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If you have been
diagnosed with prostate cancer, you are not alone. During
his lifetime, a man has about a 1 in 10 chance of being
diagnosed with prostate cancer. Over 200,000 new cases of
prostate cancer are diagnosed annually in the U.S.
Prostate cancer is a malignant tumor that begins growing
in the prostate gland. It can spread from the prostate to
nearby lymph nodes, bones, or other organs. This spread
is called metastasis. A male hormone called testosterone
can stimulate the growth of hormone-dependent prostate cancer
cells.
Prostate cancer is the second leading cause of cancer death
in men. But the good news is that survival rates have improved
a great deal. In the past 20 years, 5-year survival rates
for all stages of prostate cancer combined have increased
from 67% to 99%.
Risk Factors
While researchers still do not know exactly what causes
prostate cancer, they have identified some risk factors.
• Age. The risk of developing prostate cancer increases
as you age. More than 70% of all prostate cancers are diagnosed
in men over age 65.
• Family History. Men whose father and/or brother had prostate
cancer are up to 11 times more likely to develop prostate
cancer.
• Ethnicity. The death rate for prostate cancer is nearly
2.4 times higher in African-American men than in Caucasian
men. (Because of this additional risk, earlier screening
for prostate cancer is recommended for African-American
men. See below.)
• Diet. Research suggests that prostate health may be affected
by diet.
• Obesity. Studies have shown that the death rate from prostate
cancer increases in obese men.
Getting Tested
When should you be tested for prostate cancer?
According to the American Cancer Society, men aged 50 and
older with a life expectancy of at least 10 years, and those
over the age of 45 who are in high-risk groups (such as
African-American men and men with a family history of prostate
cancer) should have a prostate-specific antigen (PSA) blood
test and digital rectal exam (DRE) once every year. For
more information on these and other tests, see Diagnosis.
Learn more about the symptoms of prostate cancer.
Early prostate cancer usually does not cause any symptoms.
But as the tumor grows it may spread from the prostate to
surrounding areas causing a variety of symptoms. As a result
of metastasis to the spine, for example, many men experience
pain in the lower back, pelvis, or upper thighs. (To get
a clearer picture of prostate cancer and its stages, see
Grading and Staging: What the numbers mean.)
Symptoms of more advanced cases of prostate cancer may also
include:
• Interruption of urinary flow (stopping and starting)
• Inability to urinate
• Difficulty starting or stopping urination
• Frequent urination (especially at night)
• Blood in the urine
• Pain or burning during urination
Stopping testicular production of testosterone with an LH-RH
agonist such as Lupron Depot may help relieve many of these
advanced prostate cancer symptoms. Individual results may
vary.
Learn about diagnosis of prostate cancer.
The overall outlook for prostate cancer patients has dramatically
improved compared to what it was years ago. The reality
is that more men are living longer after diagnosis. As already
mentioned, in the past 20 years, 5-year survival rates for
all stages of prostate cancer combined have increased from
67% to 99%.
One of the reasons for this positive development may be
that men are getting tested at an earlier age and prostate
cancer is being detected at an earlier stage.
Diagnosing Prostate Cancer
Prostate cancer is diagnosed through a series of tests and
exams. Before starting the testing process, your doctor
may ask you questions about your medical history, your family
history of cancer and any symptoms you may be having, especially
problems related to urination. Then your doctor may recommend
one or more of the tests described below.
According to the American Cancer Society, two of these tests,
the DRE and PSA, are recommended annually for men aged 50
and older who have a life expectancy of at least 10 years,
and for those over the age of 45 who are in high-risk groups
(such as African-Americans or men with a family history
of prostate cancer).
Digital Rectal Exam (DRE)
Because the prostate lies in front of the rectum, your doctor
can feel the prostate by inserting a gloved, lubricated
finger into the rectum. This simple procedure is called
a digital rectal examination (DRE). It helps the doctor
to determine if the prostate is enlarged, or has lumps or
other types of abnormal texture.
Prostate-Specific Antigen (PSA) Test
PSA (prostate-specific antigen) is a substance produced
by the prostate cells. A PSA test measures the level of
PSA in the bloodstream, and is reported as nanograms per
milliliter, or ng/mL. Most men who do not have prostate
cancer have PSA levels under 4 ng/mL; above this level,
your chances of having prostate cancer increase. However,
some experts have suggested that a lower PSA level, 2.6
ng/mL, should be used when considering prostate cancer risk.
Very little PSA escapes from a healthy prostate into the
bloodstream, but certain prostate conditions can cause larger
amounts of PSA to leak into the blood.
These conditions include benign prostatic hyperplasia (BPH)
and prostate cancer.
