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How Prostate Cancer Occurs
Prostate cancer occurs when a tumor forms in the tissue of the prostate, a gland in the male reproductive system. In its early stage, prostate cancer needs the male hormone testosterone to grow and survive.
The prostate is about the size of a large walnut. It is located below the bladder and in front of the rectum. The prostate’s main function is to make fluid for semen, a white substance that carries sperm.
Prostate cancer is one of the most common types of cancer among American men. It is a slow-growing disease that mostly affects older men. In fact, more than 60 percent of all prostate cancers are found in men over the age of 65. The disease rarely occurs in men younger than 40 years of age.
Prostate Cancer Can Spread
Sometimes, cancer cells break away from a malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body.
When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer — not bone cancer. Doctors sometimes call this distant disease.
Surviving Prostate Cancer
Today, more men are surviving prostate cancer than ever before. Treatment can be effective, especially when the cancer has not spread beyond the region of the prostate.
Scientists don’t know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease.
Age is the most important risk factor for prostate cancer. The disease is extremely rare in men under age 40, but the risk increases greatly with age. More than 60 percent of cases are diagnosed in men over age 65. The average age at the time of diagnosis is 65.
Race is another major risk factor. In the United States, this disease is much more common in African American men than in any other group of men. It is least common in Asian and American Indian men.
A man’s risk for developing prostate cancer is higher if his father or brother has had the disease.
Other Risk Factors
Scientists have wondered whether obesity, lack of exercise, smoking, radiation exposure, might increase risk. But at this time, there is no firm evidence that these factors contribute to an increased risk.
Symptoms and Tests
Most cancers in their early, most treatable stages don’t cause any symptoms. Early prostate cancer usually does not cause symptoms.
However, if prostate cancer develops and is not treated, it can cause these symptoms:
- a need to urinate frequently, especially at night
- difficulty starting urination or holding back urine
- inability to urinate
- weak or interrupted flow of urine
- painful or burning urination
- difficulty in having an erection
- painful ejaculation
- blood in urine or semen
- pain or stiffness in the lower back, hips, or upper thighs.
Any of these symptoms may be caused by cancer, but more often they are due to enlargement of the prostate, which is not cancer.
If You Have Symptoms
If you have any of these symptoms, see your doctor or a urologist to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system. The doctor will ask questions about your medical history and perform an exam to try to find the cause of the prostate problems.
The PSA Test
The doctor may also suggest a blood test to check your prostate specific antigen, or PSA, level. PSA levels can be high not only in men who have prostate cancer, but also in men with an enlarged prostate gland and men with infections of the prostate. PSA tests may be very useful for early cancer diagnosis. However, PSA tests alone do not always tell whether or not cancer is present.
PSA screening for prostate cancer is not perfect. (Screening tests check for disease in a person who shows no symptoms.) Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. A recent study revealed that men with low prostate specific antigen levels, or PSA, may still have prostate cancer. Also, the digital rectal exam can miss many prostate cancers.
The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope.
If Cancer is Present
If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.
One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors.
If cancer is found in the prostate, the doctor needs to know the stage of the disease and the grade of the tumor. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The grade tells how closely the tumor resembles normal tissue in appearance under the microscope.
Doctors use various blood and imaging tests to learn the stage of the disease. Imaging tests, such as ultrasound, CT scans, and magnetic resonance imaging, or MRI, produce pictures of images inside the body.
In 2013, a product called UroNav was introduced. Resembling a stylized computer workstation on wheels, UroNav electronically fuses together pictures from magnetic resonance imaging (MRI) and ultrasound to create a detailed, three-dimensional view of the prostate. This image helps doctors more precisely target the area in the prostate gland that needs to be biopsied.
Stages of Prostate Cancer
There are four stages used to describe prostate cancer. Doctors may refer to the stages using the Roman numerals I-IV or the capital letters A-D. The higher the stage, the more advanced the cancer. Following are the main features of each stage.
Stage I or Stage A – The cancer is too small to be felt during a rectal exam and causes no symptoms. The doctor may find it by accident when performing surgery for another reason, usually an enlarged prostate. There is no evidence that the cancer has spread outside the prostate. A sub-stage, T1c, is a tumor identified by needle biopsy because of elevated PSA.
Stage II or Stage B – The tumor is still confined to the prostate but involves more tissue within the prostate. The cancer is large enough to be felt during a rectal exam, or it may be found through a biopsy that is done because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.
Stage III or Stage C – The cancer has spread outside the prostate to nearby tissues. A man may be experiencing symptoms, such as problems with urination.
Stage IV or Stage D – The cancer has spread to lymph nodes or to other parts of the body. The bones are a common site of spread of prostate cancer. There may be problems with urination, fatigue, and weight loss.
- Radiation Therapy
- Hormonal Therapy
Regardless of the type of treatment you receive, you will be closely monitored to see how well the treatment is working. Monitoring may include
- a PSA blood test — usually every 3 months to 1 year
- bone scan and/or CT scan to see if the cancer has spread
- a complete blood count to monitor for signs and symptoms of anemia
- looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function
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