Prostate Cancer: The Facts

What is it?

As the name implies, Prostate Cancer originates in the prostate, which is part of the urinary tract. The prostate is an organ in men that is found just beneath the bladder and in front of the rectum. The main function of the prostate gland is to produce and excrete a fluid that is part of semen. Semen, which contains sperm and several different fluids, is released during ejaculation. Several different hormones including testosterone regulate the prostate function. A healthy prostate is about the size of a walnut, but certain conditions can cause it to become enlarged. The majority of men, especially older men, experience enlargement of the prostate at some point during their lifetime. Enlargement is often not caused by Prostate Cancer and in many cases poses no serious health risk. However, for some men this abnormal enlargement is a result of a malignant tumor from Prostate Cancer.

Prostatic Cancer, or Prostate Cancer, is the term given to cancers that begin in the prostate. Prostate Cancer can remain isolated in the prostate gland or it can spread to other tissue and organs. The extent to which the cancer has spread upon diagnosis determines the stage. Stages are typically determined by the following criteria:

• Stage I (A) - Cancer is localized in the prostate, causes no symptoms, and cannot be detected by a rectal exam.
  
  
• Stage II (B) - The tumor has not spread outside the prostate, but it can be detected through a blood test or rectal exam.
  
  
• Stage III (C) - The cancer has spread outside of the prostate to nearby tissue.
  
  
• Stage IV (D) - The cancer has spread to distant tissue and organs.
  

Who gets it?

Females do not have prostate glands so they cannot develop Prostate Cancer. Prostate Cancer accounts for 36% of all cancers in men and 13% of cancer deaths in men. Next year in the U.S., about 184,000 men are expected to be newly diagnosed with Prostate Cancer. It is the most common cancer among men with the exception of skin cancers. Prostate Cancer can develop at any age, but occurs most commonly in men over the age of 50. Furthermore, 80% of Prostate Cancer cases occur in men over the age of 65. Race also seems to be a factor in determining the likelihood of developing Prostate Cancer. Two times as many African-Americans are diagnosed than are Caucasians.

It is not known exactly how Prostate Cancer begins, but there are certain risk factors that have been attributed to a higher chance of developing it. The primary risk factors include:

• Over 50 years of age
  
• High fat diets
  
• Family history of Prostate Cancer
  

A slightly higher percentage of men in Rhode Island develop Prostate Cancer when compared to the national average. It is currently the leading cause of cancer death among white males and the second leading cause of cancer death among black males in Rhode Island.

How is it detected?

Several diagnostic tests can be performed on a patient who experiences symptoms commonly associated with Prostate Cancer. Also, routine screenings for Prostate Cancer are recommended to increase the chances for survival. Currently accepted guidelines for Prostate Cancer screenings in men over 50 are as follows:

• PSA blood test-annually
  
• Digital rectal exam-annually
  

Men with a family history of prostate cancer or in another high risk group should begin screenings at a younger age.

Some of the most commonly used tests to determine if, and to what degree, Prostate Cancer is present are as follows:

Diagnostic Tests:

• PSA Blood test: Measures the levels of a certain protein (antigen) produced by prostate cells. Results over 10 are considered high and results between 4 and 10 are considered borderline. High test results can be a result of other conditions and are routinely found in non-cancerous older men.
  
  
• Digital Rectal Exam (DRE): The doctor inserts a gloved finger into the rectum to feel for lumps or abnormalities on the prostate. The exam is painless and only takes a short time.
  
  
• Transrectal Ultrasonography: Sound waves are emitted by a probe in the rectum to produce an image, or sonogram, of the prostate.
  
  
• Biopsy: Tissue samples are removed and examined to determine cancerous state of the cells.
  
  
• Intravenous pyelogram (IVP): A special dye is put in the blood stream and X-rays are taken to obtain a picture of the bladder and urinary tract. Used to help determine if the cause of the symptoms is something other than Prostate Cancer.
  
  
• CT, MRI and other imaging studies: Used to determine if the cancer has spread to other organs.
  
  
• RTPCR: A blood test to determine the presence of circulating prostate cancer cells. This remains somewhat experimental.
  
  
• Prostascint: This scan may be used to determine if there are microscopic cancer cells in the lymph node system.
  

Most early Prostate Cancers do not produce symptoms and are found by screening. Prostate Cancer is associated with a number of different symptoms. These symptoms usually are caused by other diseases and do not necessarily mean that cancer is present. The occurrence of any of these symptoms should be reported to a physician so that the cause can be determined and may prompt either a Digital Rectal Exam or PSA or both.

Symptoms:

• A need to urinate frequently, especially at night
  
• Difficulty starting urination or holding back urine
  
• Inability to urinate
  
• Weak or interrupted flow of urine
  
• Painful or burning urination
  
• Painful ejaculation
  
• Blood in urine or semen
  
• Frequent pain or stiffness in the lower back, hips, or upper thighs.
  

Is it curable?

When Prostate Cancer is detected before it has spread outside of the prostate it has a 95% 5-year survival rate. If the cancer has spread only to nearby tissue then there is still a high survival rate of 85-90%. Once the cancer has spread to distant organs the survival rate drops to 31%. The chances of survival are the greatest when the cancer is detected early. For this reason, it is extremely important to have screening tests and to report any symptoms.

It's easier to prevent cancer than to treat it....

Certain lifestyle and dietary habits can greatly reduce your risk of developing Prostate Cancer (as well as other cancers). Some of these include:

• Not smoking
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat diet
  

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