The prostate gland is about the size of a walnut and produces the liquid that nourishes, protects, and carries sperm on ejaculation.
Prostate cancer is cancer that forms in tissues of the prostate – a gland in the male reproductive system found below the bladder and in front of the rectum. Prostate cancer usually occurs in older men.
Who is at risk?
The exact causes of prostate cancer are not known, and doctors often cannot explain why one man develops prostate cancer and another does not. However, it is clear that prostate cancer is not contagious and is impossible to "catch" it from another person.
Research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for prostate cancer:
Many of these risk factors can be avoided. Others, such as family history, cannot be avoided. You can help protect yourself by staying away from known risk factors whenever possible.
Scientists have also studied whether BPH, obesity, smoking, a virus passed through sex, or lack of exercise might increase the risk for prostate cancer. At this time, these are not clear risk factors. Also, most studies have not found an increased risk of prostate cancer for men who have had a vasectomy, i.e., surgery to cut or tie off the tubes that carry sperm out of the testicles.
Most men who have known risk factors do not get prostate cancer. On the other hand, men who do get the disease often have no known risk factors, except for growing older.
If you think you may be at risk, you should talk with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.
Screening for prostate cancer
Your doctor can check you for prostate cancer before you have any symptoms. Screening can help doctors find and treat cancer early. But studies so far have not shown that screening tests reduce the number of deaths from prostate cancer. You may want to talk with your doctor about the possible benefits and harms of being screened. The decision to be screened, like many other medical decisions, is a personal one. You should decide after learning the pros and cons of screening.
Your doctor can explain more about these tests:
The digital rectal exam and PSA test can detect a problem in the prostate. They cannot show whether the problem is cancer or a less serious condition. Your doctor will use the results of these tests to help decide whether to check further for signs of cancer. Information about other tests is in the "Diagnosis" section.
Signs and symptoms
A man with prostate cancer may not have any symptoms. For men who have symptoms of prostate cancer, common symptoms include:
Most often, these symptoms are not due to cancer. BPH, an infection, or another health problem may cause them. Any man with these symptoms should tell his doctor so that problems can be diagnosed and treated as early as possible. He may see his regular doctor or a urologist. A urologist is a doctor whose specialty is diseases of the urinary system.
If you have a symptom or test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor will ask about your personal and family medical history. You will have a physical exam. You may have lab tests. Your visit may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA level.
You also may have other exams:
You may want to ask the doctor these questions before having a biopsy:
If cancer is not found
If the physical exam and test results do not suggest cancer, your doctor may suggest medicine to reduce symptoms caused by an enlarged prostate. Surgery also can relieve these symptoms. The surgery most often used in such cases is transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. You should talk to your doctor about the best treatment option.
If cancer is found
If cancer is present, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread.
One system of grading prostate cancer uses G1 through G4. Another way of grading is with the Gleason score. The pathologist gives each area of cancer a grade of 1 through 5. The pathologist adds the two most common grades together to make a Gleason score. Or the pathologist may add the most common grade and the highest (most abnormal) grade to get the score. Gleason scores can range from 2 to 10.
Staging the disease
To plan your treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor, whether the cancer has spread outside the prostate and, if so, where it has spread.
You may have blood tests to see if the cancer has spread. Some men also may need imaging tests:
These are the stages of prostate cancer:
Recurrent cancer is cancer that has come back (recurred) after a time when it could not be detected. It may recur in or near the prostate. Or it may recur in any other part of the body, such as the bones.
A healthy, low-fat diet may help to prevent prostate cancer, and vitamin E, selenium and lycopene (found in tomatoes) may offer protection.