Men's Health; What you Need To Know About Prostate Cancer
What Is Prostate Cancer?
The prostate is a gland in the male reproductive system. It makes most of the semen that carries sperm. The walnut-sized gland is located beneath the bladder and surrounds the upper part of the urethra, the tube that carries urine from the bladder.
Prostate cancer is a major health concern for American men. The disease is rare before age 50, and experts believe that most elderly men have traces of it.
The American Cancer Society predicts that 220,800 new cases of prostate cancer would be diagnosed in 2015. An estimated 27,640 men will die of it. African-American men are more likely to get prostate cancer and have the highest death rate. Other than skin cancer, prostate cancer is the most common cancer in American men. In other parts of the world - notably Asia, Africa, and Latin America - prostate cancer is rare.
Prostate cancer is usually a very slow growing cancer, often causing no symptoms until it is in an advanced stage. Most men with prostate cancer die of other causes, and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads outside the prostate, it is dangerous.
Prostate cancer in its early stages (when it’s only found in the prostate gland) can be treated with very good chances for survival. Fortunately, about 85% of American men with prostate cancer are diagnosed in an early stage of the disease.
Cancer that has spread beyond the prostate (such as to the bones, lymph nodes, and lungs) is not curable, but it may be controlled for many years. Because of the many advances in available treatments, most men whose prostate cancer becomes widespread can expect to live five years or more. Some men with advanced prostate cancer live a normal life and die of another cause, such as heart disease.
What Causes Prostate Cancer?
Prostate cancer affects mainly older men. About 80% of cases are in men over 65, and less than 1% of cases are in men under 50. Men with a family history of prostate cancer are more likely to get it.
Doctors don’t know what causes prostate cancer, but diet contributes to the risk. Men who eat lots of fat from red meat are most likely to have prostate cancer. Eating meat may be risky for other reasons: Meat cooked at high temperatures produces cancer-causing substances that affect the prostate. The disease is much more common in countries where meat and dairy products are common than in countries where the diet consists of rice, soybean products, and vegetables. Hormones also play a role. Eating fats raises the amount of testosterone in the body, and testosterone speeds the growth of prostate cancer.
A few job hazards have been found. Welders, battery manufacturers, rubber workers, and workers frequently exposed to the metal cadmium seem to be more likely to get prostate cancer.
Not exercising also makes prostate cancer more likely. Adding certain foods in your diet may help reduce the risk, including tomato sauce and vegetables like broccoli, cauliflower, and cabbage.
Prostate Cancer Risk Factors
All men are at risk for developing prostate cancer. About one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 36 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer cells in their prostate. Besides being male, there are other factors, such as age, race, and family history that may contribute to the risk.
Age. The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after the age of 40 in black men and men who have a close relative with prostate cancer. About two-thirds of all prostate cancers are diagnosed in men age 65 and older. The older the patient, especially if they are over 70, the less aggressive the disease usually behaves.
Family history. Men whose relatives have had prostate cancer are considered to be at high risk. Having a father or brother with the disease more than doubles your risk for prostate cancer, according to the American Cancer Society. Having a brother with prostate cancer appears to increase your risk more than having an affected father does. That risk is even higher when there are multiple family members affected. Screening for prostate cancer should be started at age 40 in these men.
Studies have identified several inherited genes that appear to increase prostate cancer risk. Testing for most of these genes is not yet available. Experts estimate that the hereditary form of prostate cancer accounts for just 5% to 10% of all cases.
Race. Prostate cancer occurs about 60% more often in African-American men than in white American men, and when it is diagnosed, the cancer is more likely to be advanced. However, Japanese and African males living in their native countries have a low incidence of prostate cancer. Rates for these groups increase sharply when they immigrate to the U.S. African-Americans are the second group of men for whom prostate cancer testing should begin at age 40.
Some experts theorize that this suggests an environmental connection, possibly related to high-fat diets, less exposure to the sun, exposure to heavy metals such as cadmium, infectious agents, or smoking. To date, the reasons for these racial differences are not understood.
Diet. Research also suggests high dietary fat may be a contributing factor for prostate cancer. The disease is much more common in countries where meat and dairy products are dietary staples compared to countries where the basic diet consists of rice, soybean products, and vegetables.
How Can Prostate Cancer Be Prevented?
There is no evidence that one can prevent prostate cancer. But you may be able to lower your risk. A diet that helps maintain a healthy weight may reduce your risk for prostate cancer. The American Cancer Society recommends:
Antioxidants in foods, especially in fruits and vegetables, help prevent damage to the DNA in the body's cells. Such damage has been linked to cancer. Lycopene, in particular, is an antioxidant that has been thought to lower the risk of prostate cancer. It can be found in foods such as:
It's not clear whether lycopene actually helps prevent prostate cancer, and recent studies have not been able to show that it does. Researchers continue studying other ways to lower prostate cancer risk. It’s still too soon, though, to know whether studies are finding new ways to prevent prostate cancer. Here are some examples of what's being considered:
Testing for Prostate Cancer
While testing, or screening for prostate cancer, can find it early, experts disagree on whether it actually helps save lives. The American Cancer Society recommends that men talk to their doctor before having a test to check for prostate cancer. Men need to understand the risks and benefits of testing. Then, the man and his doctor can decide whether to proceed with testing using a PSA test and digital rectal exam.
