Prostate cancer is the uncontrolled growth of abnormal cells in the prostate gland. This gland produces part of the fluid in semen. It is located below the bladder and in front of the rectum, near the base of the penis.

Prostate cancer is one of the most common cancers in American men. It will account for nearly 232,000 newly diagnosed patients in 2008, and nearly 30,000 men will die of it. About 1.3 million men in the United States have been diagnosed with prostate cancer. Many others have the disease, but have not been diagnosed.

These figures show that prostate cancer is common, but the disease is not always dangerous. This is because it affects elderly men, with an average age in the 70's or 80's. Their prostate cancer may never cause symptoms. Also, these men often have other illnesses which may be more important to address than a cancer that may never cause them symptoms.

When cells in the prostate become cancerous (malignant), they form small islands of cancer that are confined to the prostate. This localized form of cancer affects about one-third of men as they grow older. In many cases, it takes years, or even decades, for this cancer to grow beyond the prostate gland's tough outer capsule.

Although researchers do not know the exact cause of prostate cancer, they have identified several factors that increase the risk of getting this disease:

Older age � Microscopic islands of cancer can be seen in the prostates of about 30% of men at age 60. The percent jumps to between 50% and 70% at age 80. Overall, about 3 out of 4 cases of prostate cancer are diagnosed in men over age 65.

African American heritage � African American men are more likely to get prostate cancer than other men and the cancer often is more advanced when it is diagnosed. In the United States, an African American man is twice as likely to die of prostate cancer as a white man. New studies suggest that prostate cancer in African American men may not be more aggressive than prostate cancer that develops in other men. When there is equal access to health care, the outcomes appear to be essentially the same between African Americans and other ethnic/racial groups.

Family history � If a man's father or brother has been diagnosed with prostate cancer, his cancer risk is 2 to 3 times higher than a man with no family history of the illness. Genetic (inherited) factors may be responsible for approximately half of the rare prostate cancers that develop in men under the age of 55. Recent research has identified several genetic defects that may be particularly common in men who develop prostate cancer. While no genetic test is available, other tests are being developed to help identify men who may be susceptible to prostate cancer.

Lifestyle factors � Obesity and eating a high-fat diet, especially one rich in animal fats, increases the risk of prostate cancer. Also, obese men with prostate cancer do not respond as well to treatment compared to men with normal body weights.

In men in the United States, prostate cancer is the most common cancer and the second leading cause of cancer deaths. Prostate cancer strikes about 1 out of every 11 white men, and 1 out of every 9 African American men.

In its early stages, prostate cancer rarely causes symptoms. Indeed, the majority of men who are diagnosed with prostate cancer have no symptoms whatsoever. The cancer is usually first suspected by an abnormal blood test, known as the prostate specific antigen (PSA) test. However, if the cancer grows to invade the urethra or bladder, it can cause the following problems:

• A less forceful urine stream
• Urinating more often than normal (frequency)
• An intense need to urinate (urgency)
• A sudden inability to pass urine (urinary retention)
• Repeated urinary tract infections
• Blood in the urine or semen
• Decreased ability to get or maintain an erection (erectile dysfunction)
• Decrease in the volume of semen during ejaculation
• Lower abdominal pain

If prostate cancer spreads to the lymph nodes, bones or other organs, it can cause bone pain, weight loss, anemia, shortness of breath and other symptoms.

Most cases of prostate cancer are detected by screening for the disease before it causes any symptoms. Your doctor will ask about your symptoms, your medical history and your family history of prostate cancer. Your doctor will want to know whether you have ever been diagnosed with any noncancerous condition of the prostate, such as prostatitis (inflammation of the prostate) or enlarged prostate (benign prostatic hyperplasia), that could have symptoms similar to prostate cancer.

Your doctor will examine you and do a digital rectal exam to feel the prostate gland. In this exam, the doctor inserts his or her index finger into your rectum and gently feels the surface of the prostate through the rectal wall to check for lumps, hardness and enlargement. Your doctor will ask for a urine specimen, and probably will order a prostate-specific antigen (PSA) blood test.

