Prostate Cancer: Diagnosis and Prevention

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Prostate CancerDiagnosis and Prevention
By Christopher Scott 7/25/2005
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• What is the prostate?
• The prostate gland is found only in men
  therefore, only men get prostate cancer.
• It is just below the bladder and in front of the
  rectum. The urethra, the tube that carries urine,
  runs through the prostate.
• The prostate normally starts out about the size
  of a walnut. By the time a man is age 40, the
  prostate may already have grown to the size of an
  apricot by age 60, it may be as big as a lemon.
• Most cancers are named after the part of the body
  where the cancer first starts. Prostate cancer
  starts in the prostate gland.

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The Prostate
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• Main duties of the prostate gland
• One of the prostate's main duties is to create
  the seminal fluid which mixes with and carries
  sperm out of the penis upon ejaculation.
• The prostate also helps to pump the semen and
  sperm with sufficient power out of a man's body
  on its way to fertilizing a woman's egg.
• The prostate functions as a gland and contains
  muscle fibers which contract and relax

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• What is prostate cancer?
• Except for skin cancer, cancer of the prostate is
  the most common malignancy in American men.
• It was estimated that nearly 221,000 men in the
  United States will be diagnosed with prostate
  cancer in 2003.
• In most men with prostate cancer grows very
  slowly. The majority of men with low-grade, early
  prostate cancer (confined to the gland) live a
  long time after their diagnosis.
• Even without treatment, many of these men will
  not die of the prostate cancer, but rather will
  live with it until they eventually die of some
  other, unrelated cause. Nevertheless, nearly
  29,000 men have died of prostate cancer in 2003.

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• Prostate cancer
• Prostate cancer is the number-two cancer killer
  in men.
• Unfortunately, once the cells that make up
  prostate cancer have grown inside the prostate
  for a long enough time to reach a critical mass
  in size and number of cells, the cancer can
  spread outside of the prostate gland to other
  parts of the body.
• Like boiling water in a pot bubbling over,
  prostate cancer "pours" out of the prostate gland
  into the surrounding tissue.
• Once free of the prostate, the cancer cells can
  find new homes in the bones, liver, brain, lungs,
  spinal cord, or elsewhere.
• When that happens, the cancer that was simply
  annoying becomes deadly. More than 20 of all
  prostate cancers in the U.S. have moved beyond
  the prostate gland before they are detected.

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• What causes prostate cancer?
• While researchers still do not know the exact
  answer to this question, they have identified
  some risk factors. These include environment,
  genetics and family history.
• Incidence increases with age More than 70 of
  all prostate cancers are diagnosed in men over
  age 65. Information regarding first-degree
  relatives (i.e., father, brother) has shown an
  over 2- to 11-fold increase in the risk of
  prostate cancer in men who have a history of this
  disease in their family.
• The death rate for prostate cancer is more than 2
  times higher in African-American men than in
  Caucasian men. Because of additional risk,
  earlier screening for prostate cancer is
  recommended for African-American men.
• According to the American Cancer Society, men
  aged 50 and older, and those over the age of 45
  who are in high-risk groups, such as
  African-American men and men with a family
  history of prostate cancer.

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• What are some of the symptoms of prostate
  cancer?
• 9 of the most common symptoms are
• Need to urinate frequently, especially at night.
• Difficulty starting to urinate or hold back
  urine.
• Inability to urinate.
• Weak or interrupted flow of urine.
• Painful or burning urination.
• Difficulty having an erection.
• Painful ejaculation.
• Blood in urine or semen (this can also be a
  symptom of prostatitis, an inflammation of the
  prostate)

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• Who is at risk for prostate cancer?
• All men are at risk. The most common risk factor
  is age.
• More than 70 percent of men diagnosed with
  prostate cancer each year are over the age of 65.
  
