Prostate Cancer

 

The prostate and seminal vesicles are part of the male reproductive system. The prostate is about the size of a walnut. The seminal vesicles are two smaller pairs of glands attached to the back of the prostate. The prostate sits below the bladder, in front of the rectum. It surrounds the urethra, a small tube that carries urine from the bladder out through the penis.

 

The main job of the prostate and seminal vesicles is to make fluid for semen. During ejaculation, sperm moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture— semen—goes through the urethra and out of the penis as ejaculates.

 

 

Diagram of the Male Reproductive System

 

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What is Prostate Cancer?

 

Cancer is the result of abnormal cell growth, which takes over the body’s normal cell function, making it harder for the body to work the way it should. Prostate cancer develops when abnormal cells form and grow in the prostate gland. Not all abnormal growths, also called tumors, are cancerous (malignant). Some tumors are not cancerous (benign).

 

• Benign growths, such as benign prostatic hyperplasia (BPH), are not life threatening. They do not spread to nearby tissue or other parts of the body. These growths can be removed and may grow back slowly (but often do not grow back).
  
  
• Cancerous growths, such as prostate cancer, can spread (metastasize) to nearby organs and tissues such as the bladder or rectum, or to other parts of the body. If the abnormal growth is removed, it can still grow back. Prostate cancer can be life threatening if it spreads far beyond the prostate (metastatic disease).

 

 

What is Early-stage Prostate Cancer?

 

Prostate cancer stays “localized” when cancer cells are found only in the prostate or even a little bit beyond it (extra-prostatic extension), but do not move to other parts of the body. If the cancer moves to other parts of the body, it is called “advanced” prostate cancer.

 

Prostate cancer is often grouped into four stages.

 

• Early-stage | Stages I & II: The tumor has not spread beyond the prostate. This is often called “early-stage” or “localized” prostate cancer.
• Locally Advanced | Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called “locally advanced prostate cancer.”
• Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called “advanced prostate cancer.”

 

 

Symptoms

 

In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Prostate cancer can also cause symptoms unrelated to BPH. If you have urinary problems, talk with your healthcare provider about them.

 

Symptoms of prostate cancer can be:

 

• Dull pain in the lower pelvic area
• Frequent urinating
• Trouble urinating, pain, burning, or weak urine flow
• Blood in the urine (Hematuria)
• Painful ejaculation
• Pain in the lower back, hips or upper thighs
• Loss of appetite
• Loss of weight
• Bone pain

 

 

Causes

 

The cause of prostate cancer is unknown, but researchers know many things can increase a man's risk for the disease.

 

• Age: As men age, their risk of getting prostate cancer goes up. Harm to the DNA (or genetic material) of prostate cells is more likely for men over the age of 55.
  
  
• Ethnicity: African American men have a higher rate of the disease. One in six African American men will be diagnosed with prostate cancer. Prostate cancer occurs less often in Asian American and Hispanic/Latino men than in non-Hispanic white men.
  
  
• Family History: Men who have a grandfather, father or brother with prostate cancer face a higher risk of getting the disease. Having family members with breast and ovarian cancer also raises a man’s risk for prostate cancer.
  
  
• Weight: Studies link being overweight in your 50s and later to a greater risk of advanced prostate cancer. Doctors advise keeping to a healthy weight to reduce risk.

 

 

What are the Signs of Prostate Cancer?

 

In its early stages, prostate cancer may have no symptoms. When symptoms do occur, they can be urinary symptoms like those of an enlarged prostate or Benign Prostatic Hyperplasia (BPH). Talk with Dr. Tubre if you have any of these symptoms:

 

• Dull pain in the lower pelvic zone
• Frequent need to pass urine
• Trouble passing urine, pain, burning or weak urine flow
• Blood in the urine (hematuria)
• Painful ejaculation
• Pain in the lower back, hips or upper thighs
• Loss of hunger
• Loss of weight
• Bone pain

 

 

Diagnosis

 

The American Urological Association (AUA) recommends talking with Dr. Tubre about the benefits and harms of screening (testing) for prostate cancer. If you fall into any of the groups below, you should think about talking to Dr. Tubre to see if screening is right for you:

 

• Between 45–69 years old
• African American
• Have a family history of prostate cancer
• Have symptoms

 

 

Blood Tests

 

The PSA blood test measures a protein in your blood called the prostate-specific antigen (PSA). Only the prostate and prostate cancers make PSA. Results for this test are usually shared as nanograms of PSA per milliliter (ng/mL) of blood. The PSA test is used to look for changes to the way your prostate produces PSA. It is used to stage cancer, plan treatment and track how well treatment is going. A rapid rise in PSA may be a sign something is wrong. In addition, Dr. Tubre may want to test the level of testosterone in your blood.

 

The PSA test is not used alone to make a diagnosis. Dr. Tubre may also use a digital rectal exam (DRE) test for a better sense of your prostate health.

 

Digital Rectal Exam

 

The digital rectal exam (DRE) is a physical exam used to help Dr. Tubre feel for changes in your prostate.

 

 

Illustration of the Digital Rectal Exam (DRE)

 

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This test is also used to screen for and stage cancer, or track how well treatment is going. During this test, the doctor feels for an abnormal shape, consistency, nodularity or thickness to the gland. For this exam, the doctor puts a lubricated gloved finger into the rectum.

 

The DRE is safe and easy, but cannot spot early cancer by itself. It is often done with a PSA test. Together, the PSA and DRE can help to find prostate cancer early, before it spreads. Early prostate cancer treatment may stop or slow the spread of cancer.

