Prostate cancer is marked by an uncontrolled (malignant) growth of cells in the prostate gland. The prostate is the walnut-sized gland in men, located just below the bladder and in front of the rectum, surrounding the urethra – the tube that carries urine out of the bladder. The prostate produces and stores fluid that helps to make semen, and is involved in regulating bladder control.
Growths in the prostate can be benign (not cancer) or malignant (cancer).
Benign growths (benign prostatic hyperplasia (BPH)
Is rarely a threat to life
Don’t invade the tissues around them
Don’t spread to other parts of the body
Can be removed and can grow back very slowly (but usually don’t grow back)
Malignant growths (prostate cancer):
May sometimes be a threat to life
Can spread to nearby organs and tissues (such as the bladder or rectum)
Can spread (metastasize) to other parts of the body (like lymph nodes or bone)
Often can be removed but sometimes grow back
Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph nodes to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors, causing damage where they land.
When prostate cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer in bone.
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
Trouble urinating, pain, burning, or weak urine flow
Blood in the urine (Hematuria)
Pain in the lower back, hips or upper thighs
Loss of appetite
Loss of weight
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No one knows why or how prostate cancer starts. Autopsy studies show 1 in 3 men over the age of 50 have some cancer cells in the prostate. Eight out of ten “autopsy cancers” found are small, with tumors that are not harmful.
Even though there is no known reason for prostate cancer, there are many risks associated with the disease.
What Are The Risk Factors for Prostate Cancer?
“Screening” means testing for a disease even if you have no symptoms. The prostate specific antigen (PSA) blood test and digital rectal examination (DRE) are two tests that are used to screen for prostate cancer. Both are used to detect cancer early. However, these tests are not perfect. Abnormal results with either test may be due to benign prostatic enlargement (BPH) or infection, rather than cancer.
The two main types of screenings are:
PSA Blood Test
The prostate-specific antigen (PSA) blood test is one way to screen for prostate cancer. This blood test measures the level of PSA in the blood. PSA is a protein made only by the prostate and prostate cancers. The test can be done in a lab, hospital or healthcare provider’s office.
Very little PSA is found in the blood of a man with a healthy prostate. A low PSA is a sign of prostate health. A rapid rise in PSA may be a sign that something is wrong. Prostate cancer is the most serious cause of a high PSA result. Another reason for a high PSA can be benign (non-cancer) enlargement of the prostate. Prostatitis, inflammation of the prostate, can also cause high PSA results.
A rise in PSA level does not tell us the type of cancer cells present. The rise tells us that cancer may be present.
Talk with your healthcare provider about whether the PSA test is useful for you. If you decide to get tested, be sure to talk about changes in your PSA level with your provider.
The digital rectal examination (DRE) helps your doctor find prostate problems. For this exam, the healthcare provider puts a lubricated gloved finger into the rectum. The man either bends over or lies curled on his side on a table. During this test, the doctor feels for an abnormal shape or thickness to the prostate. DRE is safe and easy to do. But the DRE by itself cannot detect early cancer. It should be done with a PSA test.
How is Prostate Cancer Graded and Staged?
Grading (with the Gleason Score) and staging defines the progress of cancer and whether it has spread:
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 your doctor 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.
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.
Some cancers grow so slowly. Others grow fast and are life-threatening so treatment is usually necessary. Deciding what treatment you should get can be complex. Talk with your healthcare team about your options. Your treatment plan will depend on:
The stage and grade of the cancer (Gleason score and TNM stage)
Your risk category (whether the cancer is low, intermediate or high risk)
Your age and health