Prostate Cancer FAQ
This section answers the most frequently asked questions by patients with prostate cancer. Relevant questions to ask your doctor after a prostate cancer diagnosis and a list of useful links are also provided. Click on a question below to access the corresponding answer.
- What is the prostate?
- What is prostate cancer?
- What are the major risk factors?
- What are the signs and symptoms?
- Can prostate cancer be prevented?
- How is prostate cancer diagnosed?
- What is the survival rate?
- What are the treatment options?
What is the prostate?
The prostate is a gland, found only in men, normally about the size of a walnut and located below the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine out of the bladder, and is part of a man’s reproductive system involved in the production of seminal fluid. With age, the prostate tends to grow and it can squeeze the urethra, which may slow or stop the flow of urine from the bladder to the penis.
What is prostate cancer?
Cancer can develop in the prostate, leading to changes in the gland’s cells, which begin to multiply in a non-regulated fashion.
According the American Cancer Society (ACS), prostate cancer is the most frequent cancer in men. It affects about 1 in every 6 men over the course of his life and rarely occurs before age 50. More than 209,000 new cases are expected to be diagnosed in 2008 in the United States and Canada. Prostate cancer accounts for 33% of all male cancers and 10% of all male cancer-related deaths. With an estimated 33,000 deaths in 2008, prostate cancer is also the second leading cause of cancer deaths in men. According to the National Cancer Institute, more than 96% of all patients diagnosed with prostate cancer are 55 years and older. Statistically, 91% of prostate cancers are discovered in local and regional stages. Prostate cancer can be treated in a highly effective manner when localized in the prostate.
Most prostate cancer cases evolve very slowly and may progress over a long period before showing any symptoms. In some men, the tumor may grow rapidly and expand beyond the organ (in the bones for example), thereby causing pain in the bones, paralysis and death.
Although there are several cell types in the prostate, nearly all prostate cancers start in the gland cells. While painful, most prostate cancers do not kill. Most patients will die before the prostate cancer symptoms fully develop, due to other causes. But sometimes prostate cancer can grow and spread quickly. Even with the latest methods, it is hard to tell which prostate cancers will grow slowly and which will grow quickly.
What are the major risk factors?
The incidence of prostate cancer grows exponentially with age, making it the main risk factor for the disease. Family background also plays a role, as well as race and nationality. Indeed, prostate cancer is more frequent in African-Americans than among Caucasians, and is even less frequent in Asians. Prostate cancer seems to occur in certain families, thereby suggesting a genetic or hereditary factor; for example, when a man has a father or brother affected with prostate cancer, the risk of developing the illness is two to three times greater than the average. However, it is not clear whether this is due to genetic or environmental factors. It is suspected that the diet of North Americans, high in fat and animal proteins and low in fibre, also plays a role in prostate cancer development.
Many of these risk factors can be avoided. Others, such as family history, cannot be avoided. You can help protect yourself by staying away from known risk factors whenever possible.
What are the signs and symptoms?
In its early stages, prostate cancer is asymptomatic. As the cancerous tissue expands, symptoms may emerge. The most frequent symptoms are urinary problems: low or interrupted urinary flow, frequent or painful micturition, incontinence, difficulty urinating or bloodstained urine, followed by fatigue, weight loss and bone pains. Other symptoms include difficulty having an erection, blood in the urine or semen and frequent pain in the lower back, hips, or upper thighs
Most often, these symptoms are not due to cancer. Benign prostatic hyperplasia (BPH), an infection, or another health problem may cause them. Professional advice must be taken whenever possible, so that problems can be diagnosed and treated as early as possible.
Can prostate cancer be prevented?
As stated by the Prostate Cancer Research Foundation of Canada, there are no definitive proven preventative remedies. However, current information indicates that men who modify certain aspects of their lifestyle may lower their risk.
Maintaining a low-fat diet is a good start. Meals consisting of fruits and vegetables, bread and grain products are recommended. A growing body of evidence also suggests that certain micronutrients may lower the risk of prostate cancer. They include lycopene, selenium, vitamin D and phytoestrogens.
How is prostate cancer diagnosed?
Screening
The current standard screening method includes the measurement of prostate specific antigen (PSA) levels in the blood combined with a digital rectal exam. The American Cancer Society recommends that all men 40 and over should have a digital rectal exam as part of their regular annual physical checkup, and men aged 50 and over be tested annually for PSA in their blood.
PSA is produced by the prostate as a component of seminal fluid. In normal men, small amounts leak into the blood. The level of PSA in the blood can be increased by many conditions such as inflammation of the prostate, urinary retention, prostatic infection, benign prostatic hyperplasia, prostate cancer and prostatic manipulation. The PSA test can be used for screening prostate cancer or for monitoring the recurrence of prostate cancer. The results of a PSA test combined with those of the digital rectal exam help determine whether further medial evaluation, such as a biopsy, should be undertaken.
Your doctor may recommend prostate cancer screening before you have any symptoms in order to detect and treat cancer early.
