Prostate Cancer Facts

About Prostate Cancer

 Prostate cancer is the most commonly diagnosed non-skin cancer in the United States. One in six American men will develop prostate cancer in the course of his lifetime. A little-known fact is that a man is 33% more likely to develop prostate cancer than an American woman is to get breast cancer.
  

What is Prostate Cancer

The prostate is a walnut-sized gland located between the bladder and the penis and in front of the rectum. The urethra, the tube which carries urine from the bladder and out of the body through the penis, passes through the center of the prostate. The microscopic nerves that control erection are attached to both sides of the prostate as they extend to the penis. The prostate is not a vital organ; however, it is surrounded with lots of small and sensitive nerves and blood vessels that can be damaged as a result of the disease and its treatment. In some ways, it functions as “Grand Central Station” for the male reproductive and urinary systems where urine and semen must pass through the prostate to leave the body. Its importance is less related to what it does than to the problems that it creates when something goes awry.

The term “primary tumor” refers to the original tumor; secondary tumors are caused when the original cancer spreads to other locations in the body. Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect.

About Metastatic Prostate Cancer

If untreated and allowed to grow, the cells from these tumors can spread in a process called metastasis. In this process, prostate cancer cells are transported through the lymphatic system and the bloodstream to other parts of the body, where they lodge and grow secondary tumors. Once the cancer has spread beyond the prostate, cure rates drop dramatically.

The spread of cancer outside the prostate can be detected by the presence of prostate cancer cells in areas surrounding the prostate such as the seminal vesicle, lymph nodes in the groin area, the rectum and bones. When prostate cancer spreads to another site, such as bone, the new tumor is still considered to be prostate cancer, not bone cancer.

  

Prostate Cancer Symptoms

 Only rarely does early-stage prostate cancer show any symptom at all. However, men may experience some of these prostate problems as they mature:
  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

You should speak with your doctor if you have any of the above symptoms. They are usually caused by non-cancerous conditions that are treatable. But the only reliable way to find PC at an early stage, with an excellent chance of cure, is through screening.

  

Screening & Diagnosis

 A few broad-scope public health organizations proclaim that age 50 is soon enough to begin testing for PC. However, the American Urological Association Foundation (the organization of doctors most aware of the nature of the disease) as well as almost all PC survivor organizations consider a delay to that age to be risky. They, the Georgia Prostate Cancer Coalition, and the National Alliance of State Prostate Cancer Coalitions strongly support early detection of prostate cancer. We recommend that men, by age 40 (age 35 for African-Americans and men with a family history of prostate cancer), obtain a baseline prostate specific antigen (PSA) blood test along with a digital rectal exam (DRE). Continue testing regularly thereafter. These tests can be performed quickly and easily in a physician’s office, clinic, or other medical facility. Free testing is available in a number of Georgia facilities.

PSA readings which increase over time may be more important than the PSA score of one test. You should keep track of all your scores and discuss them with your physician. The results of these screens could lead to a recommendation for a biopsy of prostate tissue. If cancer is found, it is analyzed for the degree of aggressiveness. The degree of aggressiveness is portrayed by a Gleason Score or grade, which will be an important factor in your treatment decision.

About The PSA Test

PSA is an enzyme produced in the prostate that is found in the seminal fluid and the bloodstream. An elevated PSA level in the bloodstream does not necessarily indicate prostate cancer, since PSA can also be raised by infection or other prostate conditions such as BPH (benign prostate hyperplasia). Many men with an elevated PSA do not have prostate cancer.

It is important to note that the PSA test is an imperfect screening tool. A man can have prostate cancer and still have a PSA level in the “normal” range. Approximately 25% of men who are diagnosed with prostate cancer have a PSA level below 4.0. In addition, only 25% of men with a PSA level of 4–10 are found to have prostate cancer. With a PSA level exceeding 10, this rate jumps to approximately 65%.

About The Digital Rectal Exam

The digital rectal exam should be performed along with the PSA test. The DRE is performed by a physician who will insert a gloved finger into the rectum to feel the peripheral zone of the prostate where most prostate cancers occur. The physician will be checking for hardness of the prostate or for irregular shapes or bumps extending from the prostate – all of which may indicate a problem. The DRE is particularly useful because the PSA test may miss up to 25% of cancers, and the DRE may catch some of these.

