Definition, Symptoms, Causes, Risk factors, Complications, Screening

By Mayo Clinic Staff

Prostate cancer is cancer that occurs in a man’s prostate — a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

Prostate cancer that is detected early — when it’s still confined to the prostate gland — has a better chance of successful treatment.

Prostate cancer may not cause signs or symptoms in its early stages. Prostate cancer that is more advanced may cause signs and symptoms such as:

Trouble urinating

Decreased force in the stream of urine

Blood in the urine

Blood in the semen

General pain in the lower back, hips or thighs

Discomfort in the pelvic area

Bone pain

Erectile dysfunction

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that worry you.

There is debate regarding the risks and benefits of screening for prostate cancer, and medical organizations differ on their recommendations. Discuss prostate cancer screening with your doctor. Together, you can decide what’s best for you.

t’s not clear what causes prostate cancer. Doctors know that prostate cancer begins when some cells in your prostate become abnormal. Mutations in the abnormal cells’ DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die.

The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can break off and spread (metastasize) to other parts of the body.

Factors that can increase your risk of prostate cancer include:

Older age. The risk of prostate cancer increases with age. Prostate cancer is most common in men older than 65.

Being black. Black men have a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced. It’s not clear why this is.

Family history of prostate or breast cancer. If men in your family have had prostate cancer, your risk may be increased. Also, if you have a family history of the BRCA1 or BRCA2 gene mutation or a very strong history of women with breast cancer, your risk for prostate cancer may be higher.

Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease that’s more difficult to treat.

Complications of prostate cancer and its treatments include:

Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as your bladder, or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it can no longer be cured.

Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery.

Erectile dysfunction. Erectile dysfunction can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.

Prostate screening tests might include:

Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but studies haven’t proved that these tests save lives. For that reason, there is debate surrounding prostate cancer screening.

When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly. More-aggressive cancer cells have a higher grade.

The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score.

For more go to: http://www.mayoclinic.org

 

Prostate cancer: What’s the Prognosis? Look to the Gleason Score

From Johns Hopkins

The most important factor in predicting the current state of the prostate cancer and the success of any treatment is the Gleason score. The Gleason score is based on tumor grade, which is an indication of the tumor’s aggressiveness. The tumor grade reflects how far the cancer cells deviate from normal, healthy cells.

Normal prostate epithelial cells form highly organized glands, with well-defined borders. Cancer cells, in contrast, display various degrees of disorganization and distortion. Cancers whose cells appear closest to normal are considered grade 3 and generally are the least aggressive; those with highly irregular, disorganized features are classified as grade 4 or 5 and generally are the most aggressive.

The Gleason score is derived by determining the two most prevalent organizational patterns in the tumor, assigning each a grade and then adding the two numbers together. For example, if the most common pattern — the primary grade — is 3 and the next most common pattern — the secondary grade — is 4, the Gleason score would be 7 or 3+4. But if the primary grade is 4 and the secondary grade is 3, the Gleason score would be 4+3, and this would be considered to be more aggressive. In other words, the primary grade carries more weight than the secondary pattern in determining the aggressiveness of the cancer.

In some cases the pathologist will report a tertiary pattern that is associated with prognosis but is not a part of the overall score. For example, a pathologist may report that the biopsy shows a Gleason 3+3 (score 6), with a tertiary pattern 4.

Bottom line. Most doctors classify a Gleason score of 6 as a low-grade tumor, a Gleason score of 7 as intermediate, and Gleason scores of 8, 9 and 10 as high grade. Gleason scores of 8 to 10 are associated with the least favorable outlook.

For more go to: http://www.hopkinsmedicine.org/

 

Treating prostate cancer

By Deborah Kotz From Boston Globe

While debate rages over how aggressively to treat early-stage prostate cancer, men with advanced metastatic disease could gain a year of life if they receive a chemotherapy drug soon after their diagnosis rather than receiving the drug after hormonal treatments have lost their effectiveness, a new Dana-Farber Cancer Institute study finds. Researchers from Dana-Farber and other cancer centers tested both methods in 790 men diagnosed with end-stage prostate cancer that had spread to other organs and was dependent on hormones to grow. The group that received hormone therapy along with the chemotherapy drug docetaxel (Taxotere) lived for nearly 58 months on average compared with 44 months for those who initially received only the hormone therapy.

The chemotherapy treatment also delayed disease progression, which was monitored by an increase in prostate-specific antigen (PSA), the appearance of new metastases, or a worsening of symptoms. The men who received docetaxel as a first-line therapy had an average of nearly 33 months before the cancer progressed, compared with nearly 20 months for those who did not get the drug initially, according to the study, which was presented last Sunday at the annual meeting of the American Society of Clinical Oncology in Chicago.

“The benefit is substantial and warrants this being a new standard treatment for men who have high-extent disease and are fit for chemotherapy,” said Christopher Sweeney of Dana-Farber’s Lank Center for Genitourinary Oncology. D.K.

For more on this story go to: http://www.bostonglobe.com/lifestyle/health-wellness/2014/06/08/men-with-advanced-prostate-cancer-live-longer-with-new-treatment/ftz5rdErNwL2329hrxwLmM/story.html

IMAGE: urology.jhu.edu