PSA is a protein made by the prostate and secreted into the semen. Prostate cancer and certain noncancerous prostate disorders can cause increased amounts of PSA to leak out of the prostate into the blood. There is no consensus among health care professionals about the value of or the need to do PSA testing.

If the PSA level in your blood is higher than normal or your digital rectal exam shows a possible problem, your doctor may order additional tests, such as a prostate needle biopsy. In this procedure, a needle is used to remove small pieces of tissue from the top, middle and bottom parts of the prostate. Your doctor also may want to take tissue samples from any suspicious areas identified by the digital rectal exam or seen on the ultrasound. A doctor who specializes in the diagnosis of diseased tissues (pathologist) will examine the tissue.

Tell your doctor if you are taking any prescription or over-the-counter medication to treat an enlarged prostate. Certain prostate medications, such as finasteride (Proscar) and dutasteride (Avodart), can affect the results of the PSA test.

If your biopsy confirms that you have prostate cancer, the pathologist will assign a Gleason score to your tumor. The Gleason score is an indication of how abnormal the cancer cells look under a microscope compared to normal prostate cells. The score provides a rough estimate of how likely the cancer is to grow and spread rapidly.

Gleason scores generally indicate the following:

• Gleason score (total) of 2 to 4: Low-grade or nonaggressive cancer
• Gleason score (total) of 5 to 7: Intermediate grade
• Gleason score (total) of 8 or higher: High-grade or aggressive cancer

Once prostate cancer develops, it usually grows slowly over many years. A small percentage of cases of prostate cancer grow and spread rapidly. Almost all prostate cancer will respond to one form of treatment or another. The important question is whether all prostate cancers need any specific treatment at all. Recent advances have helped doctors determine which prostate cancers can be watched safely for a period of time before undertaking any specific treatment.

There is some evidence that prostate cancer is less common in men who regularly eat a low-fat diet that is rich in lycopene (an antioxidant released when tomatoes are cooked). More recent studies have questioned the value of lycopene.

Some medications have been tested to prevent prostate cancer, including finasteride, which is normally prescribed for benign enlargement of the prostate gland. While men taking this drug had a lower risk of developing prostate cancer, they also appeared more likely to be diagnosed with an aggressive form of the disease. For this reason, experts are divided as to whether finasteride should be offered to men who have a higher than average risk of prostate cancer.

Prostate cancer can be treated several ways. You and your doctor should weigh many important medical and lifestyle issues before deciding on a treatment plan. The best treatment will take into account:

• The extent of your cancer
• The chances that your cancer will grow and spread rapidly
• Your age and life expectancy
• Any health conditions that would increase the risks of surgery or other treatments
• Your willingness to risk side effects

If your cancer is confined to the prostate gland and has not penetrated the prostate capsule, you have these treatment options:

Watchful waiting � In this approach, the expectation is that you will not need treatment unless you begin to have symptoms. Instead, your doctor will monitor your cancer periodically with physical examinations and PSA tests. This strategy generally is reserved for men whose biopsy shows a low Gleason score (nonaggressive tumor). It also is a good option for elderly men who are too ill to tolerate radiation or surgery, or who have other serious medical conditions that limit their life expectancies.

Active surveillance (with delayed intention to treat) � Active surveillance is often used for men whose prostate cancer may not necessarily need any specific intervention now, but with the expectation that treatment may be advised at any time. Men are followed more closely compared to the "watchful waiting" approach. About every three to four months, men are scheduled for a PSA blood test, a physical examination that includes a digital rectal exam, and periodic repeat biopsies. If any of these show increased disease activity, specific treatments can be started.

Radiation therapy � Several forms of radiation therapy are used to treat prostate cancer. External beam radiation therapy directs radiation into the body from outside the body. Radiation can also be delivered by placing the radiation source into the prostate gland through brachytherapy (seed implantation) or interstitial radiation therapy. These internal forms may be used alone or in combination with external beam radiation. The seeds may be permanent or temporary.

