International Prostate Cancer Foundation
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Understanding Prostate Cancer

Education

 

Understanding Prostate Cancer

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According to the National Cancer Institute, prostate cancer is the second most common type of cancer among men in the United States.  Men with certain risk factors are more likely than others to develop the disease.
Published data suggests that one of the most important factors in treating prostate cancer is early diagnosis and accurate treatment by experienced surgeons.
Before a treatment plan is determined, however, it is important to understand the disease and to research all the options available. 

 

understanding prostate cancer

Prostate cancer strikes 1 in 7 men in their lifetime.

Nearly 164,000 patients in the United States will be diagnosed with prostate cancer in the next year.

With early diagnosis and treatment, survival rates are over 90%.

Early recovery of continence and potency is possible with the latest medical advancements and surgical experience.

What is Prostate Cancer?
Prostate cancer develops when abnormal cells in the prostate gland start to grow more rapidly than normal cells, and in an uncontrolled way. Most prostate cancers grow more slowly than other types of cancer, and even the more aggressive prostate cancers tend to grow more slowly than other types of cancer. Compared with other cancers, prostate cancer has one of the highest five-year survival rates. Many men live with prostate cancer for many years without symptoms and without it spreading. 

Early (or localized) prostate cancer means cancer cells have grown but, as far as it is possible to tell, have not spread beyond the prostate.

There are two stages of advanced prostate cancer. If the cancer grows and spreads outside the prostate gland into the seminal vesicles (glands that lie close to the prostate) or nearby parts of the body, such as the bladder or rectum, it is called locally advanced prostate cancer or progressive. Metastatic prostate cancer is when the cancer has spread to distant parts of the body such as the lymph glands or bones.

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symptoms of the disease

Typically, there are no symptoms in the early stages of prostate cancer, and even with advanced prostate cancer there may be no symptoms. Where symptoms do occur, they are often due to non-cancerous conditions, such as benign prostate hyperplasia (BPH).

Men over the age of 50 often experience urinary problems. An otherwise normal prostate may grow, which can change patterns of urine flow. This enlargement is called benign prostate hyperplasia (BPH) and is generally a normal part of aging − it is not cancer. 

Symptoms of advanced prostate cancer may include unexplained weight loss, feeling the frequent or sudden need to urinate, or pain in the lower back/pelvic area or sciatica. These are not always a sign of prostate cancer, but you should speak with a doctor if you have any of these symptoms or other urinary problems.

Call your doctor if you experience:

Frequent urination, especially at night
An urgent need to urinate
Weak urine flow
Urine flow that starts and stops (or is difficult to start or stop)
Pain or burning during urination
Blood in the urine and/or semen
Pain in the lower back, hips and thighs
Difficulty achieving an erection
Painful ejaculation


You should consult with your doctor if you experience any of the symptoms above as these symptoms can also indicate the presence of other diseases or disorders.


recurrence of the disease

When prostate cancer is caught in its earliest stages, initial therapy can lead to high chances for cure, with most men living cancer-free for five years. Although prostate cancer is highly treatable, recurrence is something that many patients are concerned about. A recurrence means that the cancer has come back, either in the same place where it originally developed or elsewhere in the body.

Prostate cancer can be slow to grow following initial therapy, and it has been estimated that up to 20-30% of men may relapse after the five-year mark and begin to show signs of disease recurrence. Recurrent prostate cancer is typically detected through prostate-specific antigen (PSA) tests and imaging scans. However, the relative survival rates remain high; 94 percent of patients live at least 15 years after their original diagnoses.

Treatment for recurrent prostate cancer is different than treatment for an initial tumor. Patients who have already undergone surgery may instead receive radiation therapy or chemotherapy as a second-line treatment; they may also consider a clinical trial. The grade and location of the recurrence, along with the original treatment plan and the patient’s health, will help determine which treatments will be used if the prostate cancer returns.

You should consult with your doctor and build the plan best for your specific case of recurrence.