• Dramatic differences in the incidence of prostate
  cancer are also seen in different countries, and
  there is some evidence that a diet higher in fat,
  especially animal fat, may account for some of
  these differences.
• Genetic factors also appear to play a role,
  particularly for families in whom the diagnosis
  is made in men under 60 years of age. The risk of
  prostate cancer rises with the number of close
  relatives who have the disease.

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• How is prostate cancer diagnosed?
• The diagnosis of prostate cancer can be confirmed
  only by a biopsy.
• During a biopsy, a urologist (a doctor who
  specializes in diseases of urinary and sex organs
  in men, and urinary organs in women) removes
  tissue samples, usually with a needle.
• This is generally done in the doctors office
  with local anesthesia. Then a pathologist (a
  doctor who identifies diseases by studying
  tissues under a microscope) checks for cancer
  cells.

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• Signs and Symptoms of Prostate Cancer
• When symptoms finally appear, they often are
  similar to those caused by prostate enlargement
• When cancer grows through the prostate capsule,
  it invades nearby tissues. It also may spread to
  the lymph nodes of the pelvis, or it may spread
  throughout the body (metastasize) via the
  bloodstream or the lymphatic system.
• Prostate cancer tends to metastasize to the bone.
  As a result, bone pain, particularly in the back,
  can be another symptom of prostate cancer.

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• What can go wrong with the prostate gland?
• Three main types of problems
• Infection - called prostatitis
• Enlargement
• Cancer
• Can afflict the prostate.
• Prostatitis is fairly common in men from the teen
  years on.

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• What is an Enlarging Prostate?
• In many men, the prostate begins to grow when
  they are in their 50s, and it may continue to
  grow for the rest of their lives. An enlarged
  prostate is usually an enlarging prostate for
  most men over age 50, which means that if your
  prostate has started to grow, it may continue to
  grow.
• As the prostate grows, it puts pressure on the
  urethrathe tube that carries urine and semen out
  of the body. This increasing pressure on the
  urethra can lead to bothersome urinary symptoms
  and future problems such as surgery on your
  prostate.
• This condition is known as Enlarging Prostate, or
  benign prostatic hyperplasia (BPH). Although
  prostate cancer can also cause the prostate to
  grow, Enlarging Prostate is not a cancerous
  condition it is not the same as prostate cancer,
  and it does not lead to cancer.
• Enlarging Prostate is not life threatening, but
  you and your doctor need to keep an eye on it so
  that it does not get worse.

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• Know the symptoms of Enlarging Prostate
• If you have an enlarging prostate, you may find
  that you likely have one or more of the following
  symptoms
• It is difficult to start urinating.
• It is difficult to empty your bladder completely,
  and because of this, urine may dribble after you
  are done.
• The stream of your urine is weak and may start
  and stop.
• You urinate more often, especially at night.
• You feel the need to urinate more often.
• You get sudden strong urges to urinate.
• You feel bothered about the difficulty your
  urinary problems are causing you.

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• What is prostatitis? 
• To put it simply, prostatitis is inflammation of
  the prostate gland. Here are some of the main
  classifications of prostatitis
• What are the symptoms of prostatitis? 
• Each type of prostatitis has a slight variation
  in signs and symptoms
• Acute bacterial prostatitis
• Fever and chills
• Pain in lower back or rectum
• Urinary symptoms
• Chronic bacterial prostatitis
• Relapsing urinary tract infections
• Painful urination or other voiding problems
• Genital pain
• Nonbacterial prostatitis
• Urinary symptoms such as difficult or painful
  urination

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• How is prostatitis diagnosed? 
• Since the prostate lies in front of the rectum,
  your doctor will most likely perform a digital
  rectal examination (DRE) by inserting a gloved,
  lubricated finger into the rectum.
• By doing this, he or she will be able to feel the
  prostate and determine if it is enlarged or if it
  has lumps or other abnormalities.
• The physician may also check for possible
  infection or other prostate or urinary tract
  disorders.

