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Prostate Cancer

Last updated Jan. 3, 2019

Approved by: Krish Tangella MD, MBA, FCAP

This video explains what the function of the prostate is, what prostate cancer is and how cancer starts in the prostate. Prostate cancer is the most common cancer in men in the UK so it's important to know the facts. Dr. Vincent Gnanapragasm from Cambridge University talks us what Prostate Cancer is.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Cancer of the Prostate
  • Prostatic Adenocarcinoma

What is Prostate Cancer? (Definition/Background Information)

  • Prostate Cancer is a type of cancer that develops within the tissue of a male prostate gland. The prostate is a gland that encircles the urethra in males. It secretes a fluid that forms a part of the semen
  • It is among the most prevalent types of cancers in men. Men over the age of 65 years have an increased risk of developing this condition; while men below 45 years, are rarely diagnosed with Prostate Cancer
  • If Prostate Cancer is detected and diagnosed early and is found confined within the prostate gland, the prognosis for a successful treatment is usually good.

The type of normal prostate cells that transform to malignancy defines the Prostate Cancer type. This helps determine the appropriate treatment course. The types include:

  • Adenocarcinoma of the Prostate Gland: It is the most commonly diagnosed type of Prostate Cancer comprising approximately 95% of all cases. This type of cancer usually develops from cells in the peripheral region of the prostate. There are two types of adenocarcinoma - the acinar type and the ductal type. Among these, the acinar type of adenocarcinoma is the most common kind
  • Small Cell Carcinoma of the Prostate Gland (SCCP): It is also known as Oat-Cell Carcinoma. It is a very rare, aggressive, and neoplastic type of Prostate Cancer comprising only 2% of all cases. These cancer cells are small, round and appear as oats, when viewed under a microscope by the pathologist

Who gets Prostate Cancer? (Age and Sex Distribution)

  • Men under the age of 45 years are rarely diagnosed with Prostate Cancer. A majority of the cases are detected and diagnosed in men over the age of 65
  • All races and ethnic groups are prone to the condition, but it is more prevalent among African Americans

What are the Risk Factors for Prostate Cancer? (Predisposing Factors)

The underlying cause of Prostate Cancer is unknown at this time, although physicians believe that certain factors may increase an individual’s risk for the condition. These risk factors include:   

  • Advancing age: The probability of Prostate Cancer increases as one ages. Most cases occur in adult men over 65 years old
  • Race: African Americans are found to have a higher risk than any other race
  • Family history: Men with one or more immediate family members or relatives with a history of Prostate Cancer
  • Personal history: Individuals, with a history of Prostate Cancer, have an increased risk for disease recurrence
  • Obesity: Obese men have an elevated risk for developing the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Prostate Cancer? (Etiology)

  • Currently, medical research is being conducted to determine the exact cause of Prostate Cancer
  • The direct cause of the cancer is not entirely known, although some researchers believe that certain factors may increase one's risk for the condition

What are the Signs and Symptoms of Prostate Cancer?

Early-stage Prostate Cancer rarely has any signs or symptoms. The condition may be difficult to diagnose initially, because several of the primary symptoms could be the result of additional medical conditions too. The overlapping signs and symptoms may cause a delayed diagnosis of Prostate Cancer.

Signs and symptoms are usually observed during the later stages of the disease and these include:

  • Hematuria (blood in urine)
  • Frequent urination at night (nocturia)
  • Pain when urinating
  • Abnormal pain in the bones
  • Hematospermia (blood in semen)

How is Prostate Cancer Diagnosed?

There are a variety of tests to detect, locate, and diagnose Prostate Cancer and its potential spread. A surgical procedure, called biopsy, usually performed by an urologist, is the only test a physician relies on to make an accurate diagnosis of Prostate Cancer. However, if a prostate gland biopsy is not feasible due to the risk of damaging vital organs, additional testing may be recommended.

