What Is Prostate Cancer? What Causes Prostate Cancer?
Editor's ChoiceMain Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology; Cancer / Oncology; Men's health
Article Date: 14 May 2009 - 9:00 PDT
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3.9 (42 votes) |
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4.42 (12 votes) |
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Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate - a gland in the male reproductive system. The word "prostate" comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means "one standing in front", from proistanai meaning "set before". The prostate is so called because of its position - it is at the base of the bladder.
What is the prostate?
The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.The urethra - a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body - goes through the prostate.
Urine control
As the urethra goes through the prostate: the prostate gland is also involved in urine control (continence) with the use of prostate muscle fibers. These muscle fibers in the prostate contract and release, controlling the flow of urine flowing through the urethra.
The Prostate Produces Prostate-specific antigen (PSA)
The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man's PSA levels by checking his blood. If a man's levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition.
It is a myth to think that a high blood-PSA level is harmful to you - it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.
Male hormones affect the growth of the prostate, and also how much PSA the prostate produces. Medications aimed at altering male hormone levels may affect PSA blood levels. If male hormones are low during a male's growth and during his adulthood, his prostate gland will not grow to full size.
In some older men the prostate may continue to grow, especially the part that is around the urethra. This can make it more difficult for the man to pass urine as the growing prostate gland may be causing the urethra to collapse. When the prostate gland becomes too big in this way, the condition is called Benign Prostatic Hyperplasia (BPH). BPH is not cancer, but must be treated.
Prostate Cancer
In the vast majority of cases, the prostate cancer starts in the gland cells - this is called adenocarcinoma. In this article, prostate cancer refers just to adenocarcinoma.Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer - it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.
Experts say that prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells - Prostatic intraepithelial neoplasia (PIN). According to Medilexicon`s medical dictionary, Prostatic intraepithelial neoplasia means "dysplastic changes involving glands and ducts of the prostate that may be a precursor of adenocarcinoma; low grade (PIN 1), mild dysplasia with cell crowding, variation in nuclear size and shape, and irregular cell spacing; high grade (PIN 2 and 3), moderate to severe dysplasia with cell crowding, nucleomegaly and nucleolomegaly, and irregular cell spacing."
Doctors say that nearly 50% of all 50-year-old men have PIN. The cells are still in place - they do not seem to have moved elsewhere - but the changes can be seen under a microscope. Cancer cells would have moved into other parts of the prostate. Doctors describe these prostate gland cell changes as low-grade or high-grade; high grade is abnormal while low-grade is more-or-less normal.
Any patient who was found to have high-grade PIN after a prostate biopsy is at a significantly greater risk of having cancer cells in his prostate. Because of this, doctors will monitor him carefully and possibly carry out another biopsy later on.
Classification of prostate cancer
It is important to know the stage of the cancer, or how far it has spread. Knowing the cancer stage helps the doctor define prognosis - it also helps when selecting which therapies to use. The most common system today for determining this is the TNM (Tumor/Nodes/Metastases). This involves defining the size of the tumor, how many lymph nodes are involved, and whether there are any other metastases.When defining with the TNM system, it is crucial to distinguish between cancers that are still restricted just to the prostate, and those that have spread elsewhere. Clinical T1 and T2 cancers are found only in the prostate, and nowhere else, while T3 and T4 have spread outside the prostate.
There are many ways to find out whether the cancer has spread. Computer tomography will check for spread inside the pelvis, bone scans will decide whether the cancer has spread to the bones, and endorectal coil magnetic resonance imaging will evaluate the prostatic capsule and the seminal vesicles.
The Gleason Score
A pathologist will look at the biopsy samples under a microscope. If cancer tissue is detected, the pathologist then grades the tumor. The Gleason System of grading goes from 2 to 10. The higher the number, the more abnormal the tissues are compared to normal prostate tissue.
Two numbers are added up to get a Gleason score:
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1. A number from 1 to 5 for the most common pattern observed under the microscope. This is the predominant grade and must be more than 51% of the sample.
2. A number from 1 to 5 for the second most common pattern. This is the secondary grade and must make up more than 5% but less than 50% of the sample.
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1. If the predominant grade is 3 and the secondary grade is 4, the Gleason score is 7.
