What is prostate cancer?
The prostate is part of the male reproductive system and is normally about the size and shape of a walnut. It is located below the bladder in front of the rectum and surrounds the urethra (the tube-like structure that carries urine from the bladder out through the penis). The main function of the prostate is to produce fluid for the semen.
Prostate cancer is a common form of cancer in men that typically develops in the cells that create and release mucus and other bodily fluids (a type of cancer known as adenocarcinoma). It usually grows slowly and initially remains confined to the prostate gland. However, certain other types of this cancer may grow rapidly and aggressively.
While the cause of prostate cancer is unknown, there are certain factors that increase the risk of prostate cancer developing. Risk factors include:
- A family history of prostate or breast cancer
- Race/ethnicity (black males have a much higher risk of prostate cancer)
What are the symptoms of prostate cancer?
In the early stages, prostate cancer may not cause any symptoms. Advanced prostate cancer may result in symptoms including:
- Blood in semen
- Decreased size and strength of the urine stream
- Difficulty with urination
- Discomfort in the pelvic area
- Erectile dysfunction
How is prostate cancer diagnosed?
A physician may recommend a prostate screening to determine if prostate cancer is present. Screening tests include:
- Digital Rectal Exam (DRE) – During a DRE, the physician will insert a gloved, lubricated finger into the rectum to feel for any irregularities (e.g., change in shape, size or texture) in the prostate.
- Prostate-Specific Antigen (PSA) Test – The PSA test is a blood sample that is taken to analyze the levels of PSA in the bloodstream. If the level is high, it may be an indication that the prostate is inflamed, infected, enlarged or cancerous.
If an abnormality is detected on a DRE or a PSA test, additional testing is required to confirm a diagnosis. Tests may include a transrectal ultrasound—where a probe is inserted into the rectum—or taking a sample of prostate tissue (biopsy) using a thin needle.
Once a cancer diagnosis is confirmed, a physician will determine which stage the cancer is in and begin discussing treatment options.
Stages of prostate cancer are:
- Stage I: This stage indicates a very early form of cancer that is confined to a small area of the prostate.
- Stage II: The tumor may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or, cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
- Stage III: The cancer has metastasized (spread) to the seminal vesicles or other nearby tissues.
- Stage IV: The cancer has spread to other tissues, such as lymph nodes, bones or other organs.
How is prostate cancer treated?
Treatment for prostate cancer may not be immediately necessary when the cancer is in the very early stages. Instead, a physician may recommend active surveillance. Active surveillance involves follow-up bloodwork, rectal exams and biopsies to monitor the progression of the cancer.
This approach may be an option if the cancer isn’t showing any symptoms, is confined to a small area of the prostate and is expected to grow slowly. In addition, it may serve as an option for individuals who have other serious health conditions or are elderly and more physically difficult to treat.
If the cancer is more advanced, there are several treatment options available:
Radiation therapy utilizes high-energy beams targeted in the affected area to kill cancer cells, and can be given in one of two ways:
- External beam radiation therapy – This therapy uses a machine that moves around the body to direct the beams in exact locations. This form of radiation therapy is typically used following surgery to destroy any remaining cancer cells.
- Brachytherapy – This option involves inserting rice-sized radioactive pellets via an X-ray-guided needle into the prostate tissue. The pellets deliver a low dose of radiation over time.
Prostate cancer cells feed and thrive on the male hormone testosterone. The purpose of hormone therapy is to stop the body from producing testosterone so that the cancer cells grow more slowly or die.
Hormone therapy options include:
- Medications to stop the body’s production of testosterone
- Medication to prohibit testosterone from reaching cancer cells
- Surgery to remove the testicles (known as orchiectomy), which reduces testosterone levels in the body
When surgery is considered an option, it involves removing the entire prostate gland (known as a robotic prostatectomy) and some of the surrounding tissues as well as lymph nodes. There are three surgical approaches to the robotic prostatectomy:
- Incision through the lower abdomen (retropubic surgery)
- Incision between the anus and the scrotum
- Minimally invasive robotic surgery
This technique uses an X-ray-guided needle to insert special gases into the tumor that freeze the cancer cells and then heat them up again. The cycle of freezing and heating destroys the cells, as well as a small portion of surrounding healthy tissue.
Chemotherapy may be utilized to kill any cancer cells remaining after surgery or shrink a tumor as much as possible before surgery. It can be delivered through a vein in the arm (intravenously), taken in pill form or a combination of both.
In some cases, chemotherapy may be used in conjunction with radiation therapy when surgery isn’t an option.
Immunotherapy (also known as biological therapy) assists the immune system in fighting cancer cells. The treatment involves taking the immune cells, genetically modifying them in a lab to combat cancer and then injecting them back into the body intravenously.