Prostate Cancer

Overview 

The prostate is a walnut-shaped gland that's part of a man's reproductive system. It sits below the bladder. The size of the prostate changes with age. There are different types of prostate cancers, but most are adenocarcinomas. This cancer starts in the gland cells — the cells that make the prostate fluid that is added to the semen. There are rare types of prostate cancer, including sarcomas, transitional cell carcinomas, small cell carcinomas and neuroendocrine tumors. 

Prostate cancer causes

Researchers continue to work to uncover the causes of prostate cancer. But today, there is no known cause. Certain risk factors may contribute to the development of prostate cells becoming cancer cells. What we do know is that prostate cancer occurs when changes in the DNA of normal prostate cells happen. 

Prostate cancer risk factors

Understanding what raises your risk for certain cancers can help you make an informed decision about the risk factors you can change. Other risk factors, such as a person’s age or family history, cannot be changed.

Several factors may influence the risk of getting prostate cancer. These include:

• Age
• Ethnicity
• Exposure to certain chemicals
• Family history
• Inflammation of the prostate, including prostatitis
• Inherited gene
• Obesity
• Sexually transmitted infections
• Smoking

Prostate cancer symptoms

Many prostate cancers are found early through screening. Although early-stage prostate cancer may not cause any symptoms, more advanced prostate cancer can have symptoms, including:

• Blood in the urine or semen
• Loss of bladder or bowel control
• Pain in the hips, back, chest or other areas from cancer that has spread to the bones
• Problems urinating
• Trouble getting an erection
• Weakness or numbness in the legs or feet

Prostate cancer diagnosis

With prostate cancer screening, most prostate cancers are found early. If your doctor suspects cancer based on the results of a screening test or symptoms, more tests are needed to confirm a diagnosis. Your urologist may use the following methods to help determine the cause of your symptoms

• Medical history and physical exam - this helps doctors understand your current symptoms and how long you’ve had them.
• Digital rectal exam (DRE) - an exam that looks at the rectum and feels for any bumps or hard areas on the prostate.
• Advanced imaging - imaging such as a magnetic resonance imaging (MRI), a bone scan, positron emission tomography (PET) scan and computed tomography (CT) scan may be used to collect more detailed images of your body.
• PSA blood test - this test is called a prostate-specific antigen (PSA) test and examines the PSA protein in the blood that is made by cells in the prostate gland. High levels of PSA require more testing to look for cancer.
• Prostate biopsy - if other tests suggest a presence of prostate cancer, your urologist will likely perform a biopsy. This procedure uses an imaging test and a thin tube to remove a small piece of prostate tissue. The diagnosis of prostate cancer is made through a biopsy.

Prostate cancer treatments

One of the most important factors in treatment is the stage of prostate cancer. Staging is based on how much cancer has spread and the PSA level score when first diagnosed. For cancer that hasn’t spread, urologic oncologists determine treatment based on the growth of the tumor, your PSA level and the prostate biopsy. Age and overall health, as well as personal preferences, are also considered. Treatment may include:

• Brachytherapy - a type of radiation therapy used to treat cancer. It places radioactive sources inside the patient to kill cancer cells and shrink tumors. 
• Chemotherapy - therapy that uses drugs injected through IV, taken orally (by mouth) or applied to the skin to attack and kill cancer cells.
• Clinical trials - participation in clinical trials for prostate cancer is an effective treatment approach. There are currently almost 100 Phase III drug trials and more than 500 Phase I/II trials related to prostate cancer treatment in the United States.
• Radiation therapy - therapy that uses high-energy radiation to shrink tumors and kill cancer cells.
• Radical prostatectomy - a procedure to remove the prostate gland and tissues surrounding it. 
• Surgery - a procedure to remove cancer while preserving as much healthy tissue as possible.
• Watchful waiting - treatment that involves closely monitoring the cancer but not giving treatment unless it progresses. 

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing an oncologist for more specialized treatment.