Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. The prostate is a small walnut shaped gland in the pelvis of men. It is located next to the bladder and can be examined by getting a digital rectal exam. Prostate cancer is a form of cancer that develops in the prostate gland. It is the second-leading cause of cancer deaths for men in the U.S. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. This year, nearly 175,000 men will be diagnosed with prostate cancer.
What are the risk factors for prostate cancer?
A risk factor is anything that affects your chance of getting a disease such as cancer.
- Age: Prostate cancer is very rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50.
- Race/ethnicity: Prostate cancer occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races.
- Family history: Prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor.
- Gene changes: Scientists have found several inherited gene changes that seem to raise prostate cancer risk, but they probably account for only a small percentage of cases overall.
- Diet: Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer.
- Obesity: Most studies have not found that being obese(very overweight) is linked with a higher overall risk of getting prostate cancer.
Can prostate cancer be found early?
No one knows why or how prostate cancer starts. Autopsy studies show 1 in 3 men over the age of 50 have some cancer cells in the prostate. Eight out of ten “autopsy cancers” found are small, with tumors that are not harmful. Even though there is no known reason for prostate cancer, there are many risks associated with the disease.
What Are The Risk Factors for Prostate Cancer?
As men age, their risk of getting prostate cancer goes up. It is rarely found in men younger than age 40. Damage to the genetic material (DNA) of prostate cells is more likely for men over the age of 55. Damaged or abnormal prostate cells can begin to grow out of control and form tumors.
Age is a well-known risk factor for prostate cancer. But, smoking and being overweight are more closely linked with dying from prostate cancer.
African American men have, by far, the highest incidence of the disease. One in six African American men will get prostate cancer. African American men are more likely to get prostate cancer at an earlier age. They are also more like to have aggressive tumors that grow quickly, spread and cause death. The reason why prostate cancer is more prevalent in African American men is unclear yet it may be due to socioeconomic, environmental, diet or other factors. Other ethnicities, such as Hispanic and Asian men, are less likely to get prostate cancer.
Men with a family history of prostate cancer also face a higher risk of also developing the disease. A man is 2 to 3 times more likely to get prostate cancer if his father, brother or son had it. This risk increases with the number of relatives diagnosed with prostate cancer. The age when a close relative was diagnosed is also an important factor.
Studies show prostate cancer risk may double for heavy smokers. Smoking is also linked to a higher risk of dying from prostate cancer. However, within 10 years of quitting, your risk for prostate cancer goes down to that of a non-smoker the same age.
Prostate cancer numbers and deaths vary around the world but are higher in North America and Northern Europe. Higher rates may be due to better or more screening procedures, heredity, poor diets, lack of exercise habits, and environmental exposures.
Diet and lifestyle may affect the risk of prostate cancer. It isn’t clear exactly how. Your risk may be higher if you eat more calories, animal fats, refined sugar and not enough fruits and vegetables. A lack of exercise is also linked to poor outcomes. Obesity (or being very overweight) is known to increase a man’s risk of dying from prostate cancer. One way to decrease your risk is to lose weight, and keep it off.
Can Prostate Cancer Be Prevented?
Doing things that are “heart healthy”, will also keep your prostate healthy. Eating right, exercising, watching your weight and not smoking can be good for your health and help you avoid prostate cancer.
Some healthcare providers believe drugs like finasteride (Proscar ®) and dutasteride (Avodart ®) can prevent prostate cancer. Others believe they only slow the development of prostate cancer. Studies do show that men taking these drugs were less likely to be diagnosed with prostate cancer. Still, it is not clear if these drugs are affective so you should talk to your doctor about the possible side effects.
How is prostate cancer diagnosed?
“SCREENING” means testing for a disease even if you have no symptoms. The prostate specific antigen (PSA) blood test and digital rectal examination (DRE) are two tests that are used to screen for prostate cancer. Both are used to detect cancer early. However, these tests are not perfect. Abnormal results with either test may be due to benign prostatic enlargement (BPH) or infection, rather than cancer.
The American Urological Association (AUA) recommends talking with your healthcare provider about whether or not you should be screened. The two main types of screenings are:
PSA Blood Test
The prostate-specific antigen (PSA) blood test is one way to screen for prostate cancer. This blood test measures the level of PSA in the blood. PSA is a protein made only by the prostate and prostate cancers. The test can be done in a lab, hospital or healthcare provider’s office.
Very little PSA is found in the blood of a man with a healthy prostate. A low PSA is a sign of prostate health. A rapid rise in PSA may be a sign that something is wrong. Prostate cancer is the most serious cause of a high PSA result. Another reason for a high PSA can be benign (non-cancer) enlargement of the prostate. Prosatitis, inflammation of the prostate, can also cause high PSA results.
A rise in PSA level does not tell us the type of cancer cells present. The rise tells us that cancer may be present.
Talk with your healthcare provider about whether the PSA test is useful for you. If you decide to get tested, be sure to talk about changes in your PSA level with your provider. Make sure to watch your video on the PSA Blood test.
The digital rectal examination (DRE) helps your doctor find prostate problems. For this exam, the healthcare provider puts a lubricated gloved finger into the rectum. The man either bends over or lies curled on his side on a table. During this test, the doctor feels for an abnormal shape or thickness to the prostate. DRE is safe and easy to do. But the DRE by itself cannot detect early cancer. It should be done with a PSA test.