PSA Progression

We typically refer to Advanced Disease as the state of prostate cancer that has grown beyond the prostate and is unlikely to be cured with surgery or radiation alone. After a man experiences PSA progression after surgery or radiation, hormonal therapy is often given at some point, and often for many years. Some men will not require any therapy, however, if their PSA doubling time is quite prolonged. However, many men will continue to progress at some point despite the above hormonal treatments and require more aggressive therapy. This comes in the form of additional second and third line hormonal therapies, investigational agents (many are in trials right now from new hormonal therapies to prostate cancer vaccines to bone-targeting drugs), and chemotherapy.


PSA screening

Visit the resources section for prevention tips, support groups, and more!

Prostate specific antigen (PSA)
Prostate specific antigen (PSA) is a protein made by both normal prostate cells and cancerous prostate cells. PSA levels are measured using a blood test. The PSA test does not specifically test for cancer. A PSA reading above the typical range for your age may indicate the possibility of prostate cancer.

The amount of PSA in blood can be raised even when a man does not have cancer. Other factors can increase PSA levels, including benign prostate hyperphasia (BPH), recent sexual activity or an infection in the prostate. In addition, some men with prostate cancer have normal PSA levels.

Because PSA levels can be variable, your doctor will often use results from more than one blood test, over time, to help determine your risk of prostate cancer. Your doctor will also compare your PSA result against other men the same age as you. 

Screening and Biopsy
The prostate cancer death rate in the United States has been nearly halved since the beginning of prostate-specific antigen (PSA)-based screening over 25 years ago. A prostate cancer screening may reveal results that prompt a doctor to recommend a biopsy. There are many other supplementary tests and considerations that can help a man who is undergoing screening decide if a biopsy is necessary, including:

Lower vs. higher free PSA test
PSA velocity (rate of rise over time)
PSA density (PSA per volume of prostate)
Family history
Ethnicity
Prior biopsy findings
Digital rectal exam results
Different forms of PSA (i.e. bPSA, pro-PSA)

In general, a lower free PSA (percentage) indicates a higher risk of finding cancer at biopsy, as does a higher PSA velocity and PSA density. 

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What is a Biopsy?
A prostate biopsy is a diagnostic test, in which a small needle is inserted into the prostate gland to obtain 12 to 14 tissue samples for further evaluation under a microscope. During a biopsy, small amounts of tissue are taken from different parts of the prostate. The samples are sent to a lab where a pathologist examines the tissue to see whether cancer cells are present. Multiple tissue samples are taken so that the pathologist can indicate the extent of the tumor in the prostate.

A biopsy is usually done with the help of a transrectal ultrasound (TRUS) probe. The ultrasound shows the shape and size of the prostate on a screen. The image helps guide the doctor to insert a thin, hollow needle into the prostate. The TRUS probe is inserted through the rectum (transrectal biopsy) or the skin between the anus and the scrotum (transperineal biopsy). Transperineal biopsies may allow better sampling of the whole prostate and reduce the risk of infection. However, the procedure takes longer, and is performed in an operating room under a general or local anesthetic.

A biopsy can be uncomfortable and for a few days there may be a small amount of blood in your urine, semen or bowel movements. You may be given antibiotics to reduce the possibility of infection. 

Where Can I Find Free Prostate Cancer Screening?
Local hospitals and local prostate cancer support groups usually either offer screening or have a list of places you can go for screening. Visit the resources section for prevention tips, support groups, and more!


results/prognosis

If the biopsy shows you have prostate cancer, other tests may be done to show the stage of the cancer; including a bone scan, MRI scan or CT scan.

Diagnostic tests will provide information about the grade and volume of the cancer. The volume is how much cancer is in the prostate. The grade tells how fast the cancer may grow. Your doctor will describe the grade using the Gleason or ISUP score.

Your doctor will also assign a stage to the cancer. This describes how advanced the cancer is. The TNM (Tumor, Nodes, Metastasis) system is used for staging. The cancer may also be staged as localized, locally advanced, advanced or metastatic.

Your doctor may talk to you about the expected outcome of the disease; this is called your prognosis.  Generally, the prognosis is better when prostate cancer is diagnosed while it is in its early stages, and at a lower grade.

You will need to discuss your prognosis with your doctor. However, it is not possible for any doctor to predict the exact course of the cancer. Test results, the extent of the spread of the cancer, and factors such as your age, level of fitness, medical and family history are important in assessing your prognosis. These factors will also help your doctor advise you on the best management or treatment options and tell you what to expect.