 

Biopsy

 

If screening tests show an issue with the prostate, a prostate biopsy may be performed. This helps make an accurate diagnosis. A biopsy is a tissue sample taken from your prostate or other organs to look for cancer cells. There are many approaches to prostate biopsies. These can be done through a probe placed in the rectum, through the skin of the perineum (between the scrotum and rectum) and may use a specialized imaging device, such as an MRI Scan. The biopsy removes small pieces of tissue for review under a microscope. The biopsy takes 10 to 20 minutes. A pathologist (a doctor who classifies disease) looks for cancer cells within the samples. If cancer is seen, the pathologist will "grade" the tumor.

 

Staging and Grading

 

Prostate cancer is grouped into four stages. The stages are defined by how much and how quickly the cancer cells are growing. The stages are defined by the Gleason Score and the T (tumor), N (node), M (metastasis) Score.

 

Gleason Score

 

If a biopsy finds cancer, the pathologist gives it a grade. The most common grading system is called the Gleason grading system. The Gleason score is a measure of how quickly the cancer cells can grow and affect other tissue. Biopsy samples are taken from the prostate and given a Gleason grade by a pathologist. Lower grades are given to samples with small, closely packed cells. Higher grades are given to samples with more spread out cells. The Gleason score is set by adding together the two most common grades found in a biopsy sample.

 

The Gleason Score will help Dr. Tubre understand if the cancer is a low-, intermediate- or high-risk disease. The risk assessment is the risk of recurrence after treatment. Generally, Gleason scores of 6 are treated as low-risk cancers. Gleason scores of around 7 are treated as intermediate/midlevel cancers. Gleason scores of 8 and above are treated as high-risk cancers. Some of these high-risk tumors may have already spread by the time they are found.

 

Staging

 

The Tumor, Nodes and Metastasis (TNM) is the system used for tumor staging. The TNM score is a measure of how far the prostate cancer has spread in the body. The T (tumor) score rates the size and extent of the original tumor. The N (nodes) score rates whether the cancer has spread into nearby lymph nodes. The M (metastasis) score rates whether the cancer has spread to distant sites.

 

Tumors found only in the prostate are more successfully treated than those that have metastasized (spread) outside the prostate. Tumors that have metastasized are incurable and require drug-based therapies to treat the whole body.

 

 

Stages

 

How is Prostate Cancer Graded and Staged?

 

Grading (with the Gleason Score) and staging defines the progress of cancer and whether it has spread:

 

Grading

 

When prostate cancer cells are found in tissue from the core biopsies, the pathologist "grades" it. The grade is a measure of how quickly the cells are likely to grow and spread (how aggressive it is).

 

The most common grading system is called the Gleason grading system. With this system, each tissue piece is given a grade between three (3) and five (5). In the past, we assigned scores of one (1) and two (2). A grade of less than three (3) means the tissue is close to normal. A grade of three (3) suggests a slow growing tumor. A high grade of five (5) indicates a highly aggressive, high-risk form of prostate cancer.

 

The Gleason system then develops a "score" by combing the two most common grades found in biopsy samples. For example, a score of grades 3 + 3 = 6 suggests a slow growing cancer. The highest score of grades 5 + 5 = 10 means that cancer is present and extremely aggressive.

 

The Gleason score will help Dr. Tubre understand if the cancer is as a low-, intermediate- or high-risk disease. Generally, Gleason scores of 6 are treated as low risk cancers. Gleason scores of around 7 are treated as intermediate/mid-level cancers. Gleason scores of 8 and above are treated as high-risk cancers.

 

If you are diagnosed with prostate cancer, ask about your Gleason score and how it impacts your treatment decisions.

 

Staging

 

Tumor stage is also measured. Staging describes where the cancer is within the prostate, how extensive it is, and if it has spread to other parts of the body. One can have low stage cancer that is very high risk. Staging the cancer is done by DRE and special imaging studies.

 

The system used for tumor staging is the TNM system. TNM stands for Tumor, Nodes and Metastasis. The "T" stage is found by DRE and other imaging tests such as an ultrasound, CT scan, MRI or bone scan. The imaging tests show if and where the cancer has spread, for example: to lymph nodes or bone.

 

These staging imaging tests are generally done for men with a Gleason grade of 7 or higher and a PSA higher than 10. Sometimes follow-up images are needed to evaluate changes seen on the bone scan.

 

 

Diagram of Prostate Cancer Staging

 

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Imaging Tests

 

Not all men need imaging tests. Dr. Tubre may recommend imaging exams based on results from other tests.

 

Prostate cancer may spread from the prostate into other tissues. It may spread to the nearby seminal vesicles, the bladder, or further to the lymph nodes and the bones. Rarely, it spreads to the lungs and or other organs.

 

Your healthcare provider may recommend a pelvic CT scan , an MRI scan or a bone scan to check if your cancer has spread.

 

 

What Are The Survival Rates For Prostate Cancer?

 

Many men with prostate cancer will not die from it; they will die from other causes. For men who are diagnosed, it is better if it is caught early.

 

Survival rates for men with prostate cancer have increased over the years, thanks to better screening and treatment options. Today, 99% of men with prostate cancer will live for at least 5 years after diagnosis. Many men having treatment are cured. Most prostate cancer is slow-growing and takes many years to progress. One out of three men will survive after five years, even if the cancer has spread to other parts of the body.