Prostate Cancer

Prostate cancer occurs when cells in the prostate, a male reproductive gland located between the bladder and the rectum ^* , take on an abnormal appearance and start dividing without control or order. These cancer cells often spread to nearby tissues and organs and sometimes to other parts of the body.

Christina's Story

Christina loved that her grandfather lived with her family. He certainly didn't act like most seventy-year-olds! He taught her everything she knew about basketball and shot baskets with her every night during the season. Lately, though, Grandpa admitted that he wasn't quite feeling up to playing with Christina. He often woke up feeling tired because he had to go to the bathroom several times each night.

Christina heard her grandfather tell her mother that he felt like his bladder was always full and that sometimes his urine even looked pinkish or reddish, like it might have blood in it. When Grandpa's doctor heard what his symptoms were, he told him to come in right away. The doctor ran some tests and confirmed his initial suspicion: Grandpa had prostate cancer.

When Christina heard the word "cancer," she was scared. She knew that people could die from this disease. Grandpa reassured her that there were treatments available that could help him. Plus, the doctor had said that his cancer was growing slowly and had not spread to other parts of the body. This was a very good sign.

What Is Prostate Cancer?

Prostate cancer is the most common kind of cancer and second most common cause of cancer deaths in men in the United States. It is found almost exclusively in men age 50 and older. With each decade of life after 50, a man's chance of developing prostate cancer increases. Each year, about 200,000 men in the United States find out that they have this disease.

Prostate cancer occurs when cells in the prostate gland divide without control or order, forming tumors ^* . The prostate is the walnut-sized male gland located below the bladder and in front of the rectum. The prostate surrounds the upper part of the urethra (yoo-REE-thra), the tube that empties urine from the bladder and out of the penis. This gland releases a thick fluid that helps transport sperm ^* .

Prostate cancer varies widely among men with the condition. Some men develop small, slow-growing tumors that remain within the prostate gland. Others develop fast-growing, aggressive tumors that spread quickly into the surrounding bone. They also can spread to nearby organs such as the bladder, rectum, and lymph nodes ^* . There are still other men who fit somewhere in between these two extremes. How doctors treat the disease usually depends on how rapidly the tumor is growing.

What Are the Symptoms of Prostate Cancer?

When it first starts to develop, prostate cancer usually does not cause any symptoms. That is why doctors recommend that men age 40 and older have digital rectal examinations as part of their yearly checkups. During this exam, the doctor inserts a gloved finger into the rectum and feels the prostate, which is located just on the other side of the wall of the rectum. If the gland feels hard, lumpy, or enlarged, this may be an early sign of prostate cancer.

As it continues to develop, prostate cancer may cause some of the following symptoms:

• a need to urinate frequently, especially at night
• difficulty urinating or holding back urine
• pain or burning while urinating or having sex
• blood in the urine or semen
• frequent pain or stiffness in the lower back, hips, or upper thighs.

Although these symptoms may indicate prostate cancer, they can also be caused by some other condition.

How Is Prostate Cancer Diagnosed?

Doctors usually start with a digital rectal examination. They also may take a blood sample and test it for a substance called prostate-specific antigen (AN-ti-jen), or PSA. Usually, this substance is present at abnormally high levels when a man has prostate cancer or some other problem with the prostate. Physicians may order additional laboratory tests or a urine sample to check for blood or other signs of infection.

The only sure way to know whether cancer is present is to do a biopsy (BY-op-see). The doctor uses a needle to remove a small amount of tissue from the prostate and has it examined under a microscope. The appearance of the cells will show whether cancer is present, and if so, how quickly it is likely to grow and spread. Cells that are slightly abnormal but still look a lot like healthy prostate cells suggest that the cancer is slow growing. Extremely abnormal-looking cells mean that the cancer is likely to grow and spread more quickly.

If cancer is diagnosed, the doctor may order additional tests to determine whether it has spread to other parts of the body.

How Is Prostate Cancer Treated?

Treatment depends on several different things: the man's age and general health, how aggressive the cancer is, and whether it has spread outside the prostate.

Sometimes, the best treatment is no treatment at all. This might sound strange at first, but for some older men and men with serious health problems, the possible risks and side effects of treatment may out-weigh the benefits. Also, men whose cancer is slow growing or found at an early stage may not require treatment right away. In these cases, doctors prefer to monitor the situation carefully and wait to see how the cancer develops.

When treatment is necessary, the usual methods are surgery, radiation therapy, or hormonal (hor-MOAN-al) therapy. Some patients may receive a combination of these treatments. The surgery is called radical prostatectomy (RAD-i-kal pros-ta-TEK-to-mee), and it involves removing the entire prostate gland. Sometimes, nearby lymph nodes are removed as well.

Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing and dividing. These rays might come from a machine, or they may come from radioactive material that is placed into or near the tumor. Hormonal therapy works by blocking the male hormones that the prostate cancer cells need to grow.

There are different approaches to hormonal therapy. Sometimes, surgeons might remove the testicles (TES-ti-kulz), the smooth, oval-shaped glands located behind the penis. These are the body's main source of male hormones. Doctors also might give drugs or other hormones that prevent the testicles from making testosterone (tes-TOS-ter-one).

Life after Prostate Cancer

In many men, prostate cancer can be controlled or even cured. However, the treatments often cause lasting side effects. Some men can no longer have an erection, which means that the penis no longer becomes hard during sex. Also, some men can no longer control the release of urine from the bladder. Fortunately, new treatments and surgical methods are available that may avoid these side effects. However, if these side effects occur, men may feel depressed or upset. Some men find it helpful to join a support group so they can talk to others in the same situation.

Can Prostate Cancer Be Prevented?

There is nothing a man can do to prevent prostate cancer. A diet high in fruits and vegetables and low in fat may help, but researchers have not confirmed this. Studies are under way to test certain drugs that could help to prevent prostate cancer, but no definite results are available. The best way for men to protect themselves is to see their doctors every year for checkups and report any unusual symptoms right away. Like other types of cancer, prostate cancer is easier to treat when found early.