The prostate gland is a small, walnut-sized organ of the male reproductive system that is located underneath the urinary bladder (which is the organ where urine is collected and stored) and in front of the rectum or the lower end of the bowel. The prostate gland secretes a sticky and clear fluid that is necessary for the nourishment and transport of the male sex cells known as sperm. The sperm is mixed with seminal fluid and secretions from the prostate gland. This mixture is transported through the urinary tract, which runs directly through prostate gland.

Prostate Cancer

Cancer is defined as the abnormal or uncontrolled growth of cells. When these cells break off, travel to other parts of the body, and continue this growth at another location, the process is called metastasis.

Normally, cells just grow, divide, and die; but when these cells mutate, they may grow and divide faster without dying. These abnormally large cells can then clump together to form tumors. If these tumors are able to damage other healthy cells and tissue, then they are called malignant tumors. If they continue to grow but do not cause any harm to other cells, then they are called benign tumors.

When abnormal cell growth occurs in the prostate gland, it is called cancer of the prostate. These cancerous cells can become aggressive and travel to other parts of the body (which is known as metastasized prostate cancer).

Risk Factors

• Age: The risk increases with age. Men above the age of 50 are at higher risk.

 

• Ethnicity: African-Americans are at higher risk, though the reason is unknown.

 

• Family history: Any man with immediate family members who currently have prostate cancer or have suffered from the disease in the past are at higher risk.

 

• Overweight: Those who are obese or overweight may have an increased risk of developing prostate cancer.

Symptoms

There are usually no symptoms of prostate cancer during its early stages. As the cancer advances, a person may experience difficulty in urination or may urinate frequently (particularly at night). They may also notice reduced urine flow or experience pain while urinating. There could even be blood or pus in the urine.

In addition, blood may be present in semen and a man may experience substantial pain while ejaculating. Tumors may cause swelling in the legs or pain in a hip, lower back, or lower pelvic region. A man may also lose his appetite and experience unusual weight loss.

Screenings and Diagnosis

In most instances, prostate cancer is discovered during a routine screening. Many medical organizations recommend considering prostate cancer screenings for men above the age of 50. But these screenings are not without controversy. There are risks associated with prostate screenings such as infection, bleeding, erectile dysfunction, bowel dysfunction, impotence, and incontinence. Furthermore, most prostate cancers spread slowly, never move outside of the prostate, and may not require treatment if found. Some doctors therefore believe that risks of testing and treating certain cases of prostate cancer may exceed the benefits.

Other experts argue that screening tests are an important life-saving tool. If detected early, the more aggressive cancers that do require treatment may be stopped with greater ease. It is not certain whether the decrease in prostate cancer related deaths can be attributed to prostate-specific antigen (PSA) cancer screenings and associated treatments, but the two may be an indicator that early detection and treatment have paid off for some men.

Determining which men will benefit from prostate cancer exams and treatments is difficult, but age and family history may be considered. Before suggesting extensive treatment to patients who have been screened and diagnosed with prostate cancer, some doctors suggest an approach of watchful waiting or active surveillance, especially in older adults. Because their life expectancy is lower and because they are more likely to have health problems that can make treatment less beneficial, waiting may be a good option for elder patients. Consult with a doctor before undergoing screening exams or treating prostate cancer.

Those who decide to undergo testing, PSA exams are a common approach. The PSA exam tests blood for a protein produced by the prostate gland that is found in the blood and semen. If a high PSA level is found in the blood, it may indicate an infection, inflammation, enlargement, or cancer of the prostate.