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• How is prostatitis treated? 
• Acute and chronic bacterial prostatitis is
  routinely treated with antibiotics.
• If you have nonbacterial prostatitis, your doctor
  might prescribe medications to reduce the
  difficulty in urination or anti-inflammatory
  drugs for pain.
• Lifestyle changes (diet, stress management) may
  be suggested by your doctor

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• The PSA test and others screening for prostate
  cancer
• There are four major tests for prostate cancer,
  including the well-known PSA test. These tests
  fall into two categories those that screen for
  the disease, and those that help the doctor
  determine the stage of the disease when it is
  found. Screening tests for prostate cancer
  include
• Prostate-specific antigen test (PSA test.) The
  PSA test analyzes a blood sample drawn. It checks
  the sample for PSA, a substance the prostate
  gland naturally produces to help liquefy semen. A
  small amount of PSA naturally enters the
  bloodstream. If higher-than-normal levels of PSA
  occur (above a level of 4 ng/ml), it may indicate
  prostate infection, inflammation (prostatitis),
  enlargement of the prostate glandor cancer.
• Digital rectal exam (DRE). The prostate is
  located next to the rectum. A doctor performs a
  digital rectal exam by inserting a gloved,
  lubricated finger into the rectum to examine the
  prostate. If the doctor finds any abnormalities
  in the texture, shape or size of the gland, more
  tests may be needed.

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• Urine test. A urine test checks the urine for
  abnormalities that may indicate a problem. The
  test does not detect prostate cancer, but it can
  help detect or rule out other conditions with
  similar symptoms.
• Transrectal ultrasound. If the doctor has
  concerns, he or she may use transrectal
  ultrasound to further evaluate the prostate. This
  involves inserting a small probe into the rectum.
  The probe emits sound waves to produce a picture
  of the prostate gland
• Grading Staging
• Once prostate cancer is discovered, the tumor is
  graded and staged. The grade estimates how
  aggressive a prostate cancer is how fast it is
  growing and the likelihood of its spreading.
• The staging estimates the size and location of
  the cancer (including how far it has spread).
  Grading and staging will help determine what type
  of treatment, if any, is most appropriate.

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• Grading
• The grade indicates how different the cancer
  cells appear from normal cells, when seen through
  a microscope. Sometimes you will hear the grade
  referred to as the Gleason grade. A Gleason grade
  ranges from 1 through 5.
• Prostate cancers often have areas with different
  grades. Therefore, a grade is assigned to each of
  the two areas that make up most of the cancer.
• These two grades are added together to yield a
  Gleason score of between 2 and 10. Low Gleason
  grades and scores indicate slow-growing cancer.
  High grades and scores indicate a cancer likely
  to grow aggressively.

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• Staging
• Staging is the assessment of the size and
  location of prostate cancer (that is, how far the
  cancer has already spread).
• Staging is necessary for the patient and
  physician to decide what type of treatment is
  most appropriate.
• There is more than one system for staging
  prostate cancer. The TNM system is used most
  often and gives three key pieces of information
• T refers to the Tumor. There are actually two
  types of T classifications for prostate cancer.
  The clinical stage is based on digital rectal
  exam, needle biopsy and transrectal ultrasound
  findings. The pathologic stage is based on what
  the doctor finds when the entire prostate gland,
  both seminal vesicles and, in some cases, nearby
  lymph nodes are removed and examined.
• N describes how far the cancer has spread to
  nearby lymph Nodes.
• M shows whether the cancer has spread
  (Metastasized) to other organs of the body

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• T Stages (Tumor)
• T1The tumor cannot be felt or seen with imaging
  such as transrectal ultrasound.
• T1aThe cancer is found incidentally during a
  transurethral resection (TURP) for benign
  prostatic enlargement and is present in less than
  5 percent of the tissue removed.
• T1bThe cancer is found through TURP and is
  present in more than 5 percent of the tissue
  removed.
• T1cThe cancer is found by needle biopsy done
  because of an elevated PSA level.
• T2The cancer can be felt through a digital
  rectal exam (DRE).