When that discussion should take place is based on a man's age, level of risk, and general health status. Here are the general recommendations about when to consider testing:
The U.S. Preventive Services Task Force, however, doesn't recommend routine PSA screening for men in the general population, regardless of age. They say the tests may find cancers that are so slow-growing that medical treatments - which can have serious side effects - would offer no benefit.
When to Seek Medical Care
Who should undergo regular screening for prostate cancer?
Go to the nearest hospital emergency department right away if you have any of the following symptoms:
Symptoms depend on the level at which the spine is compressed. Typical symptoms that might signal acute spinal cord compression include:
Stages of Prostate Cancer
Like other forms of cancer, the prognosis for prostate cancer depends on how far the cancer has spread at the time it’s diagnosed. Doctors use a system of classification called staging to describe prostate cancer’s local extent and evidence of spread. Prostate cancer stages can be complex and difficult to understand.
Growth and Spread
Prostate cancer grows locally within the prostate, often for many years. Eventually, prostate cancer extends outside the prostate. Prostate cancer can spread beyond the prostate in three ways:
Prostate cancer stages describe the precise extent of prostate cancer’s spread.
In stage I, prostate cancer is found in the prostate only. Stage I prostate cancer is microscopic; it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.
Prostate Cancer Stage II
In stage II, the tumor has grown inside the prostate but hasn’t extended beyond it.
Prostate Cancer Stage III
Stage III prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.
Prostate Cancer Stage IV
In stage IV, the cancer has spread (metastasized) outside the prostate to other tissues. Stage IV prostate cancer commonly spreads to lymph nodes, the bones, liver, or lungs.
Tests to Identify Prostate Cancer Stage
After a prostate cancer diagnosis, tests are done to detect how the cancer has spread, if it has, outside the prostate. Not all men need every test. It depends on the characteristics of a man’s prostate cancer seen on biopsy. Tests to help determine the stage of prostate cancer include:
The TNM System for Prostate Cancer Stages
As they do for most cancers, doctors use the TNM system for prostate cancer stages. The prostate cancer stages are described using three different aspects of tumor growth and spread. It’s called the TNM system for tumor, nodes, and metastasis:
T - tumor; describes the size of the main area of prostate cancer.
N - nodes; describes whether prostate cancer has spread to any lymph nodes and to what extent.
M - metastasis; means distant spread of prostate cancer, for example, to the bones or liver.
There are other ways of classifying prostate cancer, such as the Gleason system. Sometimes, the TNM system and Gleason score are combined together to describe prostate cancer stage.
Accurately identifying the prostate cancer stage is extremely important. Prostate cancer stage helps determine the optimal treatment, as well as prognosis. For this reason, it’s worth going through extensive testing to get the correct prostate cancer stage.
The prostate is a gland in the male reproductive system. It makes most of the semen that carries sperm. The walnut-sized gland is located beneath the bladder and surrounds the upper part of the urethra, the tube that carries urine from the bladder.
Prostate cancer is a major health concern for American men. The disease is rare before age 50, and experts believe that most elderly men have traces of it.
The American Cancer Society predicts that 220,800 new cases of prostate cancer would be diagnosed in 2015. An estimated 27,640 men will die of it. African-American men are more likely to get prostate cancer and have the highest death rate. Other than skin cancer, prostate cancer is the most common cancer in American men. In other parts of the world - notably Asia, Africa, and Latin America - prostate cancer is rare.
Prostate cancer is usually a very slow growing cancer, often causing no symptoms until it is in an advanced stage. Most men with prostate cancer die of other causes, and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads outside the prostate, it is dangerous.
Prostate cancer in its early stages (when it’s only found in the prostate gland) can be treated with very good chances for survival. Fortunately, about 85% of American men with prostate cancer are diagnosed in an early stage of the disease.
Cancer that has spread beyond the prostate (such as to the bones, lymph nodes, and lungs) is not curable, but it may be controlled for many years. Because of the many advances in available treatments, most men whose prostate cancer becomes widespread can expect to live five years or more. Some men with advanced prostate cancer live a normal life and die of another cause, such as heart disease.
What Causes Prostate Cancer?
Prostate cancer affects mainly older men. About 80% of cases are in men over 65, and less than 1% of cases are in men under 50. Men with a family history of prostate cancer are more likely to get it.
