Win Your Fight Against Prostate Cancer!



Prostate Cancer

Scientists are studying prostate cancer to learn more about this disease. They are finding out more about its causes and are exploring new ways to treat it. Research keeps increasing our knowledge about prostate cancer.

The Prostate

The prostate is part of a man's reproductive system. It is located in front of the rectum and under the bladder. A healthy prostate is about the size of a walnut, and it is shaped like a donut. The urethra (the tube through which urine flows) passes through the prostate. If the prostate grows too large, it squeezes the urethra. This may cause urinary problems by slowing or stopping the flow of urine from the bladder to the penis.

The prostate is a gland that makes part of seminal fluid. During ejaculation, seminal fluid helps carry sperm out of the man's body as part of semen.

Male hormones (androgens) make the prostate grow. The testicles are the main source of male hormones, including testosterone. The adrenal glands also make testosterone, but in small amounts.

Understanding Cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:

Benign tumors are rarely life-threatening. Generally, benign tumors can be removed, and they usually do not grow back.

Cells from benign tumors do not invade tissues around them.

Cells from benign tumors do not spread to other parts of the body.

Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. In BPH, the prostate grows larger and presses against the urethra and bladder. This interferes with the normal flow of urine.

BPH is a very common problem. In the United States, most men over the age of 50 have symptoms of BPH. For some men, symptoms may be severe enough to require treatment.

Malignant tumors are cancer:

Malignant tumors are generally more serious than benign tumors. They may be life- threatening.

Malignant tumors can often be removed, but they may grow back.

Cells from malignant tumors can invade and damage nearby tissues and organs.

Cells from malignant tumors can spread to other parts of the body. The cells spread by breaking away from the original cancer (primary tumor) and entering the bloodstream or lymphatic system. They invade other organs, forming new tumors and damaging these organs. The spread of cancer is called metastasis.

When prostate cancer spreads outside the prostate, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, cancer cells are more likely to have spread through the lymphatic system to other lymph nodes, the bones, or other organs.

When cancer spreads (metastasizes) 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 tumor.

For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it is treated as prostate cancer, not bone cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

Prostate Cancer: Who's at Risk?

No one knows the exact causes of prostate cancer. Doctors can seldom explain why one man develops the disease and another does not. However, it is clear that prostate cancer is not contagious. No one can "catch" this disease from another person.

Research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for prostate cancer:

  • Age:

    Age is the strongest risk factor for prostate cancer. This disease is rare in men younger than 45, but the chance of getting it goes up sharply as a man gets older. In the United States, most men with prostate cancer are older than 65.

  • Family history:

    A man's risk of prostate cancer is higher than average if his father or brother had the disease.

  • Race:

    Prostate cancer is more common in African American men than in white men, including Hispanic white men. It is less common in Asian and American Indian men.

  • Certain prostate changes:

    Having abnormal cells called high-grade prostatic intraepithelial neoplasia (PIN) may increase the risk of prostate cancer. These prostate cells look abnormal under a microscope.

  • Diet:

    Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk of prostate cancer. Also, men who eat a diet rich in fruits and vegetables may have a lower risk.

    Scientists have studied whether BPH, obesity, smoking, a sexually transmitted virus, or lack of exercise might increase the risk of prostate cancer. At this time, these do not appear to be important risk factors. Also, most studies have not found an increased risk of prostate cancer for men who have had a vasectomy (surgery to cut or tie off the tubes that carry sperm out of the testicles). Other possible risk factors are under study.

    Many men who have known risk factors do not get prostate cancer. On the other hand, many who do get the disease have none of these risk factors (other than being over 65). Men may want to talk with their doctor about factors that generally increase the chance of getting prostate cancer and about their own risk.

    Diagnosis

    If a man has symptoms or test results that suggest prostate cancer, his doctor asks about his personal and family medical history, performs a physical exam, and may order laboratory tests. The exams and tests may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA level.

    The doctor also may order other exams:

    Transrectal ultrasound:

    The doctor inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that cannot be heard by humans (ultrasound). The sound waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.

    Cystoscopy:

    The doctor looks into the urethra and bladder through a thin, lighted tube.

    Biopsy:

    A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a needle through the rectum into the prostate and removes a small amount of tissue (transrectal biopsy). The doctor takes tissue samples from several areas of the prostate. Ultrasound may be used to guide the needle. A pathologist uses a microscope to check for cancer cells in the tissue.

    A biopsy is the only sure way to diagnose prostate cancer.

    A man who needs a biopsy may want to ask the doctor some of the following questions:

    Where will the biopsy take place? Will I have to go to the hospital?

    How long will it take? Will I be awake? Will it hurt?

    What are the risks? What are the chances of infection or bleeding after the biopsy?

    How long will it take me to recover?

    How soon will I know the results?

    If I do have cancer, who will talk to me about the next steps? When?

    Diagnosis

    If a man has symptoms or test results that suggest prostate cancer, his doctor asks about his personal and family medical history, performs a physical exam, and may order laboratory tests.

    The exams and tests may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA level.

    The doctor also may order other exams:

    Transrectal ultrasound: The doctor inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that cannot be heard by humans (ultrasound). The sound waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.

    Cystoscopy: The doctor looks into the urethra and bladder through a thin, lighted tube.

    Biopsy: A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a needle through the rectum into the prostate and removes a small amount of tissue (transrectal biopsy). The doctor takes tissue samples from several areas of the prostate. Ultrasound may be used to guide the needle. A pathologist uses a microscope to check for cancer cells in the tissue. A biopsy is the only sure way to diagnose prostate cancer.

    A man who needs a biopsy may want to ask the doctor some of the following questions:

    Where will the biopsy take place? Will I have to go to the hospital?

    How long will it take? Will I be awake? Will it hurt?

    What are the risks? What are the chances of infection or bleeding after the biopsy?

    How long will it take me to recover?

    How soon will I know the results?

    If I do have cancer, who will talk to me about the next steps?

    When?

    If Cancer Is Not Found

    If the physical exam and test results do not suggest cancer, the doctor may recommend medicine to reduce symptoms caused by an enlarged prostate.

    Surgery is another way to relieve these symptoms. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR).

    In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. Men should talk to their doctor about the best treatment option.

    If Cancer Is Found

    If cancer is present, the pathologist usually reports the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow more quickly and are more likely to spread than those with lower grades.

    One system of grading prostate cancer uses G1 through G4.

    Another way of grading is with the Gleason score. The pathologist studies tissue samples from the prostate under a microscope. Each area of cancer gets a grade of 1 through 5. The pathologist adds the two most common grades together to make a Gleason score, or the pathologist may add the most common grade and the highest (most abnormal) grade. Gleason scores can range from 2 to 10.





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