Prostate cancer occurs when malignant cells build up in or on the surface of the prostate. The prostate is a gland that makes part of the seminal fluid. During ejaculation, the seminal fluid helps carry sperm out of the man's body as part of semen. The prostate surrounds the urethra, the tube through which urine flows. A healthy prostate is about the size of a walnut. If the prostate grows too large, it squeezes the urethra. This may slow or stop the flow of urine from the bladder to the penis.
Prostate Cancer Overview and Symptoms
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells forms a mass of tissue called a tumor. Cancer cells also can break away from the prostate tumor and enter blood vessels or lymph nodes. The cancer cells can attach to other tissues and grow to form new tumors. The spread of cancer is called metastasis.
Benign Prostate Growths
Prostate growths can be benign (not cancer). Benign prostatic hyperplasia (BPH) is a benign growth of prostate cells. It is not cancer. The prostate grows larger and squeezes the urethra. This prevents the normal flow of urine. BPH is a very common problem. In the United States, most men over the age of 50 have symptoms of BPH. For some men, the symptoms may be severe enough to need treatment.
Unfortunately, there are no early warning signs for prostate cancer. Most cases develop in men over 65.
The following symptoms could indicate prostate cancer, BPH or other health problems:
- Urinary problems — not being able to pass urine or frequent urination, weak flow, flow that starts and stops, pain or burning during urination
- Difficulty having an erection
- Blood in urine or semen
- Frequent pain in the lower back, hips or upper thighs
Prostate Cancer Diagnosis
Your doctor can check for prostate cancer before you have any symptoms. During your annual physical exam, you may have a PSA test or digital rectal exam. It is recommended that both a PSA test and digital rectal exam be performed every year after age 50. When men are screened annually with these tests, prostate cancer is caught early and the possibility of a cure is greatest.
If prostate cancer is suspected, additional diagnostic tests include:
- Transrectal ultrasound – The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses these sound waves/echoes to create a picture called a sonogram.
- Transrectal biopsy – This is the only sure way to diagnose prostate cancer. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts needles through the rectum into the prostate and removes small tissue samples from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.
If cancer cells are discovered, the pathologist also will determine the cancer grade. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.
Our doctors also use gene-based tests to identify men who are at the highest risk of having prostate cancer. The tests use advanced techniques to measure gene activity and other molecular markers. These test results help guide our doctors and our patients in making treatment decisions.
Prostate Cancer Treatment
Prostate cancer treatment will vary depending on the stage of the disease and other personal factors. However, it may include:
- Active surveillance– Early-stage prostate cancer patients may choose to "watch and wait"
- Brachytherapy seed implants– low-dose radioactive "seeds," each about the size of a grain of rice, are implanted within the prostate to kill cancer cells locally
- Cyberknife– a robotically-controlled radiation delivery machine
- External radiation– traditional radiation techniques encompass the entire prostate and, for those at high risk of the disease spreading, the pelvic lymph node
- Hormonal therapy– helps block production or action of the male hormones that have been shown to fuel prostate cancer
- Robot-assisted prostatectomy– minimally invasive approach to the traditional "open" prostatectomy