Other forms of radiation include proton beams (more focused forms of radiation) and Cyberknife therapy, in which a robotic assisted device delivers pinpoint radiation to the prostate gland. The Cyberknife treatment allows shorter treatment periods than the five to eight weeks generally required for traditional external beam radiation.

The effectiveness of radiation therapy may be improved by adding hormonal therapy or androgen deprivation therapy.

Side effects of radiation therapy can include impotence, diarrhea, rectal bleeding and incontinence. More men experience side effects from external-beam radiation than from brachytherapy.

Surgery � With a radical prostatectomy, your entire prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes are removed. There are several methods. In the most common, an incision is made just below the belly button, allowing access to the gland and to one or several chains of lymph nodes that drain the prostate gland. This operation uses one incision. The perineal approach requires an incision between the scrotum and the anus. A second abdominal incision would be needed to get a sample of lymph nodes. In both procedures, the surgeon tries to do as little damage to the surrounding nerves as possible. This can reduce side effects such as erectile dysfunction and incontinence.

More recently, laparoscopic surgery has gained in popularity. This requires smaller incisions.

Complications of patients undergoing radical prostatectomy include:

• impotence
• erectile dysfunction
• urinary incontinence
• bowel complications
• cardiovascular complications
• death

Cryoablation � This treatment freezes and then thaws the cancer, which destroys it. The procedure is still in its infancy. No long-term studies are available to reveal survival rates. More work is needed to understand the best way to use cryoablation.

High intensity focused ultrasound � This treatment has gained in popularity in countries outside of the United States. It uses high energy sound waves to destroy abnormal prostate tissue that contains cancer. Ongoing studies should be able to help doctors determine if this procedure is safe and effective.

Treatment for non-localized prostate cancer � For men whose prostate cancer has grown through the prostate capsule but has not spread (metastasized) to other organs, watchful waiting or radiation therapy (with or without hormonal therapy) are usually recommended.

For men with prostate cancer that has spread to other organs, doctors usually prescribe androgen-deprivation (hormone) therapy. Androgens are male sex hormones, such as testosterone. This treatment reduces testosterone and other androgens that stimulate the prostate cancer to grow. Usually, doctors prescribe drugs to block the effects of testosterone or stop the testicles from producing it. Another approach is to surgically remove the testicles. Side effects of androgen-deprivation therapy include impotence, breast enlargement, liver abnormalities, weight gain, decreased sex drive, osteoporosis and abnormalities in how the body uses sugar and fat. Some men experience hot flashes.

For prostate cancer that has spread to other organs and no longer responds to hormonal therapy, doctors may recommend chemotherapy.

Call your doctor immediately if you notice blood in your urine or semen, or if your urination is painful, uncomfortable or abnormal in any way.

If you are age 50 or older, ask your doctor about the pros and cons of prostate cancer screening. Some experts believe screening is the best way to prevent death and disability from prostate cancer. Other experts worry that screening may cause more harm than good because some men will get side effects from treatment they may not have needed. Your doctor should be able to help you decide whether regular digital rectal exams and PSA testing makes sense for you.

If you decide to get screened, your doctor probably will do a prostate exam and check your PSA level every 1 to 2 years beginning at age 50. Screening may start at age 45 for African American men and men who have a family history of prostate cancer.

The prognosis usually is excellent. About 70% of men with localized cancer are cured. Prostate cancer rarely is cured once it has spread, but many men survive for years or even decades after being diagnosed. In fact, many more men die of other causes while they have prostate cancer than die as a result of the cancer.

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
6116 Executive Blvd.
Room 3036A
Bethesda, MD 20892-8322
Toll-Free: 1-800-422-6237
TTY: 1-800-332-8615
http://www.nci.nih.gov/

American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/

American Urological Association
1000 Corporate Blvd.
Linthicum, MD 21090
Phone: 410-689-3700
Toll-Free: 1-866-746-4282
Fax: 410-689-3800
Email: auafoundation@auafoundation.org
http://www.urologyhealth.org/

American Foundation for Urologic Disease
1000 Corporate Blvd.
Suite 410
Linthicum, MD 21090
Phone: 410-689-3990
Toll-Free: 1-800-828-7866
http://www.afud.org/