Understanding Prostate Cancer

Approximately 1 in 8 men will be diagnosed with prostate cancer during their lifetime, making it the second most common cancer in American men behind skin cancer, according to the American Cancer Society. That may be a shocking stat to read because you may not hear about prostate cancer all that often. It may be even more shocking when you consider the fact that breast cancer has the same diagnosis rate in American women, yet you may hear about breast cancer research, prevention and treatment more often.

That’s why we spoke with Ghufran Ahmed, M.D., an internist and physician on the medical staff at Texas Health Allen and at Texas Health Adult Care, a Texas Health Physicians Group practice, to understand more about prostate cancer.

 

What is Prostate Cancer?

The prostate is a small gland located below the bladder, and it is responsible for producing some of the fluids contained in semen, the liquid that transports sperm. Prostate cancer happens when normal cells in the prostate gland change into abnormal cells and grow out of control.

Prostate cancer is most likely to develop in older men, with most men being diagnosed after the age of 40. About 60% of cases are diagnosed in men over the age of 65, and the average age at diagnosis is about 66. While it is rare in men under 40, certain factors can increase your risk of developing prostate cancer at a younger age.

“Risk factors include increasing age, race, and family history,” Ahmed says. “African American men have the highest risk factor followed by Caucasian men. You’re also twice as likely to develop prostate cancer if you have a first-degree (father, brother or son) that has or has had prostate cancer.”

 

Symptoms of Prostate Cancer & Testing

Prostate cancer often does not present with symptoms in early stages, which makes it a tricky disease to diagnose without regular preventative screening. The most common screening test in asymptomatic men is a prostate-specific antigen (PSA) blood test, followed by a rectal exam.

“PSA is a protein made by the prostate gland and it can be high when a person has prostate cancer,” Ahmed explains. “PSA screening usually begins at age 40 and can be repeated yearly.”

High PSA levels can also be caused by other conditions such as benign prostatic hyperplasia, a prostate infection and perineal injury, so your physician may follow-up a high PSA screening with additional testing, such as a prostate biopsy, an ultrasound of the prostate, MRI scan, or other imaging tests, Ahmed adds.

Symptoms common in more advanced stages of prostate cancer can include:

  • Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night
  • Blood in the urine or semen
  • Trouble getting an erection (erectile dysfunction or ED)
  • Pain in the hips, back (spine), chest (ribs), or other areas from cancer that has spread to bones
  • Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord

It is important to keep in mind that many of these issues can be caused by something other than prostate cancer, so regular screening and additional testing are recommended.

 

Cancer Staging and Treatment

If you are diagnosed with prostate cancer, your physician(s) will work to figure out if or how far the cancer has spread. This is called staging. The clinical tumor stage varies from stage 1 to stage 4 lesions, with subgroups within these four main stages. As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage 4, means cancer has spread further in the body and may be harder to treat.

Prostate cancer treatment will depend on your stage and other factors, such as family history, your test results, and additional risk factors. While you may assume that a diagnosis of prostate cancer may need to be treated right away, Ahmed notes that active surveillance is actually quite common with prostate cancer. In fact, because prostate cancer tends to grow very slowly, some men may never need treatment.

“With active surveillance, a patient will not have treatment right away but they do have routine tests to keep an eye on cancer growth,” he explains. “If your test results change or the cancer starts to grow more quickly, your doctor will talk about active treatment then.”

Other treatment options include:

  • Surgery: Prostate cancer can sometimes be treated with surgery to remove the prostate gland.
  • Radiation therapy: Radiation kills cancer cells. Radiation can be given from a machine that moves around your body or it can be given directly into the prostate gland.
  • Hormone therapy: Male hormones in the body make prostate cancer grow. Hormone therapy reduces the levels of these hormones which can shrink the cancer.
  • Chemotherapy: Men with advanced prostate cancer might get chemotherapy if hormone therapy stops working. In some cases, chemotherapy and hormone therapy are given at the same time.

“Remember, the right treatment option or options will depend on the stage of the cancer, your age, whether you have other health problems, and how you feel about the treatment options,” Ahmed adds.

 

Outlook

While prostate cancer can be a serious disease, most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today, according to the American Cancer Society.

A relative survival rate compares people with the same type and stage of cancer to people in the overall population that do not have that same cancer. These rates come from the SEER (Surveillance, Epidemiology, and End Results) database, which is maintained by the National Cancer Institute.

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States based on how far the cancer has spread and places them into groups, similar to cancer staging. The groups are referred to as localized, regional, and distant.

  • Localized: There is no sign that the cancer has spread outside the prostate.
  • Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
  • Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

The 5-year relative survival rate for localized and regional prostate cancer is nearly 100%, which distant prostate cancer has a 5-year relative survival rate of 30%. For all SEER stages combined, the 5-year relative survival rate is 98%.

But Ahmed adds that there is an up to 50% chance of reappearance within the first two years after the completion of treatment, with a 75% recurrence within 5 years and 95% recurrence within 9 years.

“A digital rectal examination is recommended yearly for all patients after complete definitive therapy,” Ahmed says. “Additionally, a serum PSA level should also be obtained every 6-12 months for the first 5 years after treatment.”

 

Prevention

While much research still needs to be done on what can prevent someone from getting prostate cancer, leading a healthy lifestyle can’t hurt.

For now, the best advice about diet and activity to possibly reduce the risk of prostate cancer is to:

  • Get to and stay at a healthy weight.
  • Keep physically active.
  • Follow a healthy eating pattern, which includes a variety of colorful fruits and vegetables and whole grains, and avoids or limits red and processed meats, sugar-sweetened beverages, and highly processed foods.

Use our “Find a Physician” tool to find a doctor who can help you manage your prostate health.

Interested in learning more about men’s health risks? Read “Top 10 Health Risks for Men.”

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