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OVERVIEW

What is the prostate gland?

Prostate cancer is the growth of abnormal cells in a man’s prostate gland. The prostate gland is part of the male reproductive system. The prostate makes a fluid that mixes with sperm and other fluids during ejaculation. A normal prostate is about the size of a walnut.

Prostate cancer is one of the most common types of cancer in men. Most types of prostate cancer grow slowly. However, some types can grow quickly and spread to other parts of the body. When cancer spreads, healthcare providers say the cancer has “metastasized.”

SYMPTOMS

What are the symptoms of prostate cancer?

Prostate cancer, especially in its early stages, often does not have any symptoms. Symptoms are more likely to appear as the cancer grows.

These can include:

• Difficulty urinating
• A weak urine stream
• Dribbling after you finish urinating
• A need to urinate often, especially at night
• Pain during urination
• Blood in the urine or semen
• Difficulty having or maintaining an erection
• Pain with ejaculation
• Pain or stiffness in the lower back, hips, pelvis, and upper thighs
• Unplanned weight loss and/or loss of appetite

CAUSES & RISK FACTORS

What causes prostate cancer?

Healthcare providers don’t know exactly what causes prostate cancer, but they do know that certain things may increase your risk for developing prostate cancer. These include:

• Older age: Men of any age can get prostate cancer. However, it’s most common in men older than 65 years of age.
• Black men are more likely to develop prostate cancer than Caucasian men.
• Family history: Men who have had a father or brother with prostate cancer are at increased risk of developing the disease.
• Obesity: Obese men who are diagnosed with prostate cancer are more likely to have an advanced or aggressive cancer.

DIAGNOSIS & TESTS

Prostate cancer is diagnosed with a biopsy of the prostate. A biopsy is usually done if symptoms or a screening raises concern. A prostate cancer screening is a test your healthcare provider uses to look for the disease before you have symptoms. There are two screening tests available: a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. You and your healthcare provider will decide if you need a screening. However, these tests can only tell your healthcare provider whether your prostate is healthy. Abnormal test results don’t always mean you have cancer. How often you should be screened depends on your age and your personal risk factors.

 During a DRE, your healthcare provider will put a gloved, lubricated finger into your rectum to feel your prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, your healthcare provider may suggest additional testing to check for prostate cancer.

The PSA test is a blood test that measures the level of PSA in your blood. A blood test involves inserting a small needle into a vein in your arm to take a sample of blood. The test measures the level of PSA (a substance produced by the prostate) in your blood.  Men who have prostate cancer may have a higher level of PSA in their blood. However, a PSA level can also be high because of less serious causes, such as infection or prostate enlargement. The Canadian Task Force on Preventative Health Care (CTFPHC) recommend against routine PSA-based screening for prostate cancer.

If your screening test results are abnormal, your healthcare provider may recommend other tests to determine whether you actually have cancer. Those tests may include:

• Ultrasound: A transrectal ultrasound provides your healthcare provider with an image of your prostate. During the test, your healthcare provider will insert a small probe into your rectum. This probe sends out sound waves (called ultrasound) that bounce off your prostate gland. A computer uses the sound waves to create an image of your prostate.
• Biopsy: A transrectal biopsy is when your healthcare provider removes a very small piece of your prostate to check it for cancer cells. A biopsy is the only 100% sure way to diagnose prostate cancer. During the biopsy, your healthcare provider will insert a needle through your rectum and into your prostate. The needle collects tissue from your prostate. Your healthcare provider may take tissue samples from several different areas of your prostate.

If your biopsy is normal, you do not have prostate cancer. Talk to your healthcare provider about whether another condition may have caused your symptoms or your high PSA level. Ask your healthcare provider about how often you should have checkups.

If your biopsy results are positive for cancer, the next step is for your healthcare provider to grade and stage the cancer.

Grading tells you how aggressive (fast-growing) the cancer is. Cancers with higher grades are more likely to grow and spread than cancers with lower grades. A common system of grading is called the Gleason score. Gleason scores range from 2 (not aggressive) to 10 (very aggressive).

Staging tells you how advanced the cancer is, or how far it has spread. To determine the stage, your healthcare provider may order imaging tests such as ultrasound, bone scan, computerized tomography (CT) scan, or magnetic resonance imaging (MRI). Stages I or II mean the cancer was caught early and has not spread outside of the prostate. Stages III and IV mean the cancer has spread to nearby tissues or organs, or to other body parts.

PREVENTION

Can prostate cancer be prevented or avoided?

Some risk factors, such as family history and hormone levels, can’t be prevented. However, your weight, physical activity, and diet may lower your risk for prostate cancer. Work toward a healthy lifestyle by eating the recommended daily amount of fruits and vegetables, exercising, and maintaining a healthy weight (or losing weight, if you need to).

TREATMENT

The treatment options for prostate cancer depend on your age, your overall health, and the grade and stage of your cancer. If you have prostate cancer, it is very important for your healthcare provider to monitor the growth of your cancer carefully.

Fast-growing tumors can quickly spread to other organs in the body, and this makes treatment much more difficult. But men who have slow-growing tumors may not need treatment for a long time, and some do not ever need treatment.

Common treatment options include the following:

• Watchful waiting. During watchful waiting, you have no treatment, but you see your healthcare provider often. During this time, your healthcare provider will monitor the growth of your cancer through follow-up blood tests, rectal exams, and biopsies. If there’s no sign the cancer is growing, you continue to have no treatment.
• Radiation therapy. There are 2 types of radiation therapy. In one type, called external (beam) radiation therapy, radiation is given from a machine like an x-ray machine. In another type, called internal radiation therapy, radioactive pellets (called “seeds”) are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy. Both types have about the same results in curing prostate cancer. Sometimes, both types are used together.
• Radical prostatectomy. Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. After the prostate gland is taken out through an incision, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.
• Hormone therapy. Hormone therapy lowers the level of male hormones, called androgens. These hormones are produced mostly in a man’s testicles. Androgens such as testosterone cause the prostate tumor to grow. Androgen deprivation or suppression shots or pills can be given over a period of several months. Surgery may be required to remove the testicles. Once the level of androgens is sufficiently reduced, the prostate cancer usually shrinks, and new growth slows down. Hormone treatments are often used in combination with other kinds of prostate cancer treatments. However, hormone therapy does not cure prostate cancer.
• This therapy uses drugs to damage cancer cells and make it difficult for them to grow in number. This medicine is delivered to your body through an intravenous (IV) drip. Chemotherapy is given over the course of weeks or months, depending on the severity of your prostate cancer. It has many notable side effects. The most common side effects are nausea and hair loss

Living with prostate cancer

Living with prostate cancer depends on how early you were diagnosed. Also, it depends on the type of treatment you received. For example, if you had to have your prostate removed, you may have to live with sexual dysfunction. If you had hormone or chemotherapy, you may have long-term effects from the medicines used on those treatments. Ask your healthcare provider how you can improve the quality of your life after treatment.

FOR MORE INFORMATION

Canadian Cancer Society

http://www.cancer.ca

Prostate Cancer Canada

http://www.prostatecancer.ca/