Doctors don’t know what causes prostate cancer, but diet contributes to the risk. Men who eat lots of fat from red meat are most likely to have prostate cancer. Eating meat may be risky for other reasons: Meat cooked at high temperatures produces cancer-causing substances that affect the prostate. The disease is much more common in countries where meat and dairy products are common than in countries where the diet consists of rice, soybean products, and vegetables. Hormones also play a role. Eating fats raises the amount of testosterone in the body, and testosterone speeds the growth of prostate cancer.
A few job hazards have been found. Welders, battery manufacturers, rubber workers, and workers frequently exposed to the metal cadmium seem to be more likely to get prostate cancer.
Not exercising also makes prostate cancer more likely. Adding certain foods in your diet may help reduce the risk, including tomato sauce and vegetables like broccoli, cauliflower, and cabbage.
Prostate Cancer Risk Factors
All men are at risk for developing prostate cancer. About one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 36 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer cells in their prostate. Besides being male, there are other factors, such as age, race, and family history that may contribute to the risk.
Age. The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after the age of 40 in black men and men who have a close relative with prostate cancer. About two-thirds of all prostate cancers are diagnosed in men age 65 and older. The older the patient, especially if they are over 70, the less aggressive the disease usually behaves.
Family history. Men whose relatives have had prostate cancer are considered to be at high risk. Having a father or brother with the disease more than doubles your risk for prostate cancer, according to the American Cancer Society. Having a brother with prostate cancer appears to increase your risk more than having an affected father does. That risk is even higher when there are multiple family members affected. Screening for prostate cancer should be started at age 40 in these men.
Studies have identified several inherited genes that appear to increase prostate cancer risk. Testing for most of these genes is not yet available. Experts estimate that the hereditary form of prostate cancer accounts for just 5% to 10% of all cases.
Race. Prostate cancer occurs about 60% more often in African-American men than in white American men, and when it is diagnosed, the cancer is more likely to be advanced. However, Japanese and African males living in their native countries have a low incidence of prostate cancer. Rates for these groups increase sharply when they immigrate to the U.S. African-Americans are the second group of men for whom prostate cancer testing should begin at age 40.
Some experts theorize that this suggests an environmental connection, possibly related to high-fat diets, less exposure to the sun, exposure to heavy metals such as cadmium, infectious agents, or smoking. To date, the reasons for these racial differences are not understood.
Diet. Research also suggests high dietary fat may be a contributing factor for prostate cancer. The disease is much more common in countries where meat and dairy products are dietary staples compared to countries where the basic diet consists of rice, soybean products, and vegetables.
How Can Prostate Cancer Be Prevented?
There is no evidence that one can prevent prostate cancer. But you may be able to lower your risk. A diet that helps maintain a healthy weight may reduce your risk for prostate cancer. The American Cancer Society recommends:
- Limiting high-fat foods.
- Cutting back on red meats, especially processed meats such as hot dogs, bologna, and certain lunch meats.
- Eating five or more servings of fruits and vegetables each day.
- Healthy food choices also include bread, cereals, rice, pasta, and beans.
Antioxidants in foods, especially in fruits and vegetables, help prevent damage to the DNA in the body's cells. Such damage has been linked to cancer. Lycopene, in particular, is an antioxidant that has been thought to lower the risk of prostate cancer. It can be found in foods such as:
- Tomatoes - both raw and cooked.
- Spinach.
- Artichoke hearts.
- Beans.
- Berries - especially blueberries.
- Pink grapefruit and oranges.
- Watermelon
It's not clear whether lycopene actually helps prevent prostate cancer, and recent studies have not been able to show that it does. Researchers continue studying other ways to lower prostate cancer risk. It’s still too soon, though, to know whether studies are finding new ways to prevent prostate cancer. Here are some examples of what's being considered:
- Some doctors are looking at whether certain drugs, such as Avodart (dutasteride) and Proscar (finasteride), which are both used to treat an enlarged prostate that isn't cancerous, can help prevent prostate cancer.
- Early studies showed that vitamins, such as selenium and vitamin E, may lower your chance of getting prostate cancer. Further research, though, has not shown this.
- Doctors continue to study the effects of supplements on prostate cancer. For now, no vitamins or supplements are known to lower the risk.
Testing for Prostate Cancer
While testing, or screening for prostate cancer, can find it early, experts disagree on whether it actually helps save lives. The American Cancer Society recommends that men talk to their doctor before having a test to check for prostate cancer. Men need to understand the risks and benefits of testing. Then, the man and his doctor can decide whether to proceed with testing using a PSA test and digital rectal exam.
When that discussion should take place is based on a man's age, level of risk, and general health status. Here are the general recommendations about when to consider testing:
- Men with no symptoms and average risk should discuss screening with their doctor at age 50.
- Men with higher risk, including African Americans and men who had a brother, father, or son diagnosed with prostate cancer before age 65, should have that discussion at 45.