2. If the predominant grade is 4 and the secondary grade is 3, the Gleason score is also 7.
It is crucial that the tumor is graded properly, as this decides what treatments should be recommended.
What are the symptoms of prostate cancer?
During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:- The patient urinates more often
- The patient gets up at night more often to urinate
- He may find it hard to start urinating
- He may find it hard to keep urinating once he has started
- There may be blood in the urine
- Urination might be painful
- Ejaculation may be painful (less common)
- Achieving or maintaining an erection may be difficult (less common)
- Bone pain, often in the spine (vertebrae), pelvis, or ribs
- The proximal part of the femur can be painful
- Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
- Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
- Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord)
If the cancer is advanced the following symptoms are also possible
What are the causes of prostate cancer?
Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.- Age
Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50. - Genetics
Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups - in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men. Studies indicate that the two genes - BRCA 1 and BRCA 2 - which are important risk factors for breast cancer and ovarian cancer have also been implicated in prostate cancer.
In a study scientists found seven new sites in the human genome that are linked to men's risk of developing prostate cancer. - Diet
A review of diets indicated that the Mediterranean diet may reduce a person's chances of developing prostate cancer. Another study indicates that soy, selenium and green tea, offer additional possibilities for disease prevention - however, a more recent study indicated that combination therapy of vitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.
A US pilot study on men with low risk prostate cancer found that following an intensive healthy diet and lifestyle regime focusing on low meat and high vegetable and fruit intake, regular exercise, yoga stretching, meditation and support group participation, can alter the way that genes behave and change the progress of cancer, for instance by switching on tumor killers and turning down tumor promoters.
Other studies have indicated that lack of vitamin D, a diet high in red meat may raise a person's chances of developing prostate cancer. - Medication
Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk. A study found that statins, which are used to lower cholesterol levels, may lower a person's risk of developing prostate cancer. - Obesity
A study found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer. - Sexually transmitted diseases (STDs)
Men who have had gonorrhea have a higher chance of developing prostate cancer, according to research from the University of Michigan Health System. - Agent Orange
Veterans exposed to Agent Orange have a 48% higher risk of prostate cancer recurrence following surgery than their unexposed peers, and when the disease comes back, it seems more aggressive, researchers say. Another study found that Vietnam War veterans who had been exposed to Agent Orange have significantly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.
What are the treatments for prostate cancer?
Early stage prostate cancerIf the cancer is small and contained - localized - it is usually managed by one of the following treatments:
- Watchful waiting - not immediate treatment is carried out. PSA blood levels are regularly monitored.
- Radical prostatectomy - the prostate is surgically removed.
- Brachytherapy - radioactive seeds are implanted into the prostate.
- Conformal radiotherapy - the radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment, thus minimizing healthy tissue exposure to radiation.
- Intensity modulated radiotherapy - beams with variable intensity are used. An advanced form of conformal radiotherapy usually delivered by a computer-controlled linear accelerator.
Treatment recommendations really depend on individual cases. In general, if there is a good prognosis and the cancer is in its early stages, all options can be considered. However, they all have their advantages and disadvantages. The patient should discuss available options thoroughly with his doctor.
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If the cancer is more aggressive, or advanced, the patient may require a combination of radiotherapy and hormone therapy. Radiotherapy requires treatment on an everyday basis for up to about eight weeks. Radical surgery is also an option - the prostate is removed. Traditional surgery requires a hospital stay of up to ten days, with a recovery time that can last up to three months. Robotic keyhole surgery has the advantage just a couple of days in hospital, followed by a much shorter recover period. However, even robotic keyhole surgery may not be ideal for very elderly patients.
In advanced prostate cancer hormone therapy is very effective in slowing down, and even stopping the growth of cancer cells. Even if the hormone therapy stops working after a while, there are still other options the patient will be able to discuss with his doctor, such as participating in clinical trials.