T2aThe cancer is in one side of the
prostate. T2bThe cancer is in both sides of the
prostate. T3The cancer has begun to spread
outside the prostate and may involve the seminal
vesicles. T3aThe cancer extends outside the
prostate but not to the seminal vesicles. T3bThe
cancer has spread to the seminal vesicles. T4The
cancer has spread to tissues next to the prostate
(other than the seminal vesicles), such as the
bladder's external sphincter (muscles that help
control urination), the rectum and/or the wall of
the pelvis.
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• N Stages (Lymph nodes)
• N0The cancer has not spread to any lymph nodes.
• N1The cancer has spread to one or more regional
  (nearby) lymph nodes in the pelvis.
• M stages (Metastasis)
• M0The cancer has not spread beyond the regional
  nodes.
• M1The cancer has spread to distant (outside of
  the pelvis) lymph nodes, bones or other organs
  such as the lungs, liver or brain.

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A-D Staging System
Stage A is early cancer. The tumor is located
within the prostate gland and cannot be felt
during a DRE.
In Stage C, prostate cancer is more advanced.
Stage C indicates that the tumor has spread
outside the prostate to some surrounding areas,
but not to other organs. This stage of cancer can
usually be detected by a DRE.
In Stage B, the tumor is considered to be within
the prostate and can be felt during a DRE.
In Stage D, the cancer has spread to the nearby
organs and usually to distant sites, such as the
bones or lymph nodes.
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How is localized prostate cancer treated? Three
treatment options are generally accepted for men
with localized prostate cancer radical
prostatectomy, radiation therapy, and
surveillance (also called watchful waiting).
Radical prostatectomy is a surgical procedure
to remove the entire prostate gland and nearby
tissues. Sometimes lymph nodes in the pelvic area
(the lower part of the abdomen, located between
the hip bones) are also removed. Radical
prostatectomy may be performed using a technique
called nerve-sparing surgery that may prevent
damage to the nerves needed for an erection.
Radiation therapy involves the delivery of
radiation energy to the prostate. The energy is
usually delivered in an outpatient setting using
an external beam of radiation. The energy can
also be delivered by implanting radioactive seeds
in the prostate using a needle. Surveillance,
taking a wait-and-see approach, may be
recommended for patients with early-stage
prostate cancer, particularly those who are older
or have other serious medical conditions.
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• How does a patient decide what is the best
  treatment option for localized prostate cancer?
• Choosing a treatment option involves the patient,
  his family, and one or more doctors. They will
  need to consider the grade and stage of the
  cancer, the mans age and health, and his values
  and feelings about the potential benefits and
  harms of each treatment option.
• Often it is useful to seek a second opinion, and
  patients may hear different opinions and
  recommendations. Because there are several
  reasonable options for most patients, the
  decision can be difficult.
• Patients should try to get as much information as
  possible and allow themselves enough time to make
  a decision. There is rarely a need to make a
  decision without taking time to discuss and
  understand the pros and cons of the various
  approaches

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• Prevention
• Doctors cannot always explain why one person gets
  cancer and another does not. However, scientists
  have studied general patterns of cancer in the
  population to learn what things around us and
  what things we do in our lives may increase our
  chance of developing cancer.
• Anything that increases a persons chance of
  developing a disease is called a risk factor
• Anything that decreases a persons chance of
  developing a disease is called a protective
  factor. For example, although you can choose to
  quit smoking, you cannot choose which genes you
  have inherited from your parents.
• Both smoking and inheriting specific genes could
  be considered risk factors for certain kinds of
  cancer, but only smoking can be avoided.
  Prevention means avoiding the risk factors and
  increasing the protective factors that can be
  controlled so that the chance of developing
  cancer decreases.
• Although many risk factors can be avoided, it is
  important to keep in mind that avoiding risk
  factors does not guarantee that you will not get
  cancer. Also, most people with a particular risk
  factor for cancer do not actually get the
  disease. Some people are more sensitive than
  others are to factors that can cause cancer. Talk
  to your doctor about methods of preventing cancer
  that might be effective for you.

