Prostate cancer is an abnormal growth in the prostate gland. This walnut-shaped gland in the male reproductive tract makes seminal fluid, which mixes with sperm. The prostate is around the urethra, near its connection to the bladder. The urethra is the tube that takes urine from the bladder to outside the body. Cancer develops when cells divide out of control. Early detection and treatment have led to better survival for all stages of prostate cancer in the past 20 years.
Early prostate cancer generally does not cause symptoms. Depending on its location within the prostate and how far it has spread, it may cause pain, problems urinating, erectile dysfunction, and other symptoms.
A weak or interrupted flow of urine, having to urinate often (especially at night), trouble holding back urine, being unable to urinate, pain or burning when urinating, blood in urine or semen, and nagging pain in the back, hips, or pelvis may occur as the cancer spreads.
These symptoms are not always due to prostate cancer and may have other less serious causes, including benign prostatic hypertrophy (BPH) and infections. Always see your health care provider for a diagnosis.
The health care provider may suspect prostate cancer from a complete medical history and physical examination. The health care provider will do a digital rectal examination (DRE) and a blood test known as prostate-specific antigen test (PSA test).
The health care provider may recommend that men older than 50 have yearly DREs and PSA tests. These tests may be helpful in making the diagnosis. Men in high-risk groups, such as African Americans, or those with a family history of prostate cancer may need testing at a younger age.
The diagnosis can be proved only by a biopsy, in which the urologist (doctor who specializes in diseases of the urinary tract) takes a sample of prostate tissue for study.
Many prostate cancers don’t lead to death, but some can spread (metastasize) through blood and lymph nodes (glands) to bones and major organs. This is called extracapsular spread.
The choice of treatment depends on a man’s age and health, how far the cancer spread (stage of disease), what the cancer looks like under the microscope, and response to first treatment. Standard treatments include watchful waiting, surgery, radiation therapy, and hormone therapy. Radiation therapy can be external beam radiation (x-rays to kill cancer cells) or proton beam therapy (special high-dose treatment). Also, tiny radioactive implant (seeds) can be put directly into the prostate. Hormone therapy affects testosterone production, so cancer cells shrink or grow more slowly.
Surgery is called radical prostatectomy. It’s used for localized cancer (one that hasn’t spread). Sometimes, chemotherapy (drugs), cryosurgery (freezing), or some treatment combination may be tried.
Prostate cancer usually occurs in older men, who often die of other causes before slowly growing prostate cancer spreads or causes symptoms. When occurring in younger men, it tends to much more aggressive. Also, treatments generally have side effects, such as incontinence and erectile dysfunction, that may decrease quality of life. Choosing a treatment is therefore hard. The decision whether to try to cure localized prostate cancer is a trade-off between survival and quality of life.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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