Video: Da Vinci Prostatectomy
This video provides an overview of the radical prostatectomy with the daVinci System from www.intuitivesurgical.com. Dr. J.H. Witt www.pznw.de St. Antonius Hospital Gronau, Germany.Related articles:
- My Radical Prostatectomy - A Personal Diary
- Men With Prostate Cancer Worry Less About Recurrence Than Their Spouses Do
- Prostate Cancer Not Prevented By Vitamin E, Selenium And Soy In Combination
- Protein Present In Prostate Cancer Cells Can Inhibit The Growth Of Tumours
- Prostate Cancer Immunotherapy Significantly Prolongs Survival In Men With Advanced Prostate Cancer
- Prostate Cancer New Guidelines For PSA Screening
- New Biomarker For Aggressive Prostate Cancer, Study
- Survival For Prostate Cancer Patients Younger Than 50 Improved By Surgery
- A New Approach To Prostate Cancer Detection
- Prostate Cancer And Vegetable Consumption
- PSA Screening Cut Prostate Cancer Deaths By 20 Per Cent, Study
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Visitor Opinions In Chronological Order (9)
Prostate Cancer AdvocateMentor
posted by Charles (Chuck) Maack on 18 May 2009 at 9:08 amI noticed that Cyrotherapy/Surgery was not listed. As another viable option of treatment, I felt it necessary to mention. Otherwise, the article is absolutely outstanding and easy to read and hopefully understand for the newly diagnosed patient.
Recurrent Prostate Cancer
posted by Maher Raphael on 13 Sep 2010 at 9:44 amThe article is outstanding. I would appreciate an article on the recurrence of PC after orostatectomy and Radiation Therapy. Thanks
Life expectancy with advanced metastatic prostate canceer.
posted by Warren Andersen on 28 Sep 2010 at 7:57 amI have advanced metastatic hormone resistant prostate cancer, with tumors up and down my spine, in my shoulders, hips and ribs (a 3"X1" tumor was removed from my right humerus in July of 2008). Your article gives me no guidance on the range of life expectancy. I have received 20 cycles of taxotere and clinical trials and lupron and zometa.
Life expectancy
posted by Craig harlten on 20 Dec 2010 at 1:46 pmMy grandfather is 83 but looks and acts 50. We just had some test done and are waitin on the results it looks like if it is prostate cancer it has started to spread to his bones. What would be his life expectancy and is it possible to stop the disease? All the information on the net is so vag. Please respond
need help
posted by BOO BOO76 on 24 Aug 2011 at 6:33 pmbeen taking lupon for prostate cancer doc stopedme fom taking psa normal now he say my white bloodcells low what could that mean
Prostate cancer
posted by Ebby Vaseghi on 8 Oct 2011 at 8:14 amDear Sir,
Thank you for your high quality information about PSA. Iam77 years old, since 12 years ago my PSA increased from2.4 to 28.5 now Sept. 13.2011.I have been biopsy four time and the result was not indicated cancer. My physician did not gave me any medicine, except some time antibiotic. It is 10 years I am vegetarian, using yoga and Vipassana Meditation. I hope can live without cancer.
Be Happy
Ebby
MY FATHER DIED AT HIS EARLY THIRTIES BECAUSE OF PROSTATE CANCER
posted by liezel on 21 Nov 2011 at 2:41 amI am 20 years old now, 8 years ago, my father died in a prostate cancer. I was only 10 at that time, no idea what causes his death. But now that I am at the right age,my curiosity about my father's death brings me to this web site. I guess most of my questions answered. Thanks for the info...
advanced prostate cancer
posted by mr stephen piper on 3 Jan 2012 at 10:59 amhi new years eve 2010 i was told that i had advanced prostate cancer ,i was 56 years old and my p.s.a was 12.4 ,however my bone scan said it should be high hundreds or even thousands,so what did i do i was put on hormone therapy i also under took a dramatic change of diet ,no processed meats, no fish and chips or crisps,big reduction in dairy products ,in came salads, dark fruits nuts and a healthy life style, i have lost 2stone 9 lbs , and although i have just had spinal surgery (the cancer got into an old spinal injury and caused a collapsed vertebrae l3 ) a first class job by mr lutchman and his team at the norfolk and norwich university hospital means i can walk ( with the aid of a crutch and feel good) what i would say to any one diagnosed with prostate cancer must above all remain positive and help your medical team help you.
How to overcome ED after operation
posted by subhas on 25 Jan 2012 at 12:06 pmMy prostate was removed in 2008. Before operation, Iwas told that I can get the erection with sex feelings and sensation. Even today I don't get any sensation or sex feelings with the result no erection.I am now 73 years and have lot of urge for sex but I don;t get the erection.
Do you think I can get?
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