Who Should Get Screened?
Screening is recommended if you are a man:
- Between 55–69 years old
- Have a family history of prostate cancer
What are the benefits and risks of screening?
The PSA test and DRE are very important tools. They help to find prostate cancer early, before it spreads. When found early, it can be treated early which helps stop or slow the spread of cancer. This is likely to help some men live longer.
A risk of a PSA test is that it may miss detecting cancer (a “false negative”). Or, the test may be a “false positive,” suggesting something is wrong when you are actually healthy. A false positive result may lead to a biopsy that isn’t needed. The test might also detect very slow growing cancer that will never cause problems if left untreated.
What is a Biopsy?
A Biopsy is a type of minor surgery. For a prostate biopsy , tiny pieces of tissue are removed from the prostate and looked at under a microscope. The pathologist is the doctor who will look carefully at the tissue samples to look for cancer cells. This is the only way to know for sure if you have prostate cancer.
The decision to have a biopsy is based on PSA and DRE results. Your doctor will also consider your family history of prostate cancer, ethnicity, biopsy history and other health factors.
Prostate Biopsy is usually done using an ultrasound probe to look at the prostate and guide the biopsy. You may be given an enema and antibiotics to prevent infection. For the test, you will lie on your side as the probe goes into the rectum. First, your provider takes a picture of the prostate using ultrasound. Your healthcare provider will note the prostate gland’s size, shape and any abnormalities. He/she will also look for shadows, which might signal cancer. Not all prostate cancers can be seen, and not all shadows are cancer. The prostate gland is then numbed (anesthetized) with a needle passed through the probe. Then, the provider removes very small pieces of your prostate using a biopsy device. The amount of tissue removed depends on the size of the gland, PSA results and past biopsies.
If cancer cells are found, the pathologist will assign a “Gleason Score” which helps to determine the severity/risk of the disease
After a biopsy, you may have blood in your ejaculate, urine and stool. This should go away fairly quickly. If not, or you get a fever, contact your doctor.
How is prostate cancer treated?
Depending on the situation, the treatment options for men with prostate cancer might include:
- Expectant management (watchful waiting)
- Radiation therapy
- Hormone therapy
- Vaccine Treatment
- Bone-directed treatment
These treatments are generally used one at a time, although in some cases they may be combined.
The treatment you choose for prostate cancer should take into account:
- Your age and expected life span
- Any other serious health conditions you have
- The stage and grade of your cancer
- Your feelings (and your doctor’s opinion) about the need to treat the cancer right away
- The likelihood that each type of treatment will cure your cancer (or help in some other way)
- Your feelings about the possible side effects from each treatment
What happens after treatment for prostate cancer?
Your doctor should give you a follow-up plan. This plan usually includes regular doctor visits and PSA blood tests, with digital rectal exams if your prostate hasn’t been removed. These will probably begin within a few months of finishing treatment. Most doctors recommend PSA tests about every 6 months for the first 5 years after treatment, and at least yearly after that. Bone scans or other imaging tests might also be done, depending on your medical situation.
Each year, more men are surviving prostate cancer and winning back their lives. Prostate cancer can be a manageable disease if caught early and treated appropriately.
Once you have finished treatment, it is time to manage your side effects. It is time to create a long-term schedule with your doctor for future tests. It’s also time to go on with your life.
Talk to your healthcare provider about the side effects or problems you have after treatment. You and your healthcare provider can decide your best next steps.
If you haven’t yet started treatment, consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects, like incontinence, is lower.
What are the Emotional Effects Following Treatment?
After treatment, you may feel very emotional. You may also worry about cancer returning. Many men still feel anxious and unsure, or upset about treatment side effects.
Whatever you’re feeling, it’s important to tell your healthcare provider about it. Work together. Build a plan with your provider to deal with your emotional health and general wellbeing.
What are The Physical Effects Following Treatment?
Erectile dysfunction and urinary incontinence are the side effects reported most often by men following prostate cancer treatment.
Erectile Dysfunction (ED) Issues After Prostate Cancer Treatment
After prostate cancer, many men experience erectile dysfunction (ED). An erection happens when sexual arousal causes nerves near the prostate to send signals. The signals cause the blood vessels in the penis to fill with blood. The blood in the vessels makes the penis erect. ED happens when this process doesn’t work well (or is damaged from surgery or radiation) and a man cannot keep an erection long enough for sexual satisfaction. Your doctor can help you understand the causes of ED and therapies that could help you recover.
Urinary Incontinence After Prostate Cancer Treatment
Urinary incontinence can sometimes result from prostate cancer treatment . Urinary incontinence is urine leakage without your control. Men may have many types of incontinence after prostate surgery.
- Stress incontinence -Coughing, laughing, sneezing, or exercising can strain the pelvic floor muscles, causing urine to leak. This is the most common type of urinary incontinence.
- Urge incontinence- You feel a sudden, urgent need to go to the bathroom, even when the bladder is not full. This happens because the bladder is overly sensitive. Urge incontinence is also called overactive bladder.
- Urinary frequency – You go to the bathroom very often. You may feel the need to go every 30 to 60 minutes.
- Mixed incontinence – You have symptoms of more than 1 type of urinary incontinence.
- Because incontinence may affect your physical and emotional recovery, it is of great value to understand how to manage this problem.