The prostate is a gland in the male reproductive system located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that makes up part of the semen.
Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.
Prostate Cancer Prediction Tool
The Memorial Sloan-Kettering Cancer Center has developed a prostate nomogram that is designed to help physicians and patients decide which treatment approaches will result in the greatest benefit. It is recommended that patients using the tool consult with a physician or other professional healthcare provider prior to making any treatment decisions.
To go to this tool, click here.
These and other symptoms may be caused by prostate cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Weak or interrupted flow of urine.
- Frequent urination (especially at night).
- Trouble urinating.
- Pain or burning during urination.
- Blood in the urine or semen.
- A pain in the back, hips, or pelvis that doesn't go away.
- Painful ejaculation.
Stages of Prostate Cancer
In stage I, cancer is found in the prostate only. It cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. The Gleason score is low. Stage I prostate cancer may also be called stage A1 prostate cancer.
In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.
In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles. The Gleason score can range from 2-10. Stage III prostate cancer may also be called stage C prostate cancer.
In stage IV, cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones. The Gleason score can range from 2-10. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.
Patients in good health are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:
RADICAL RETROPUBIC PROSTATECTOMY Surgical removal of the prostate by means of a retropubic approach in which the surgeon enters the pelvis above the pubic bone in front of the bladder to visualize the prostate and remove it.
ROBOTIC-ASSISTED PROSTATECTOMY also known as the da Vinci Prostatectomy is a minimally invasive, robotic-assisted surgical procedure that removes the cancerous prostate gland and related structures.
Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.
Tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope.
Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
There is an increased risk of bladder cancer and/or rectal cancer in men treated with radiation therapy.
Impotence and urinary problems may occur in men treated with radiation therapy.
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the production of male hormones or block them from working.
Hormone therapy used in the treatment of prostate cancer may include the following:
Luteinizing hormone-releasing hormone agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin. Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and nilutamide. Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide. Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, to decrease hormone production.
Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects. Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and pruritus (itching).
Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. This type of treatment is also called cryotherapy.
Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with cryosurgery.
Watchful waiting is often called "active surveillance" or "observation" and means that you decide to have no active treatment now. Your doctor will want to follow you closely to look for any signs that the disease may be changing. You will have tests like the ones you've already had such as digital rectal exams, PSA tests, and repeat biopsies. You can change your mind and decide to have treatment at any time. Watchful waiting is based on the fact that many early-stage prostate cancers grow so slowly that they may never cause problems or become life threatening. In some cases, it may be a way to avoid the harms of treatment without shortening life expectancy. Or it can be a decision based on your age and other serious health problems - older men in their 70s and 80s may not have the same views about undergoing surgery or radiation therapy as younger men.
You can find the NCCN guidelines here
For more information on Prostate Cancer, please visit the National Cancer Institute website.