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Understanding Prostate Cancer

Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. Understanding the risk factors and the types of tests to find prostate cancer are critical to ensuring timely and successful treatments so patients can maintain a high quality of life.

Male hormones (called androgens) are needed for the prostate to work as it's supposed to. This also keeps the prostate at a normal size. As men age, the prostate changes and grows, while androgen levels go down. These may cause changes in the cells that can lead to prostate cancer.

Tumors that grow in the prostate can cause problems with the urinary system. If it grows beyond the prostate, cancer can spread into nearby structures such as the rectum or bladder. This can also cause problems with how they work as well. It can also spread to lymph nodes or blood vessels and carry cancer to other sites in the body.

The types of prostate cancer are based on how it looks in a lab and where the cancer starts. The types are:

  • Adenocarcinoma - which starts in the cells that make seminal fluid inside the prostate (this type makes up nearly all prostate cancers)
  • Sarcoma – a rare type that starts in the connective tissues that support the prostate.
  • Neuroendocrine – a rare type that starts in the endocrine cells that are linked to hormones.
  • Transitional cell a rare type that starts in the tissue that lines the inside of the prostate gland.

Symptoms of Prostate Cancer

The symptoms of prostate cancer can differ from person to person. Urine passes from the bladder to a tube and then out of the body. The prostate gland wraps around this tube. A tumor can press on this tube and cause urinary problems.

Early signs of prostate cancer may include:

  • Burning or pain when passing urine
  • Having a hard time passing urine, starting and stopping
  • Increased need to urinate at night
  • Loss of bladder control
  • Slower flow or less urine
  • Blood in urine
  • Blood in semen
  • Problems getting or keeping an erection
  • Pain with ejaculation

Some of these issues are caused by other less serious problems. Benign prostatic hyperplasia (BPH) is a common cause. It is important to talk to your doctor if you have any of these symptoms.

Prostate cancer that has spread throughout the body may cause swelling in legs or pelvic area, numbness or pain in the hips, legs, or feet, and bone pain that doesn’t go away, or leads to fractures

Risk Factors for Prostate Cancer

Things that may increase the risk of prostate cancer include:

  • Age - Prostate cancer is rare in men under 40 years old. The risk of prostate cancer rises after age 50. Most occur in men older than 65.
  • Race/ethnicity - Prostate cancer occurs more often in African-American men and Caribbean men of African ancestry. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men. The reasons for these differences are not clear.
  • Geography - Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands. It is less common in Asia, Africa, Central America, and South America. The reasons for this are not clear. Lifestyle habits may play a role.
  • Family history - Prostate cancer seems to run in some families. This may mean there is a genetic factor. Still, most prostate cancers occur in men without a family history. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. The risk is higher if a brother has prostate cancer than a father. The more relatives have prostate cancer the higher the risk will be.
  • Gene changes - Some gene changes are passed down in families. Certain changes increase the risk of prostate cancer. For example, changes in BRCA1 or BRCA2 may increase prostate cancer risk in some men and Lynch syndrome (hereditary nonpolyposis colorectal cancer) increases risk for prostate cancer.
  • Diet - Studies are not clear on the exact effect of diet. Some things that may play a role, though not fully proven, include diets high in red meat and fat and low in vegetables and fruits, high amounts of calcium from diet or supplements.
  • Chemicals - Firefighters may have an increased risk of prostate cancer. It is thought to be due to chemicals that they come in contact with on the job.
  • Smoking or obesity – While these factors have not been found to increase the risk of prostate cancer itself, they are linked to a higher risk of dying from prostate cancer.

Reducing Your Risk for Prostate Cancer

Major risk factors for prostate cancer, such as your age, race, or family history can't be changed. However, there are many things that men can do to reduce their risk of developing prostate cancer, including:

  • Eat fewer calories or exercise more so that you maintain a healthy weight.
  • Limit fats from red meat and dairy products.
  • Watch your calcium intake. Do not take supplemental doses above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
  • Eat more fish. Fish may protect against prostate cancer because they have “good fat”.
  • Avoid trans fatty acids.
  • Try to incorporate cooked tomatoes, cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals.
  • Avoid smoking.
  • Drink alcohol in moderation, if at all.
  • Seek medical treatment for stress, high blood pressure, diabetes, high cholesterol, and depression. Treating these conditions may save your life. It will also improve your survival chances if you do get prostate cancer.
  • Avoid too many supplements with megavitamins. Too many vitamins, especially folate, may help a cancer grow. If you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you may not need a multivitamin. Ask your doctor about herbal supplements as some may harm you.

Screenings for Prostate Cancer

Screening can help to find cancer before it causes symptoms. There are two common tests to screen for prostate cancer.

Prostate Specific Antigen - Prostate specific antigen (PSA) is made by the prostate. It can be measured with a blood test. Levels can increase with prostate cancer. It can also increase because of:

  • Some medicine
  • Medical procedure
  • Benign prostatic hyperplasia (BPH)
  • Prostate infection

Age, race, and other things can affect your PSA levels. Your doctor will look at all of these factors when looking at the PSA levels. If the level is abnormal for you, other tests may be done. A prostate biopsy is often the next step. It will remove a piece of prostate for testing to look for cancer.

 Digital Rectal Exam

The prostate sits near the rectum. The doctor can feel the prostate through the wall of the rectum. This type of exam is called digital rectal exam (DRE). The health care provider inserts a gloved finger into the rectum. They use gentle pressure to feel for problems in the prostate. The US Preventive Services Task does not recommend DRE as a screening test. It may instead be used after an abnormal PSA test or symptoms.