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OVERVIEW

What is the 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.

What is prostate cancer?

Prostate cancer is when abnormal cells grow in the prostate gland. Prostate cancer is one of the most common types of cancer in men. Most types of prostate cancer grow slowly, but some types can be aggressive. This means the cancer grows quickly and can 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.

Tell your healthcare provider if you have any of the following symptoms:

• Need to urinate often, especially at night
• Strong need to urinate (urgency)
• Difficulty in starting or stopping the urine flow
• Inability to urinate
• Weak, decreased, or interrupted urine stream
• A sense of incompletely emptying the bladder
• Pain with urination
• Blood in the urine or semen
• Painful ejaculation

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.

What are the risk factors for prostate cancer?

The risk factors for prostate cancer include:

• Older age: Age is the strongest risk factor for prostate cancer. Your risk increases starting at age 50, and most cases are diagnosed in men over age 65
• Race: For unknown reasons, men of African or Caribbean descent are at higher risk.
• Family history: Men who have a father or brother with prostate cancer have an increased risk for developing prostate cancer themselves.
• Obesity: Obese men who are diagnosed with prostate cancer are more likely to have an advanced or aggressive cancer.

DIAGNOSIS & TESTS

What is prostate cancer screening?

A prostate cancer screening is a test that your healthcare provider uses to look for prostate cancer before you have any symptoms.

Should I be screened for prostate cancer?

The Canadian Task Force on Preventative Health Care (CTFPHC) recommend against routine prostate cancer screening for all men, regardless of age.  Men are encouraged to understand their risk for prostate cancer and the possible side effects of testing and treatment to make an informed choice about taking part in screening.

What prostate screening tests are available?

Prostate screening tests include:

• Digital rectal exam (DRE): 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.
• Prostate-specific antigen (PSA) test: The PSA test is a blood test that measures the level of PSA in your blood. PSA is a substance produced by the prostate. 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 you choose to be screened for prostate cancer, most healthcare providers will recommend that you have both screening tests. It’s important to remember that these tests only help your healthcare provider determine whether your prostate is healthy. An abnormal screening test result does not mean that you have cancer.

What happens if my screening test results are abnormal?

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.

What if my biopsy is normal?

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.

What if my biopsy is positive for cancer?

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.

TREATMENT

What are some of the treatment options for prostate cancer?

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:

• Active surveillance
• Radiation therapy
• Radical prostatectomy
• Hormone therapy
• Chemotherapy

What is active surveillance?

During active surveillance, 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.

What is 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 (say: “brake-ee-ther-uh-pee”).

Both types have about the same results in curing prostate cancer. Sometimes, both types are used together.

The external beam radiation therapy usually only takes about 10 minutes, but it is given 5 days a week over 8 weeks. Some people might find this time consuming. However, you don’t need any anesthesia for this kind of treatment. The side effects are milder than the side effects that can occur with seed therapy.

Brachytherapy can be done with just one hospital visit. For seed therapy, you’ll need to have anesthesia for a few minutes, but you should be able to go home right after the treatment. In brachytherapy, higher doses of radiation can be put right into the cancer. You may feel more discomfort after this treatment.

What is 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.

Other types of prostate surgery

There are several different types of prostate surgery. Some are less invasive, and each type has different risks and recovery rates. Your healthcare provider will help decide which type of surgery is the best option for you.

Your healthcare provider will talk to you about the kind of anesthesia used during surgery. You may be given general anesthesia, which puts you into a sleep-like state. Or an epidural or spinal anesthesia may be given instead. This kind of anesthesia blocks nerve routes from the spine and numbs the area.

What is the purpose of hormone therapy? Are there side effects?

The purpose of hormone therapy is to lower the level of male hormones, called androgens, which are produced mostly in the testicles. Androgens, such as testosterone, help the prostate tumor grow. Shots or pills can be given over a period of several months, or the testicles can be surgically removed. Once the testosterone is out of your body, the prostate cancer usually shrinks and new growth slows down. Hormone treatments are often used in combination with other kinds of prostate cancer treatments.

What happens after prostate cancer treatment?

Talk with your healthcare provider about how often you will need follow-up PSA blood tests or other exams.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• When should I start getting screened for prostate cancer?
• If I start having problems urinating, should I be tested for prostate cancer?
• My father had prostate cancer. Does that mean I’m more likely to get it?
• Is active surveillance the right thing for my prostate cancer?
• If we choose watchful waiting, how often will I need to come in for exams?
• What is the best treatment for my prostate cancer?
• Will I have a normal sex life after my prostate surgery?
• Will I have any problems with urinating after prostate surgery?
• How long will my treatment last?
• Are there any support groups in my area?

FOR MORE INFORMATION

Canadian Cancer Society
http://www.cancer.ca

Prostate Cancer Canada
http://www.prostatecancer.ca/

Bibliography

See a list of resources used in the development of this information:

http://familydoctor.org/familydoctor/en/diseases-conditions/prostate-cancer/bibliography.html