  

Gleason Grade

 The Gleason Grade refers to the degree of aggressiveness of a particular tumor based on the appearance of the tissue under a microscope. The Gleason grading system assigns a numerical score to each of the two largest areas of cancer in the tissue samples. The lowest possible combined Gleason Grade is 2, and the highest possible Gleason Grade is 10.

How Is It Determined/Calculated?

The Gleason grading process assigns a number ranging from 1–5 based on the degree of “cell differentiation” within the tissue sample from very well differentiated (i.e., least cancerous, most normal looking [grade 1] to very poorly differentiated and most cancerous [grade 5]).

Gleason Grades 1 and 2 closely resemble normal prostate tissue – in which the cells appear round, orderly and with defined borders. In grade 2, the cells are more loosely aggregated.

In Gleason Grade 3 cells are beginning to lose their defined borders and are starting to group together into clumps.

Gleason Grade 4 is identified by loss of normal cell structure and a more pronounced clumping together of cancerous cells.

Gleason Grade 5 means that the cells have lost most or all of their normal characteristics are very poorly differentiated and have essentially merged together into cancerous islands of cells.

Treatment

Over the years, a wide array of treatments for prostate cancer have been developed including surgery, radiation, hormone deprivation therapy, chemotherapy, dietary changes and the use of various herbal supplements. Deciding which of these treatments to select is a difficult decision. Prostate cancer is a complex heterogeneous disease that acts differently in different men. Fortunately, for most men, most prostate cancer grows very slowly. The slow rate of growth, however, coupled with the widely varied presentation, has made it difficult, if not impossible, to determine scientifically which treatment is best for which man.

Which Treatment Is Right For You?

Since there is no “one size fits all” treatment, each man must learn as much as he can about various treatment options and, in conjunction with his physician, make his own decision about what is best for him. It may be reassuring to know that 86% of all prostate cancers are diagnosed in the local and regional stages and that the 5-year relative survival rate for men whose prostate cancer is diagnosed at this early stage is nearly 100%. Additionally, according to the most recent data, the relative 10-year survival rate is 86%, and the 15-year survival rate is 56% (ACS Cancer Facts & Figures, 2004). A variety of factors that must be considered and evaluated before deciding on a treatment plan (or no treatment at all) include the stage of the prostate cancer, age, other health issues and the patient’s willingness to undergo certain procedures or therapies – some of which may have side effects.

The key is to collect as much information as possible before making a final decision – and if you are being encouraged to pursue one particular treatment by your physician, it may be valuable to get a second or third opinion, just to be sure that you have received a balanced view of your particular situation. Keep in mind that second and third opinions can sometimes be confusing because you may receive conflicting advice or opinions. That is why it is important to gather as much information about your particular cancer and the various treatment options as possible, so you can make an informed decision about which treatment is best for you.

Making a decision regarding treatment can be helped by talking with a spouse, friends, family and other men who have prostate cancer. When speaking with other men with prostate cancer, however, it is important to remember that their circumstances (including the grade and stage of their cancer) may be very different from yours. The treatment decisions that they have made may not be appropriate for you.

  

Treatment Options 

  • Watchful Waiting
  • Surgery
  • Radiation
  • Cryotherapy
  • Hormonal Therapy

Choosing the best treatment for localized prostate cancer is generally based on the man’s age, the stage and grade of the cancer, the man’s general health and the man’s evaluation of the risks and benefits of each therapy option.

While there have been many studies of this, no local treatment option has been shown to have a distinct survival advantage for all patients. However, physicians may prefer a specific treatment depending on their specialty. One study found that 93% of urologists recommended surgery (also known as “radical prostatectomy”); and 72% of radiation oncologists recommended radiation. Patients should always seek a second opinion or the opinion of different specialists (e.g., urologists, radiation oncologists and medical oncologists) if they are uncertain about which treatment to pursue. Additionally, watchful waiting, in which PSA levels are monitored but no treatment is performed, may be an option for some men