Diagnosis
If you have symptoms or if the results from the PSA test and DRE suggest you may have cancer, your doctor must then find out whether it is due to cancer or some other cause and may require that a biopsy be performed.
A biopsy is an invasive procedure consisting of the removal of cells or tissues for examination under a microscope. It is done by inserting an ultrasound probe in the rectum to guide the needle biopsies (on average 6 to 24) in various prostate zones. Biopsies performed following an elevated PSA result in positive findings approximately 1/4 of the time. The other 3/4 of the time, the “false positive” PSA, could be due to several factors. First, other conditions such as benign prostatic hyperplasia (BPH) or prostatitis can cause elevated amounts of PSA to leak into the blood. Second, there might actually be cancer in the patient’s gland, but it was missed on biopsy.
If cancer is not found, your doctor may suggest medicine to reduce symptoms caused by an enlarged prostate. If the biopsy finds cancer, more tests may be done to see whether the cancer has spread and if so, how far. This process is called staging. Staging is very important because your treatment and the outlook for your recovery depend on the stage of your cancer.
Prostate cancer stages
The U.S. National Cancer Institute has established the following schedule of stages in prostate cancer:
- Stage I: The cancer cannot be felt during a digital rectal exam. It is found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate.
- Stage II: The cancer is more advanced, but it has not spread outside the prostate.
- Stage III: The cancer has spread outside the prostate. It may be in the seminal vesicles. It has not spread to the lymph nodes.
- Stage IV: The cancer may be in nearby muscles and organs (beyond the seminal vesicles). It may have spread to the lymph nodes. It may have spread to other parts of the body.
- Recurrent cancer is cancer that has come back (recurred) after a time when it could not be detected. It may recur in or near the prostate. Or it may recur in any other part of the body, such as the bones.
Another way of grading prostate cancer is with the Gleason score. The pathologist gives each area of cancer a grade of 1 through 5. The pathologist adds the two most common grades together to make a Gleason score. Or the pathologist may add the most common grade and the highest (most abnormal) grade to get the score. Gleason scores can range from 2 to 10.
Based on your DRE results, PSA blood test results and the Gleason score of the cancer, other tests may be done to stage your cancer. A complete physical exam (including the DRE) is an important part of prostate cancer staging. The doctor will look at other parts of your body to see if the cancer has spread. He or she may also perform a bone scan and ask you about symptoms such as bone pain that could point to spread to your bones.
What is the survival rate?
The American Cancer Society (ACS) states that the five-year relative survival rate is the percentage of patients who do not die from prostate cancer within five years after the cancer is found. Of course, patients might live more than five years after diagnosis. These five-year survival rates are based on men with prostate cancer first treated more than five years ago. Men treated today may have a more favorable outlook.
According to the ACS, overall, 99% of men diagnosed with prostate cancer survive at least five years. Further, 91% survive at least 10 years, and 76% survive at least 15 years.
Ninety percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The five-year relative survival rate for these men is nearly 100%.
For the men whose cancer has already spread to distant parts of the body when it is found, 34% will survive at least five years.
What are the treatment options?
Standard treatment procedures
The type of treatment for prostate cancer depends on the stage and grade of the illness, the life expectancy and the general health condition of the patient, as well as the patient’s preference for a treatment or another. In some cases of low grade tumors, close monitoring can be proposed. For higher grades, surgery or radiation therapy are the main therapeutic options. Surgical techniques to remove the prostate are now more refined and allow for the reduction of side effects such as incontinence and impotence. After surgery, when cancer is organ-confined, risk of recurrence is very low. Radiation therapy can be performed with an external beam or by radioactive implants in the prostate. Hormonal therapy and chemotherapy can be used when cancer has spread outside the gland or when there is recurrence after the initial treatment.
The PCA3 assay
PCA3 is a biomarker believed to be more specific for prostate cancer than the currently used diagnostic tests. This highly specific molecular assay may fill an important medical need for men who have an elevated PSA level and a negative biopsy, a condition called the “PSA dilemma”. The assay is performed on a urine sample collected after you receive a digital rectal examination. Clinical research from Urological Sciences Research Foundation, MD Anderson Cancer Center, Johns Hopkins University, the University of Washington, University of Nijmegen and several other institutions have indicated that testing for expression of the marker may help to determine if patients facing this dilemma have prostate cancer.
For more information on the PCA3 assay, visit our PCA3 Test section or ask your doctor.
What questions to ask your doctor
- What is my PSA level?
- Are there additional tests that could be performed to confirm the presence or extent of cancer?
- What is my Gleason score / stage and aggressiveness of my cancer?
- What further tests do you recommend for me?
- What is the cure rate of this type of cancer?
- What are the chances that cancer spread over beyond the prostate?
- What is my survival rate?
- Will I have other urinary or rectal problems?
- What can I do to improve the success of my therapy?
- Should I follow a special diet to optimize my therapy?
- What kind of follow-up can I expect after treatment?
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