A few of the tests used to screen or diagnose Prostate Cancer include:

  • Digital rectal exam (DRE): During a DRE exam, a physician uses their fingers (using lubricated rubber gloves) to physically detect any abnormalities within the prostate
  • Computerized tomography (CT) scan: Also known as CAT scan, this radiological procedure creates detailed three-dimensional images of structures inside the body. CT scans are not tools of preference to detect Prostate Cancer; however, they may be helpful in detecting a recurrence, or to check if the cancer has metastasized to the pelvic lymph nodes or other body parts
  • Prostate specific antigen (PSA) test: Prostate specific antigen is a glycoprotein produced by the prostate gland. Occasionally, tiny amounts of PSA may flow in the bloodstream. In the test, a blood sample is drawn from the patient’s arm and checked for abnormal levels of PSA (if any)
  • Magnetic resonance imaging (MRI) scan: An MRI scan uses a magnetic field to create high-quality pictures of certain parts of the body such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of Prostate Cancer
  • Bone scan: Bone scans are primarily used to detect if the cancerous tumor in the prostate gland has metastasized to a patient’s pelvis or other body parts. A bone scan is a nuclear imaging test that involves injecting a radioactive tracer into the patient’s vein
  • Trans-rectal ultrasound (TRUS) scan: In this diagnostic method, a tiny probe is inserted into the patient’s rectum, to take pictures of the prostate gland through emission of sound waves

A biopsy refers to a medical procedure that involves the removal of cells or tissues, which are then examined by a pathologist. A biopsy procedure of the prostate gland would include:

  • Trans-rectal biopsy: During a trans-rectal biopsy, a special biopsy forceps is used to pass through the rectal wall into the prostate gland, in order to collect small tissue samples from within the gland. A pathologist examines these samples under a microscope, after processing the tissue in an anatomic pathology laboratory

Many clinical conditions may have similar signs and symptoms to prostate cancer. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Prostate Cancer?

The complications of Prostate Cancer may include:

  • Individuals with Prostate Cancer have an increased risk of the cancer metastasizing to other adjoining parts of the body such as the pelvis and bones (most frequently seen)
  • Urinary incontinence: It is an embarrassing and distressing condition that causes the loss of bladder function. It is commonly seen in patients who have undergone treatments for Prostate Cancer
  • Erectile dysfunction (impotence) is sexual dysfunction resulting from the inability of men to develop or hold an erection during sexual intercourse

How is Prostate Cancer Treated?

A treatment of Prostate Cancer depends on a number of factors that include:

  • Histological type of the Prostate Cancer
  • Stage of the cancer
  • The overall health status of the individual
  • Treatment preferences of the individual

Early-stage Prostate Cancer treatment: Active surveillance

  • It is a choice given to patients who are diagnosed with early-stage Prostate Cancer, but do not desire to undergo an immediate surgery or radiation therapy
  • Active surveillance is the process of monitoring (by a healthcare expert) the signs and symptoms of Prostate Cancer
  • Occasionally, a PSA blood test and digital rectal exam may be requested, along-with biopsies, to allow the healthcare provider observe cancer progression (if any)

Surgery for Prostate Cancer: The recommended surgical treatment for men with Prostate Cancer involves a surgical removal of the prostate gland. The recommended surgical treatments may include:

  • Radical retropubic prostatectomy: Radical retropubic prostatectomy is the surgical removal of the entire prostate gland, usually performed by a urologic oncologist. During this procedure, a surgeon removes the prostate gland, seminal vesicles, and the surrounding lymph nodes, of the pelvis through a small incision in the abdomen. This surgery is used in cases where the cancerous tumor is still centralized within the prostate gland
  • Radical perineal prostatectomy: It is also the surgical removal of the entire prostate gland, usually performed by a urologic oncologist. The prostate gland is removed through a small incision between the anus and scrotum. Like radical retropubic prostatectomy, a radical perineal prostatectomy surgery is used, when the cancerous tumor is still contained within the prostate gland
  • Laparoscopic radical prostatectomy (LRP): During LRP, an incision is made in the abdomen; using a laparoscope, the prostate gland is then removed
  • Cryosurgery: It is a cryosurgical treatment that is effective in treating early stages of Prostate Cancer. Cryosurgery involves the use of liquid nitrogen to freeze cancer cells by means of an instrument called a cryoprobe. The cryoprobe is inserted through a tiny incision between the scrotum and anus
  • Transurethral resection of the prostate (TURP): It is a urological procedure frequently used to treat advanced cases of Prostate Cancer. An urologist performs this procedure during which a surgical instrument, called a resectoscope, is passed through the urethra and into the prostate. Excess tissue within the prostate, causing obstruction of the urinary tract is removed. This procedure is also used to treat a condition called benign prostatic hyperplasia (BPH). TURP is rarely performed, and only on a small proportion of the patients - those who are not candidates for extensive radical prostatectomy procedures
  • High-frequency ultrasound (HIFUS): During a high-frequency ultrasound procedure, a tiny probe is inserted through the rectum and into the prostate, precisely targeting the cancerous cells using ultrasound. HIFUS employs an extremely accurate medical instrument that uses ultrasound to heat and eliminate cancer cells within the prostate gland