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• Resources for prostate diseases
• Dealing with prostate disease involves you, your
  family and your physician. The following Web
  sites include more information about prostate
  disease and treatment options. Some of the
  organizations mentioned can put you in contact
  with prostate disease support groups. Some even
  offer meetings where you can discuss the latest
  treatments for prostate disease with other people
  diagnosed with prostate disease. Sometimes guest
  physicians are invited to the meetings to discuss
  treatment options.
• TAP Pharmaceuticals Products Inc. cannot assure
  the accuracy or timeliness of the information
  available at the following Web sites and
  information resources.
• American Association for Cancer
  Researchwww.aacr.orgThe American Association
  for Cancer Research provides research grants and
  publishes several medical journals.
• American Cancer Society [phone]www.cancer
  .orgThe American Cancer Society (ACS) can be a
  starting point for dealing with family members
  and other issues that may arise after a prostate
  cancer diagnosis. The site also includes
  information about the ACS and statistics about
  prostate cancer incidence rates.
• American Foundation for Urologic Disease (800)
  242-2383www.afud.orgThis organization is
  dedicated to the prevention and cure of urologic
  diseases such as prostate cancer through
  research, education and public awareness. The
  site includes research facts, educational
  material and advocacy information.

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• Cancer.gov(800) 422-6237www.cancer.govThis is
  a useful gateway into the National Cancer
  Institute for information. From here you can
  access a portion of the contents of PDQ the
  Physician Data Query database which provides
  detailed information about specific cancers
  written for both medical professionals and
  patients.
• Center for Prostate Disease Research
  (CPDR)www.cpdr.orgThe CPDR is a prostate cancer
  research program funded by the U.S. Army that
  conducts research nationwide at U.S. Army, Navy
  and Air Force hospitals. The Web site explains
  the program and provides education and research
  updates.
• Doctor's Guidewww.docguide.comThis site
  contains the latest medical news for healthcare
  professionals, patients, family and friends of
  those diagnosed with enlarged prostate (BPH -
  benign prostatic hyperplasia) or prostate cancer.
  
• National Coalition for Cancer Survivorship(888)
  937-6227 www.canceradvocacy.orgThe National
  Coalition for Cancer Survivorship is a grassroots
  network of individuals and organizations working
  on behalf of people with all types of cancer.
• National Institute of Diabetes and Digestive and
  Kidney Diseases (NIDDK)www.niddk.nih.govThe
  NIDDK, under the auspices of the National
  Institutes of Health, provides a site with
  answers to questions about BPH, talks about the
  lifestyle of a patient with BPH, and provides
  additional reading

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• Prostate Cancer Foundation(800) 757-2873
  www.prostatecancerfoundation.orgThe Prostate
  Cancer Foundation, an organization dedicated to
  finding a cure for prostate cancer, is the
  largest private source for research funding for
  prostate cancer. They offer information on
  prostate cancer, treatment options and clinical
  trials.
• The Prostate Pointerswww.prostatepointers.org/pro
  stateHere you will find helpful patient
  education material on prostate cancer, compiled
  from a wide variety of medical sources.
• US TOO(800) 808-7866www.ustoo.comUS TOO helps
  survivors of prostate cancer and prostate disease
  and their families lead healthy and productive
  lives. This organization offers fellowship,
  shared counseling and discussion sessions in both
  formal and informal settings.
• Book ResourceEllsworth P, Heaney J, Gill C. 100
  Questions Answers About Prostate Cancer.
  Boston, Mass Jones and Bartlett Publishers
  2003.