Because prostate cancer is not the only cause for high PSA
levels, doctors cannot rely on PSA testing alone to confirm
prostate cancer. It is also important to know that a low
PSA level does not always mean that the prostate is cancer-free.
So if prostate cancer is suspected, additional evaluation
may be needed whether a man's PSA level is high or low.
Keep track of your PSA levels with our simple PSA Tool.
Transrectal Ultrasound (TRUS)
Transrectal ultrasound (TRUS) is used to detect abnormal
prostate growth and to guide a biopsy of the abnormal prostate
area. This procedure uses sound waves to create an image
of the prostate.
Biopsy
With a biopsy, a sample of tissue is taken out and examined
under a microscope to check for cancerous changes. Only
a biopsy can definitely confirm prostate cancer.
A doctor will usually take a number of tissue samples for
biopsy. Keep in mind that even if the biopsy is negative,
cancer may still be present. This is because even though
multiple samples are taken, biopsy can still miss some cancers.
Once prostate cancer is discovered, the tumor is graded
and staged. Grading and staging will help determine what
type of treatment, if any, is most appropriate.
When a biopsy confirms the presence of prostate cancer,
the tumor is examined under a microscope and categorized
into grades. Those grades and PSA levels can be confusing.
This section will help explain what these measurements mean.
PSA (Prostate-Specific Antigen)
PSA is a substance produced by the prostate. In the absence
of prostate disease, PSA is generally found in the blood
at a very low level. Elevated PSA readings can be a sign
of prostate cancer or a non-cancerous prostate condition.
Grade
The grade, also called a Gleason grade, indicates how different
the cancer cells are compared to normal cells, when seen
through a microscope. A Gleason grade ranges from 1 to 5.
A Gleason grade of 1 means the cancer cell clusters resemble
normal prostate tissue. If the cancer cells have little
or no resemblance to normal prostate cells, the cancer may
get a Gleason grade of 5.
Because prostate cancers often have areas with different
grades, a doctor will examine the two areas that make up
most of the cancer. A grade is then given to each of the
two areas. These two grades are added together to yield
a Gleason score of between 2 and 10.
Low Gleason grades and scores generally indicate slow-growing
cancer. High grades and scores indicate a cancer that is
likely to grow aggressively.
Staging
Your doctor may also talk to you about the stage of the
cancer. Staging is the assessment of the size and location
of prostate cancer (that is, how far the cancer has already
spread). Staging is necessary to help you and your doctor
decide what type of treatment is most appropriate.
Currently there are two different systems used to stage
prostate cancer. The traditional method classifies the disease
into four categories, rated A through D. The second system
is called TNM, which stands for Tumor-Nodes-Metastases.
A-D Staging
In this type of staging, Stage A is considered to be early
cancer. The tumor is located within the prostate gland and
cannot be felt during a DRE.
In Stage B, the tumor is considered to be within the prostate
and can be felt during a DRE.
In Stage C, prostate cancer is more advanced. Stage C indicates
that the tumor has spread outside the prostate to some surrounding
areas, but not to lymph nodes or other organs. This stage
of cancer can be detected by a DRE.
In Stage D, the cancer has spread to the nearby lymph nodes
and usually to distant sites, such as the spine, ribs, or
other bones or organs.
TNM Staging
The initials TNM stand for Tumor, Nodes, and Metastases.
TNM staging takes into consideration tumor stage (T) and
whether the cancer has spread to lymph nodes (N) and metastasized
(M) to distant sites in the body.
Tumor stage is assessed on a scale of 1 to 4.
Generally, tumors graded T1 are confined to the prostate
gland but are so small that they cannot be felt during a
DRE or detected during ultrasound.
T2 prostate cancer is confined to the prostate, but it is
large enough to be detected during a DRE.
T3 and T4 prostate cancers have expanded beyond the prostate
into surrounding tissues.
Lymph node involvement is graded on a scale of 0 to 3. N0
(N zero) means that the cancer has not spread into the lymph
nodes. The cancer will be considered N1, N2, or N3 depending
on the number and size of lymph nodes involved.
Metastasis is rated 0 or 1. M0 (M zero) means no metastasis
has occurred; M1 indicates metastasis to a distant location.
Learn about treatment options for prostate cancer and its
symptoms.
There are many choices in the treatment of prostate cancer.
The main options include surgery, radiation, hormonal therapy,
chemotherapy, and watchful waiting. In deciding which treatment
option is most appropriate for you, you and your doctor
will consider several factors, including the cancer stage
and expected benefits and risks of treatment.
In this section, you will find information on benefits of
each treatment option, and the most common side effects.
Although prostate cancer is best treated when detected at
an early stage, therapies are available that can help even
after the cancer has spread outside of the prostate.
Your doctor will determine which of these treatments is
most appropriate for you.
http://www.prostate.com/
prostatecancer/
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