Chemotherapy: Chemotherapy is a treatment method that employs medications to kill cancer cells. For Prostate Cancer, a combination of two or more chemotherapy drugs are generally used. These drugs are given intravenously through a vein in the arm, or by passing a tube through the rectal wall, thereby administering the drug directly into the prostate (called intravesical therapy).

Radiation therapy: Radiation therapy attempts to destroy cancer cells by aiming high-energy beams at them. It can be administered either by a machine placed outside the body (external beam radiation), or by a device positioned inside the prostate (brachytherapy). The therapy may be used either before a surgery is proposed, so as to decrease the size of the tumor allowing for its easier removal, or after the surgery is performed, in order to kill any remaining cancer cells.

Both radiation therapy and chemotherapy are sometimes used in a combined form during the course of treatment.

Hormone therapy: Hormonal therapy is a medical treatment used for men with advanced Prostate Cancer stages, which has metastasized beyond the prostate gland. The treatment options include taking medications that affect hormone levels in the body:

  • Luteinizing hormone (LH): Also called lutropin, this hormone therapy drug helps lower an individual’s testosterone level in the body, or decreases the body’s ability to use the available testosterone. Prostate Cancer cells rely on androgens (male hormones such as testosterone) to proliferate. Administering LH drugs, may thus cause the cancer cells to die out
  • Anti-androgens: Anti-androgens are types of medications used to disrupt the possibility of testosterone reaching the cancerous cells in the prostate. A chemical reaction caused by these medications, prevents the growth of cancerous tumor within the prostate. The types of anti-androgens medications used with this therapy type include flutamide, bicalutamide, and nilutamide
  • Bilateral orchiectomy: It is an irreversible and permanent surgical procedure in which both the testicles are removed. Bilateral orchiectomy has similar results as most hormone therapy treatments; although, the procedure may lower an individual’s testosterone level at a much faster rate

How can Prostate Cancer be Prevented?

Currently, there are no known and available methods to prevent Prostate Cancer. Nonetheless, various steps may be taken to help decrease the incidence of the condition:

  • Physical activity: High testosterone (male hormone) levels have been linked to an increased risk of Prostate Cancer. Extreme physical activities are known to reduce the body testosterone levels. Therefore, individuals with high physical activity levels, have decreased risk for getting Prostate Cancer
  • Consumption of fruits and vegetables: A healthy diet, low in saturated fats and rich in many fruits and vegetables, may help decrease the threat of Prostate Cancer. Consuming soy-based foods, incorporated into a regular diet also decreases the risk

What is the Prognosis of Prostate Cancer? (Outcomes/Resolutions)

  • The prognosis for Prostate Cancer depends on the individual’s age, physical health, location of the tumor, stage and grade/type of the cancer
  • The earlier the stage and lower the grade of cancer, the better is the prognosis
  • Individuals with Prostate Cancer have a survival rate of approximately 93% at 10 years, and 77% at 15 years (after onset of the cancer)

Additional and Relevant Useful Information for Prostate Cancer:

The National Cancer Institute estimates that around 250,000 new cases would be diagnosed, and over 33,000 people die from Prostate Cancer in the United States, during the year 2011.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 10, 2013
Last updated: Jan. 3, 2019