Prostate cancer is the most common cancer in American men aside from skin cancer. One in 6 American men will develop prostate cancer during their lifetime. At this time, more than 2 million men in the United States who have had prostate cancer at some point during their lives are still living.
The prostate is a small gland shaped like a walnut that is in the center of a man’s body within the pelvis. The prostate makes a milky fluid that carries sperm during ejaculation. It is wrapped around the tube that carries urine out of the body (the urethra). It sits just below the bladder.
What are the risk factors for prostate cancer?
Age: A man’s age is the strongest risk factor for prostate cancer. It is rare for a man to develop prostate cancer before the age of 40. After age 50 the chance of having prostate cancer increases rapidly.
African-American background: Prostate cancer is more common in African American men, than in men of other racial backgrounds. African American men are more often diagnosed with prostate cancer when it is in advanced stages. They are over 2 times more likely to die from prostate cancer than white men. Hispanic/Latino and Asian-American men are less likely to develop prostate cancer.
Family History of Prostate Cancer: Prostate cancer is known to run in families. Men who have a father or a brother who has had prostate cancer have twice the risk of developing prostate cancer than a man without a family history of the disease. One in 10 men who get prostate cancer has hereditary prostate cancer – cancer that is caused by genes inherited from their parents. Hereditary prostate cancer is of concern when a man has one of the following:
- Three or more close relatives: father, brother, son – who have prostate cancer.
- Family members with prostate cancer in three generations, one after the other, in the mother’s or father’s family.
- At least two family members have prostate cancer at age 55 or younger.
Environmental Factors: Environmental risk factors are associated with developing prostate cancer. These are:
- Geographic location: where a man lives. For example, there are more white men who develop prostate cancer living in the northwest region of the United States and in New England.
- A high-fat diet
- Eating foods with a lot of calories
- A sedentary lifestyle: getting little exercise
What is known about genetic factors and prostate cancer risk?
Research studies are helping scientists to understand the genetic factors that have a role in inherited risk for prostate cancer. Certain gene changes (mutations) have been found to increase the risk for prostate cancer, and research is ongoing regarding combinations of genetic changes that increase prostate cancer risk. More research is required to fully determine the genetic risk factors for prostate cancer.
Is genetic testing available now for prostate cancer?
Genetic testing is available for certain genes that can cause prostate cancer. Men from families with prostate cancer, breast cancer, or ovarian cancer can talk with their doctors about their risk and genetic counseling. Genetic counselors can take a detailed family history and talk about their risk for prostate cancer, and whether genetic testing is appropriate for them. For more information about genetic counseling go to the Genetics Home Reference.
There are companies that will soon be marketing and selling genetic tests that will predict a man’s risk of developing prostate cancer. It is important for you to talk with your doctor or a genetic counselor about this testing before you decide to have it to make sure that the testing will give you helpful information.
How is prostate cancer diagnosed and treated?
Symptoms: The symptoms of prostate cancer may include problems with urination and sexual function. As the prostate grows larger it can squeeze the urethra and cause frequent, small urination, difficulty beginning urination or even an inability to urinate. The flow of urine can start and stop, be weak, or create pain or a burning feeling. Erection may hurt and there can be blood in the urine or semen. Pain may also occur in the back, hips or upper thighs.
Diagnosis of prostate cancer: The blood level of Prostate Specific Antigen (PSA), an enzyme made by the prostate gland, and a digital rectal examination (DRE) are two tests that are currently used for the detection of prostate cancer. If the level of PSA in the blood is higher than normal, or if the digital rectal exam finds any enlargement or unusual lumps in the prostate, it can mean that a man has prostate cancer.
The diagnosis of prostate cancer is then made by a biopsy (taking a small piece of tissue) of the prostate.
In the future, diagnosis of prostate cancer may be based in part on genetic changes that are found in the prostate gland.
Treatment of prostate cancer: Treatment of prostate cancer depends on when the diagnosis is made and how severe the disease is at that time. Small clusters of early stage prostate cancer can be found in many men in a form that is harmless. In this situation, the doctor may take a “wait and watch approach” to these early cancers, and follow the man with regular PSA blood tests and physical exams. Often the disease can be managed this way for years, as long as the progression is slow.
Surgery may be another treatment used if the tumor has not spread to other parts of the body and the man is healthy enough to handle the operation.
If the prostate is enlarged and there is a mass that the doctor can feel, then surgery may be done to remove as much of the prostate, the tumor and tissue around the prostate to check if the cancer cells have spread (called metastasis). Sometimes the surgery can cause nerve damage that impairs sexual function. Improvements in surgical techniques have lowered that risk and surgeons are now better able to preserve sexual function.
Radiation therapy is sometimes used after surgery or instead of surgery. This treatment is aimed directly at the tumor to kill the cancer cells. It is also used in later stages of prostate cancer to relieve pain.
When the prostate cancer is in advanced stages, hormonal therapy along with surgery or other medical treatment is used to lower the activity of male hormones (androgens) that cause tumor growth. Hormonal therapy can be effective for months to years, holding the disease at bay, but the effectiveness of this treatment may lessen over time. The side effects from hormonal therapy include impotence, decreased sexual desire, smaller muscle mass, and tenderness or enlargement of breast tissue.
Chemotherapy is usually reserved for prostate cancer recurrence or advanced disease. Chemotherapy can help to keep the disease stable and stop growth of the prostate. It is used in men who have had surgery, but whose prostate cancer may come back; men who have had surgery and/or radiation, or in men whose prostate cancer has spread and hormone treatment is no longer working.