• Frequent or urgent need
to urinate; delayed or interrupted urinary stream; dribbling.
• Pain upon urination.
• Blood in the urine.
• Painful or bloody ejaculation.
• Erectile dysfunction (impotence).
• Pain in the pelvis or lower back.
When to call a doctor
• Call a doctor if you experience
difficult, painful, or unusually frequent urination.
What is it?
Prostate cancer is the growth of malignant cells
in the prostate, a walnut-size gland located just below the bladder
which produces about 30 percent of the fluid portion of semen.
Prostate cancer is common: Men have a lifetime chance of between
one in 10 and one in 13 of developing the disease.
It is the
most commonly diagnosed male cancer and the second leading
cause of male cancer deaths. Indeed, autopsy studies have shown
that 60 to 70 percent of all men who reach the age of 80 have
at least some microscopic evidence of prostate cancer. Symptoms
do not occur until the cancer has spread beyond the prostate,
highlighting the importance of regular checkups.
cancer tends to grow very slowly and takes years to spread,
immediate and aggressive treatment may not be advised in older
men. For such patients a diagnosis of prostate cancer may warrant
a strategy of "watchful waiting." This involves regular
examinations and blood tests, but treatment is undertaken only
if evidence indicates tumor growth. The specific treatment
plan depends upon a number of factors: the patient’s
age, the characteristics of the cancerous cells, the size of
the tumor, whether cancer appears to have spread to other sites,
and the risk of complications.
Prostate cancer may be cured
by removing the prostate gland before the cancer has spread.
However, much controversy prevails about when to advise surgery
because it is not possible to predict which cancers will spread
and which will not. There is no cure once the cancer has spread
beyond the prostate. In some cases though, prostate cancer
never spreads, and in general, the outlook is good when the
cancer is detected early.
What causes it?
• The cause of prostate cancer is unknown,
but age, family history, and race are the strongest risk factors.
• Age: The incidence of prostate cancer (rate of newly diagnosed
cancer) increases faster with age than any other form of cancer.
• Family history: A family history of prostate cancer and early
age at onset (under age 55) within a family increase the risk
that a male will develop the disease.
• Race: African Americans have a one-and-a-half times greater
incidence of prostate cancer than Caucasian Americans.
• The role of factors such
as male hormones, dietary fat, and environmental toxins is not
• Men over age 50 should
have regular digital rectal examinations (examination of the
prostate with a gloved finger) and
measurements of PSA (see Diagnosis) to aid in early detection
Men at high risk should begin testing between 40 and
• Patient history and physical examination, including
a digital rectal exam (DRE).
• Blood tests. The prostate specific antigen (PSA) blood test
is the most useful test for early detection. PSA, an
by the cells lining the prostate, functions to liquefy
semen after ejaculation. Normally, little PSA enters the
blood, but prostate cancer tends to boost levels of PSA in the
However, since nonmalignant abnormalities such as benign
(prostate enlargement) and prostatitis may also cause
increased blood levels of PSA, other tests are necessary to confirm
• Multiple biopsies of the
prostate are necessary to confirm the diagnosis. Transrectal
a rectal probe) allows visual imaging of the prostate
and accurate placement of biopsy needles to obtain tissue samples.
tissue samples are obtained with a needle inserted
through the rectum, guided by ultrasound.
How to treat
• Because prostate cancer tends to grow very slowly, a common
management strategy is watchful waiting, which involves
examinations and measurements of PSA to monitor the
progress of the tumor, with more aggressive treatment advised
warranted. Watchful waiting is often recommended for
men in their 70s
and 80s who are thought to have localized cancer.
• Total surgical removal of the prostate gland (radical prostatectomy)
is the most common treatment; it usually includes removal
of nearby lymph nodes. A better understanding of the
location of structures important for erectile function and urinary
have greatly reduced the risk of impotence and incontinence.
Surgery is generally recommended for men in their 50s
• Radiation therapy to destroy cancerous cells may be recommended
for somewhat older men or those who are unable to withstand
surgery. (Chemotherapy, which is useful in the treatment
of some types
of cancer, has not been effective in the treatment
of prostate cancer.)
• In advanced cases in which the cancer has spread, surgical
removal of the testicles (orchiectomy) or hormone therapy
the administration of substances that block the release
or function of male hormones) may slow the growth of prostate
thus minimize or arrest the further spread of the cancer.
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