cancer, there is no “one-size-fits-all” approach to screening
- Talk to your doctor about beginning screenings at 40 if you have a family history of prostate, breast, colon, ovarian, or pancreatic cancer or are African American
- Talk to your doctor about beginning screenings at 45 if you have no family history and are not African American
- As with all screening tests, there are benefits and harms to prostate screening tests. It is important to talk to your health care provider about your personal risk to decide if and when beginning a screening routine is right for you
How do I get screened?
- The most common screening tool for prostate cancer is the prostate-specific antigen (PSA) test, a blood test that measures the presence of the PSA protein produced by the prostate.
- When PSA is elevated it is a warning sign that you should follow up on with your doctor for further testing as PSA levels can rise due to a number of reasons, including cancer
- The digital rectal exam, or DRE, is a routine procedure where a physician feels the surface of the prostate for abnormalities by inserting a gloved and lubricated finger into the rectum for several seconds
- A DRE is performed without using any medication because the test is generally not painful and only takes a few minutes to complete
- The DRE is used to help diagnose prostate cancer and other prostate problems such as benign prostatic hyperplasia (BPH) or prostatitis even when PSA levels are not high
How is it diagnosed?
If an initial PSA result is abnormal, further testing can help you and your doctor get a better idea if you might have prostate cancer. These test may include a combination of the following:
- A digital rectal exam (DRE), if it hasn’t been done already
- An imaging test of the prostate gland, such as MRI or transrectal ultrasound (TRUS)
- Genetic testing to assess your risk of developing prostate cancer and/or aggressive prostate cancer
- A biopsy, a procedure in which small samples of the prostate are removed and examined under a microscope, is the only way to know for sure if a man has
- prostate cancer
What are the treatment options?
- Many factors impact the decision for treatment of prostate cancer, such as the age and overall health of the patient, the aggressiveness of the cancer, and the extent of the cancer at the time of diagnosis
- For many patient there are several options to treat prostate cancer, including:
- Active Surveillance
- Prostate Surgery
- High-Intensity Focused Ultrasound (HIFU)
- Brachytherapy (radioactive seed implants)
- Radiation Therapy
- Cryotherapy (freezing of the prostate)
- Hormone Therapy
- Targeted Therapy, such as PARP inhibitors