Advance Prostate Cancer

Definition

Prostate cancer forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum).

Black men tend to have significantly higher rates of prostate cancer, and the disease tends to be more advanced and harder to cure at the time of diagnosis.

• Black men have a higher chance of dying from their prostate cancer and should therefore start prostate cancer screening with yearly PSA tests and physical exams at age 40, and even earlier if a strong family history of prostate cancer exists.
• In 2007, African American men were 1.4 times, respectively, more likely to have new cases of prostate cancer, as compared to non-Hispanic white men.
• African American men develop prostate cancer 60% more often than white men.

Causes

When you’re told you have prostate cancer, it’s natural to wonder what may have caused the disease. But no one knows the exact causes of prostate cancer. Doctors seldom know why one man develops prostate cancer and another doesn’t.

However, research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for prostate cancer:

• Age over 65: Age is the main risk factor for prostate cancer. The chance of getting prostate cancer increases as you get older. In the United States, most men with prostate cancer are over 65. This disease is rare in men under 45.
• Family history: Your risk is higher if your father, brother, or son had prostate cancer.
• Race: Prostate cancer is more common among black men than white or Hispanic/Latino men. It’s less common among Asian/Pacific Islander and American Indian/Alaska Native men.
• Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk of prostate cancer. These prostate cells look abnormal under a microscope.
• Certain genome changes: Researchers have found specific regions on certain chromosomes that are linked to the risk of prostate cancer. According to recent studies, if a man has a genetic change in one or more of these regions, the risk of prostate cancer may be increased. The risk increases with the number of genetic changes that are found. Also, other studies have shown an elevated risk of prostate cancer among men with changes in certain genes, such as BRCA1 and BRCA2.

Having a risk factor doesn’t mean that a man will develop prostate cancer. Most men who have risk factors never develop the disease.

Symptoms

A man with prostate cancer may not have any symptoms. For men who do have symptoms, the common symptoms include:

• Urinary problems
  • Not being able to pass urine
  • Having a hard time starting or stopping the urine flow
  • Needing to urinate often, especially at night
  • Weak flow of urine
  • Urine flow that starts and stops
  • Pain or burning during urination
• Difficulty having an erection
• Blood in the urine or semen
• Frequent pain in the lower back, hips, or upper thighs

Most often, these symptoms are not due to cancer. BPH, an infection, or another health problem may cause them. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.

Exams and Tests

Black men have a higher chance of dying from their prostate cancer and should therefore start prostate cancer screening with yearly PSA tests and physical exams at age 40, and even earlier if a strong family history of prostate cancer exists.

Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam, and may also have one or both of the following tests:

• Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.
• Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample. The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level.

The digital rectal exam and PSA test are being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths from this disease.

The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:

• 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 the echoes to create a picture called a sonogram.
• Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) 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.

Treatments

Men with prostate cancer have many treatment options. The treatment that’s best for one man may not be best for another. The options include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. You may have a combination of treatments.

The treatment that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a urologist, a surgeon who specializes in treating problems in the urinary or male sex organs. Other specialists who treat prostate cancer include urologic oncologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

At any stage of the disease, supportive care is available to relieve the side effects of treatment, to control pain and other symptoms, and to help you cope with the feelings that a diagnosis of cancer can bring.

Possible Complications

The complications of prostate cancer are mostly due to different treatments.

When to Contact a Medical Professional

Discuss the advantages and disadvantages to PSA screening with your health care provider.

Preventions

There’s no proven prostate cancer prevention strategy. But you may reduce your risk of prostate cancer by making healthy choices, such as exercising and eating a healthy diet.