(Cancer of the Prostate; Prostatic Carcinoma)
Prostate cancer is a disease in which cancer starts in the prostate gland. The prostate is a walnut-sized gland in men. It surrounds the urethra, the tube that carries urine (pee) out of the body.
Most prostate cancers grow slowly, but some grow and spread fast.
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Cancer happens when cells in the body divide without control or order. If cells keep dividing, a mass of tissue forms. These are called growths or tumors. If a tumor is cancer it is called malignant. Tumors can invade nearby tissues and spread to other parts of the body.
The exact cause of prostate cancer is unknown. It is likely due to genes and the environment.
Prostate cancer is more common in men who are aged 65 and older. It is also more common in people who are Black. Other things that raise the risk are:
- Family members with prostate cancer—especially in a father or brother
- A high-fat diet
- Certain gene changes
- Exposure to certain chemicals, such as Agent Orange
Early prostate cancer often does not cause symptoms. When symptoms happen, they may be:
- Problems with urination, such as:
- Urinating (peeing) often, especially at night
- Problems starting urination
- Not being able to urinate
- Weak or interrupted urine flow
- Painful or burning urination
- Problems having an erection
- Painful ejaculation
- Blood in urine or semen
- Frequent pain or stiffness in the lower back, hips, or upper thighs
These symptoms may also be caused by other conditions, such as benign prostatic hyperplasia(BPH) or an infection. People with these symptoms should see a doctor right away.
Many prostate cancers are found through prostate-specific antigen (PSA) screening. It can find cancer before symptoms start.
Prostate cancer may also be found after symptoms start. The doctor will ask about symptoms and past health. A physical and rectal exam will be done. The doctor can feel an enlarged prostate through the wall of the rectum. Blood and urine tests may be done to rule out other things that cause increased prostate size.
A sample of the prostate will be removed and tested with a biopsy. This will confirm cancer. Images of the prostate and area can show the size of the growth. Tests may include:
- Transrectal ultrasound
- Pelvic MRI scan
- Abdominal and pelvic CT scan
- Prostate–specific membrane antigen based PET/CT scan (PSMA PET/CT)
Test results will be used to find details of the cancer. This includes the type, stage, and grade of the cancer. Staging is used to guide treatment. Prostate cancer is staged from 1 to 4. Stage 1 cancer has only affected nearby tissue. Stage 4 cancer has spread to other parts of the body. Grading shows ow fast the cancer is likely to grow and spread.
Treatment varies depending on the stage and grade of prostate cancer. Treatment may include:
Watchful WaitingEarly stage cancer may not cause problems. Some cancer is also slow growing and may not need treatment right away. The prostate will be monitored over time. This may also be done for people who are older and less healthy. The doctor will do tests or other follow up appointments.
Types of surgery that may be needed include:
- Pelvic lymphadenectomy—removal of pelvis lymph nodes to see if they have cancer
- Radical prostatectomy—removal of the prostate using
- TURP (Transurethral resection of the prostate)—removal of part of the prostate with an instrument inserted through the urethra (may be done to ease symptoms)
Radiation therapy can kill cancer cells and shrink tumors. Examples are:
- Conformal radiation therapy— saves nearby tissue from the harmful effects of radiation.
- Intensity-modulated radiation therapy (IMRT)—delivers higher doses of radiation to the tumor and lower doses to nearby tissues.
- Radiopharmaceuticals—drugs with radioactivity are injected into a vein to:
- Treat proteins on prostate cancer cells, or
- Target cancer spread to bones
Hormone therapy may be used if prostate cancer has spread—or returned after being treated. The goal is to lower the levels of male hormones called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth.
Orchiectomy is surgery to remove the testicles. It may be done to help control hormones. The testicles makes androgens.
Other Treatment Options
Other options may include:
- Cryosurgery—Cancer cells are frozen and destroyed. It may be used for low risk, early stage cancer for those who cannot have surgery or radiation.
- Immunotherapy—These drugs build the immune system to help fight cancer cells. They may include a vaccine or injection.
- Targeted therapies—Attack cancer cells and help spare healthy cells.
- High-intensity focused ultrasound—A probe inserted through the rectum destroys cancer cells with ultrasound energy.
- Chemotherapy (chemo)—Mainly used to ease symptoms in cancer that has spread outside the prostate. Chemo may also be helpful with hormone therapy.
To help reduce the risk of prostate cancer:
- Eat a healthful diet that is:
- High in fruits, vegetables, and fish, and
- Low in red meat
- Prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer.html.
- Prostate cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/prostate-cancer.
- Prostate cancer screening. EBSCO DynaMed website. Available at: https://www.dynamed.com/prevention/prostate-cancer-screening.
- Prostate cancer diagnosis and staging. EBSCO DynaMed website. Available at: https://www.dynamed.com/evaluation/prostate-cancer-diagnosis-and-staging.
- Schaeffer E, Srinivas S, Antonarakis ES, et al. Prostate Cancer. Version 3. 2020. In: National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines). NCCN 2020 Nov 17 from NCCN website.
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