- Men who have more than one first degree relative - brother, father, or son - diagnosed with prostate cancer before age 65 should have that discussion when they are 40.
- PSA screening in men under age 40 years is not recommended.
- Routine screening in men between ages 40 to 54 years at average risk is not recommended.
- To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening after a discussion with their doctor. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
- Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.
The U.S. Preventive Services Task Force, however, doesn't recommend routine PSA screening for men in the general population, regardless of age. They say the tests may find cancers that are so slow-growing that medical treatments - which can have serious side effects - would offer no benefit.
When to Seek Medical Care
Who should undergo regular screening for prostate cancer?
- Men aged 50 years and older should undergo a yearly digital rectal examination and blood testing for prostatic specific antigen (PSA).
- Men in the high-risk group, such as those with a family history of prostate cancer or of African American ethnicity, should begin screening as early as age 40 years.
- Difficulty initiating or stopping a urine stream.
- Frequent urination.
- Pain on urination.
- Pain on ejaculation.
Go to the nearest hospital emergency department right away if you have any of the following symptoms:
- Urinary tract infection - Burning pain on urination, urgency, frequent urination, especially with fever.
- Bladder obstruction - Not urinating or urinating very little despite drinking enough fluid; producing little urine despite straining; pain due to a full bladder.
- Acute kidney failure - Not urinating or urinating little, with little discomfort, despite drinking enough fluid.
- Deep bone pain, especially in the back, hips, or thighs, or bone fracture - Possible sign of advanced prostate cancer that has spread to the bones.
- Spinal cord compression is a true emergency and may be the first sign of cancer. It occurs when the cancer has spread to vertebrae of the spine and tailbone region. The weakened vertebrae can collapse on the spinal cord, causing symptoms and problems with function.
Symptoms depend on the level at which the spine is compressed. Typical symptoms that might signal acute spinal cord compression include:
- Weakness in the legs and difficulty walking.
- Increased difficulty urinating or moving your bowels.
- Difficulty controlling your bladder or bowels.
- Decreased sensation, numbness, or tingling in the groin or legs.
Stages of Prostate Cancer
Like other forms of cancer, the prognosis for prostate cancer depends on how far the cancer has spread at the time it’s diagnosed. Doctors use a system of classification called staging to describe prostate cancer’s local extent and evidence of spread. Prostate cancer stages can be complex and difficult to understand.
Growth and Spread
Prostate cancer grows locally within the prostate, often for many years. Eventually, prostate cancer extends outside the prostate. Prostate cancer can spread beyond the prostate in three ways:
- By growing into neighboring tissues (invasion).
- By spreading through the lymph system of lymph nodes and lymph vessels.
- By traveling to distant tissues through the blood (metastasis).
Prostate cancer stages describe the precise extent of prostate cancer’s spread.
In stage I, prostate cancer is found in the prostate only. Stage I prostate cancer is microscopic; it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.
Prostate Cancer Stage II
In stage II, the tumor has grown inside the prostate but hasn’t extended beyond it.
Prostate Cancer Stage III
Stage III prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.
Prostate Cancer Stage IV
In stage IV, the cancer has spread (metastasized) outside the prostate to other tissues. Stage IV prostate cancer commonly spreads to lymph nodes, the bones, liver, or lungs.
Tests to Identify Prostate Cancer Stage
After a prostate cancer diagnosis, tests are done to detect how the cancer has spread, if it has, outside the prostate. Not all men need every test. It depends on the characteristics of a man’s prostate cancer seen on biopsy. Tests to help determine the stage of prostate cancer include:
- Digital rectal exam.
- Prostate-specific antigen (blood test).
- Transrectal ultrasound.
- MRI of the prostate using a rectal probe.
- CT scan of the abdomen and pelvis, looking for prostate cancer metastasis to other organs.
- MRI of the skeleton, or a nuclear medicine bone scan, to look for metastasis to bones.
- Surgery to examine the lymph nodes in the pelvis for any prostate cancer spread
The TNM System for Prostate Cancer Stages
As they do for most cancers, doctors use the TNM system for prostate cancer stages. The prostate cancer stages are described using three different aspects of tumor growth and spread. It’s called the TNM system for tumor, nodes, and metastasis:
T - tumor; describes the size of the main area of prostate cancer.
N - nodes; describes whether prostate cancer has spread to any lymph nodes and to what extent.
M - metastasis; means distant spread of prostate cancer, for example, to the bones or liver.
There are other ways of classifying prostate cancer, such as the Gleason system. Sometimes, the TNM system and Gleason score are combined together to describe prostate cancer stage.
Accurately identifying the prostate cancer stage is extremely important. Prostate cancer stage helps determine the optimal treatment, as well as prognosis. For this reason, it’s worth going through extensive testing to get the correct prostate cancer stage.
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