Prostate Cancer

Prostate cancer statistics:

The fear of having prostate cancer can be devastating to men. However, it is most successfully treated when found early. Consider these statistics from the American Cancer Society:

Nearly 86 percent of all prostate cancers are discovered while they are either localized (confined to the prostate) or regional (nearby). The five-year survival rate for men diagnosed with prostate tumors discovered at these stages is 100 percent.
In the past 20 years, the five-year survival rate for all stages combined has increased from 67 percent to 97 percent.
Prostate cancer is the most common cancer among men, excluding skin cancer.
American Cancer Society (ACS) estimates for 2004 include 230,110 new cases of prostate cancer in the US.
Year 2004 estimates include 29,900 deaths occurring from prostate cancer in the US alone, making it the second leading cause of cancer death in men.

Illustration of the anatomy of the male reproductive tract

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Facts about the prostate gland:

The prostate is a sex gland in men. It is about the size of a walnut, and surrounds the neck of the bladder and urethra - the tube that carries urine from the bladder. It is partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It is made up of three lobes: a center lobe with one lobe on each side.

The prostate gland secretes a slightly alkaline fluid that forms part of the seminal fluid, a fluid that carries sperm.

What are the symptoms of prostate cancer?

There are usually no specific signs or symptoms of early prostate cancer - which is why prostate screening is so important. An annual physical examination, prostate-specific antigen (PSA) blood test, and digital rectal exam (DRE) provide the best chance of identifying prostate cancer in its earliest stages.

The following are the most common symptoms of prostate cancer. However, each individual may experience symptoms differently. Symptoms may include:

weak or interrupted flow of urine
urinating often (especially at night)
difficulty urinating or holding back urine
inability to urinate
pain or burning when urinating
blood in the urine or semen
nagging pain in the back, hips, or pelvis
difficulty having an erection

The symptoms of prostate cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

As a man gets older, his prostate may grow bigger and obstruct the flow of urine, or interfere with sexual function. An enlarged prostate gland - a condition called benign prostate hyperplasia - may require treatment with medicine or surgery to relieve symptoms. This common benign prostate condition, which is not cancer, can cause many of the same symptoms as prostate cancer.

What are risk factors for prostate cancer?

In general, all men are at risk for prostate cancer. However, there are specific risk factors that increase the likelihood that certain men will develop the disease, including the following:

age
Age is a risk factor for prostate cancer, especially men age 50 and older. More than 80 percent of all prostate cancers are diagnosed in men over the age of 65.
race
Prostate cancer is nearly twice as common among African-American men than it is among Caucasian-American men. Japanese and Chinese men native to their country have the lowest rates of prostate cancer. Interestingly, when Chinese and Japanese men immigrate to the US, they have an increased risk and mortality rate from prostate cancer, when compared to their native populations. In Japan, the incidence of prostate cancer has increased as Western diets and lifestyles have been adopted.
diet
Epidemiological data suggests that the diet consumed in Western industrialized countries may be one of the most important contributory factors for developing prostate cancer. Consider the following information regarding diet and its effect on the risk for prostate cancer:
- fat
  Studies suggest that men who eat a high-fat diet may have a greater chance of developing prostate cancer.
- fiber
  Dietary fiber intake may influence circulating levels of testosterone and estradiol, which, in turn, may decrease the progression of prostate cancer.
- soy protein
  Besides lower fat intake, another major difference between Asian and American diets is the consumption of soy, averaging 35 g/day per capita. Soy contains isoflavone which, in several studies, have been found to inhibit the growth of prostate cancer.
- vitamin E and selenium
  Vitamin E, an antioxidant, combined with selenium, has been shown to inhibit tumor growth in laboratory animals.
- carotenoids
  Carotenoids containing lycopenes have been shown to inhibit the growth of human prostate cancer cells in tissue cultures (cells grown in the laboratory). The primary source of lycopenes is processed tomatoes in tomato juice and tomato paste.
- herbal preparations
  Combination herbal preparations should be used with caution as reported side effects have included venous thrombosis, breast tenderness, and loss of libido. Many herbal preparations have not been studied in men with prostate cancer.
obesity
Obesity not only contributes to diabetes and high cholesterol, but has also been associated with some common cancers, including hormone-dependent tumors such as prostate, breast, and ovarian cancer.
environmental exposures
Some studies show an increased chance for prostate cancer in men who are farmers, or those exposed to the metal cadmium while making batteries, welding, or electroplating. Additional research is needed in this area to confirm whether this is a true association.
having a vasectomy, BPH (benign prostatic hyperplasia), or STD (sexually transmitted disease)
Researchers have looked at whether men who have had a vasectomy, BPH, or those who have been exposed to a sexually transmitted disease are at increased risk for prostate cancer. Some studies suggest a link, while others do not support these claims.
family history of prostate cancer
Having a father or brother with prostate cancer doubles a man's risk of developing this disease. The risk is even higher for men with several affected relatives, particularly if the relatives were young at the time of diagnosis. Geneticists (physicians and scientists who study inheritance and the causes of genetic disease) divide families into three groups, depending upon the number of men with prostate cancer and their ages of onset, including the following:
- sporadic - a family with prostate cancer present in one man, at a typical age of onset; sporadic means occurs by chance.
- familial - a family with prostate cancer present in more than one person, but with no definitive pattern of inheritance and usually an older age of onset.
- hereditary - a family with a cluster of three or more affected relatives within any nuclear family (parents and their children), a family with prostate cancer in each of three generations on either the mother or father's side, or a cluster of two relatives affected at a young age (55 or less). Five to 10 percent of prostate cancer cases are considered hereditary.
genetic factors
In the center of each cell of the human body, our genetic material - chromosomes - are found. Normally, cells contain 46 chromosomes, or 23 pairs, half of which are inherited from our mother, half from our father. The chromosomes contain the body's blueprint, our genes. Genes code for traits such as eye color and blood type, and also control important regulatory functions in the body such as the rate of cell growth. Some genes, when altered or mutated, give a higher risk for uncontrolled cell growth, which, in turn, can lead to tumor development. These genes have various names, but overall are referred to as "cancer susceptibility genes." Approximately 9 percent of all prostate cancers and 40 percent of cases in men younger than age 55 can be attributed to a cancer susceptibility gene that is inherited as a dominant trait (from parent to child).

Procedures used to evaluate prostate problems:

In addition to an annual physical examination that includes blood, urine, and possibly other laboratory tests, the National Cancer Institute and the American Cancer Society suggest consulting your physician about these recommendations for the evaluation of the prostate gland:

DRE (digital rectal examinations)
As recommended by your physician, DREs are usually conducted annually for men over the age of 50. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer, should consult their physicians about being tested at age 45.
PSA (prostate-specific antigen)
As recommended by your physician, PSA tests are usually conducted annually for men over the age of 50. Men in high-risk groups, such as African Americans, or those with a strong family history of prostate cancer, should consult their physicians about being tested at an earlier age.

Men in high-risk groups, such as African Americans, or those with a strong family history of prostate cancer, should talk with their physicians about being tested at a younger age.

What are some other prostate cancer evaluation procedures?

If the DRE or PSA are unusual, your physician may repeat the tests or request an ultrasound and other procedures. These evaluation tools may include:

transrectal ultrasound (TRUS) - a test using sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions such as gland enlargement, nodules, penetration of tumor through capsule of the gland, and/or invasion of seminal vesicles; may also be used for guidance of needle biopsies of the prostate gland and/or guiding the nitrogen probes in cryosurgery.
computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
radionuclide bone scan - a nuclear imaging method that helps to show whether the cancer has spread from the prostate gland to the bones. The procedure involves an injection of radioactive material that helps to locate diseased bone cells throughout the entire body, suggesting possible metastatic cancer.
(lymph node and/or prostate) biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

The diagnosis of cancer is confirmed only by a biopsy.

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