Prostate Cancer

The prostate is a gland approximately the size of a walnut located just below the bladder in men. It promotes proper sexual function by contributing fluid to the ejaculate. Prostate cancer is the most frequently diagnosed cancer among men in the United States, second only to lung cancer.

Because prostate cancer is usually a slow growing cancer, many men diagnosed with the disease will die from causes unrelated to their prostate cancer, but aggressive variants of prostate cancer do exist. Differentiating between those types is very important.

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Symptoms

Most commonly, prostate cancer causes no symptoms other than an abnormal blood test that measures the presence of prostate specific antigen (PSA). Other, but more rare, presenting symptoms can include difficulty urinating or pain in the back, hips or legs.

Causes and Risk Factors

Although the cause of prostate cancer is unknown, several factors are associated with an increased risk of developing this cancer.

  • Age. About 80 percent of these tumors are discovered in men older than 65.
  • One in six men will develop invasive cancer of the prostate during his lifetime, though not all of these cancers will be life-threatening and require aggressive treatment.
  • Family history. Men with relatives who have prostate cancer are at greater risk, especially if those relatives were diagnosed before the age of 60. If these relatives are first degree (i.e. father, brother), the risk is even higher.
  • Black men are twice as likely to develop prostate cancer as Caucasian men and are more likely to develop an aggressive form of the disease
  • High-fat diet and obesity
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Diagnosis

Screening tests have made it easier to detect early-stage prostate cancer when it is generally most responsive to cure. These tests include:

  • Prostate Specific Antigen (PSA) test. PSA is a substance that is normally secreted by prostate cells. Cancer cells may sometimes produce higher levels of PSA than normal cells, allowing the diagnosis of cancer to be made. An elevated PSA, however, does not always mean a person has prostate cancer. The latest recommendations state that all men should begin yearly PSA screening at age 40.
  • Digital rectal exam. This should be a regular part of yearly physical exams for men beginning at age 40.
  • Biopsy. This is the only sure way to determine whether prostate cancer is present. The urologist inserts a needle into the prostate gland, with the assistance of ultrasound, to remove small pieces of tissue from different areas of the gland. These will be examined by a pathologist under a microscope. If prostate cancer is present, additional testing may be required to help determine whether the disease has spread to surrounding tissues or beyond. These tests may include computed tomography (CT or CAT scan), magnetic resonance imaging (MRI) or a nuclear bone scan.
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Treatments

Treatment plans depend on such factors as tumor type, grade of disease (how aggressive), the stage of disease (how far it has spread) and the patient's age and general health. Treatment options may include:

  • Surgery, including removal of the prostate and local lymph nodes. This typically includes minimally invasive approaches such as laparoscopic or robotic-assisted surgery.
  • Radiation therapy, including traditional external beam therapy and implantable radioactive "seeds" to kill cancer cells
  • Chemotherapy
  • Hormone therapy to stop the growth of cancer cells. However, this is not usually used as a curative treatment.
  • Clinical trials, which explore new treatment options.

One clinical trial underway at Cedars-Sinai Medical Center is investigating the use of gene-chip analysis as part of National Institutes of Health-sponsored research. This technology allows researchers to unlock valuable genetic information about how prostate cancer develops and grows. Hormone therapy to stop cancer cells from growing is another treatment option being explored.