But a lower PSA level does not guarantee the absence of prostate cancer. About 15 percent of men with a PSA level lower than four and 25 percent of men with levels between 4 and 10 have biopsies that indicate cancer is present. For this reason, men who have borderline PSA levels – those ranging between four and 10 (ng/mL) – will usually be asked to undergo further PSA testing. This can include:

• A percent free PSA, which measures not only the level of PSA in the blood but also how much is bound to other proteins

 

• A PSA density, which determines the ratio of PSA to the size of the prostate

 

• An age-specific PSA that takes into account the PSA as it relates to the patient’s age

 

• A PSA velocity that measures the rate at which PSA levels rise over time; Results for the PSA velocity exam are delayed as a patient will have to be retested to determine if PSA levels rose over time

A digital rectal exam (DRE) is another test for an initial diagnosis of prostate cancer. The doctor notes the texture, size, and shape of a man’s prostate by inserting a gloved, lubricated finger into the rectum and examining the adjacent prostate gland. If any abnormalities are noticed then further tests may be necessary. This exam can infrequently find cancer in individuals who received normal results on the PSA exams but it is less effective than PSA tests.

If irregularities are found during DRE & PSA tests, a doctor may ask a patient to undergo other tests to determine whether or not prostate cancer is present.

• Ultrasound: Sound waves are used to check for any abnormality in the prostate. This is done by inserting a cigar-shaped probe into the rectum that sends sound waves to the adjacent prostate to check for any anomalies in the gland.

 

• Prostate biopsy: If an initial test indicates prostate cancer, then the doctor may suggest a prostate biopsy, which involves obtaining samples of the suspected cancer cells. A needle is inserted into the prostate, and samples of the suspect cells are drawn out and analyzed for cancer.

If the doctor suspects that the cancer has spread, he or she might require specialized tests that are designed to locate the cancerous cells in other parts of the body. These tests may include:

• Bone scan- Radioactive materials are used to measure gamma radiation from the bones.

 

• Computerized tomography (CT) scan- Three-dimensional images are taken to search for the presence of cancer.

 

• Magnetic resonance imaging (MRI) scan- A powerful magnetic field is employed to find tumors and other evidence of cancer.

Prostate cancer can be graded based on the differences between normal prostate cells and cancerous prostate cells. Based on these differences, prostate cancer is graded as follows:

• Stage I: The cancer is in its initial stages, affecting only a small portion of the prostate.

 

• Stage II: The cancer has spread, but is still confined to the prostate gland.

 

• Stage III: The cancer has spread to other adjacent areas of the body like the rectum or urinary tract.

 

• Stage IV: The cancer has spread to lymph nodes, lungs, bones, and bodily organs.

If prostate cancer is in the early stages and has not spread to other parts of the body, then an active surveillance (also known as waiting and watching) approach may be an option. This process does not involve any medications or surgery; the patient will be closely monitored with digital rectal exams, blood tests, and repeat biopsies to test for any sudden and abnormal development of cancerous cells. The patient is asked to submit to regular doctor visits, blood tests for PSA levels every one to three months, and rectal examinations and biopsies every two to three years. This approach is mainly recommended for older patients with other health issues.

If the cancer does begin to spread, then more aggressive treatment options such as surgery, radiation, and chemotherapy may be needed. These treatments are used to control the spread of the cancer. Side effects of such treatments can include an inability to ejaculate or control urination. These side effects may disappear once the treatments are completed, but that is not always the case.

According to the National Cancer Institute (NCI), nearly 9 out of 10 prostate cancers are found in the early, “local” stage when they have not yet spread outside of the prostate. In this group as well as in the group of people diagnosed once the cancer has spread to areas near the prostate, the five-year survival rate is 100 percent. This means that diagnosed individuals survive for at least five years, frequently longer. If the cancer is found after it has spread to other organs, bones, or the lymph nodes, the five-year survival rate is 31 percent. Overall, 98 percent of individuals with prostate cancer live for a minimum of five years after diagnosis. The survival rates for prostate cancer have increased in recent years. This change may be attributed to screening and treatment as well as to finding the cancers at an earlier stage and treating them with a less aggressive approach.

Prostate Cancer Can Be Treated

Early-stage prostate cancers are typically not life threatening. However, some men do benefit from treatment.  Men with a more advanced disease are at increased risk of death, and therefore treatments are nearly always recommended for cases of advanced prostate cancer. 

Though life with prostate cancer can be challenging and uncomfortable, medical technology has advanced to the point where the likelihood of succumbing to the disease is much lower than it was a generation ago.