Prostate Cancer Frequently Asked Questions

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate gland. In most men, prostate disease grows very slowly. The majority of men with low-grade, early prostate cancer (confined to the gland) live a long time after their diagnosis. However, prostate cancer is a very serious disease that may be life-threatening so it is important that you are examined and treated.

Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. A non-smoking man is more likely to develop prostate cancer than he is to develop lung, colon, rectal, bladder, melanoma, lymphoma and kidney cancers combined. In fact, a man is 35 percent more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.

Screening for prostate cancer can be performed in a physician's office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE). The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50. Men at high risk, such as African American men and men with a strong family history should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40.

Prostate cancer can only be diagnosed by the results of a biopsy. During a biopsy, a hollow needle is used to remove small tissue samples from the prostate. This is generally done in the office with local anesthesia. A pathologist will then examine the tissue samples under a microscope, checking for cancer cells.

As with all cancers, "cure" rates for prostate cancer describe the percentage of patients likely remaining disease-free for a specific time. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free.

Because approximately 90 percent of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high – nearly 100 percent of men diagnosed at this stage will be disease-free after five years. By contrast, in the 1970s, only 67 percent of men diagnosed with local or regional prostate cancer were disease-free after five years.

Age

Simply growing older increases a man's risk of developing prostate cancer. Only about 1 in 10,000 men under the age of 40 are diagnosed. However, the rate increases to 1 in 38 for ages 40 to 59, and 1 in 14 for ages 60 to 69. More than 65 percent of all prostate cancers are diagnosed in men over the age of 65.

Family History

As with breast and colon cancer, people who have family members with the prostate are more likely to get it themselves. Results from several studies suggest that family history is a major risk factor in prostate cancer. Men with a single first-degree relative – father, brother or son – with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. And, the risk is higher if the relative is diagnosed at an early age. The risk is highest in men whose family members were diagnosed before age 65.

Ethnicity

African American men are 61 percent more likely to develop prostate cancer compared with Caucasian men and nearly 2.5 times as likely to die from the disease. By contrast, Asian immigrants to the United States have much lower rates of prostate cancer.

Diet

Studies have shown that heavy intake of red meat and fatty dairy products can slightly increase the risk of developing prostate cancer.

Researchers increasingly are looking at the combined effects of hormonal, hereditary, diet, environmental, and lifestyle factors in relation to prostate cancer. For example, in countries such as China and Japan where low-fat diets are the norm, few men are diagnosed with prostate cancer. However, the incidence of prostate cancer is considerably higher among men who move from these countries to the United States, and the higher incidence persists in their sons' generation.

Some research suggests that lifestyle changes can reduce the risk of prostate cancer.

• Eat a low-fat diet including plenty of fresh fruits and vegetables. Cut back on meat and cholesterol.
• Quit smoking! Some studies have linked rapid growth of prostate tumors with smoking.
• Take good general care of your body; exercise on a regular basis, get enough rest, and reduce stress.

What Is the Prostate Gland, Where Is It, and What Does It Do?

The prostate is a walnut-sized gland that surrounds the urethra (the tube that empties urine from the bladder) in an area near the rectum. As part of the male reproductive system, the prostate makes and stores one of the components of semen. Because of its location, if the prostate grows too large, the flow of urine can be slowed or stopped.

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate.

Although these symptoms can indicate that you have prostate cancer, they are more often associated with non-cancerous conditions such as benign prostatic hyperplasia. If you are experiencing symptoms or are in a high risk group, it is important that you are checked by a physician.

When symptoms do occur, they may include:

• Frequent urination especially at night
• Weak, hesitant, or interrupted urination
• Discomfort, pain, or burning sensation during urination
• Trouble starting or holding back urination
• Blood in the urine or semen
• Difficulty in having an erection
• Painful ejaculation
• Frequent pain or stiffness in the lower back, hips, or upper thighs

Enlarged Prostate

As men age, the prostate may enlarge and block the urethra or bladder causing difficulty in urination and interference with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms for prostate cancer.

Prostatitis

Prostatitis may also cause an enlargement of the prostate, due to inflammation of the prostate gland caused by infection. Prostatitis can affect men of any age and may occur only once (acute prostatitis) or several times (chronic prostatitis). Although the condition may clear up on its own, it is important that you are checked by a physician who will likely prescribe antibiotics to treat the underlying infection.

What Treatments Are Available for Prostate Cancer?

There is a wide variety of treatment options available for men with prostate cancer, including surgery, radiation therapy, hormone therapy and chemotherapy, any or all of which might be used at different times depending on the stage of the disease and the need for treatment.

A prostatectomy is the removal of all or part of the prostate gland.

Partial Prostatectomy

Open surgery to remove part of the prostate gland, leaving the posterior portion intact. Partial prostatectomy is usually performed through an incision in the lower abdomen (retropubic prostatectomy).

Open Prostatectomy

Surgery to remove all or part of the prostate by making an incision in the patient's lower abdomen or perineum. Open prostatectomy can be either a partial or radical procedure.

Radical Prostatectomy

Open surgery to remove the entire prostate gland along with nearby tissues such as the seminal vesicles. Radical prostatectomy can be performed through an incision either in the lower abdomen (retropubic prostatectomy) or in the space between the scrotum and the anus (perineal prostatectomy).

Incontinence

After prostate surgery, some men are unable to control the flow of urine from the bladder (urinary incontinence). If the rectum is injured, men may be unable to prevent the escape of stool from the body (fecal incontinence).

Impotence

Some men may become impotent. Nerve-sparing surgery is an attempt to avoid the problem of impotence. When the doctor can use nerve-sparing surgery and the operation is fully successful, impotence may be only temporary. In some cases, however, even men who have this procedure become permanently impotent. Men can talk with their doctor about medicine and other ways to help manage the sexual effects of cancer treatment.

Lack of Sperm Production

Men who have a prostatectomy no longer produce semen, so they have dry orgasms. Men who wish to father children may consider sperm banking or a sperm retrieval procedure.