Prostate
CancerProstate
cancer is the second leading cause of death in men, second only to heart disease. Prostate
cancer has become the most diagnosed cancer in the U.S. More than 300,000 men were
diagnosed with prostate cancer in 1996. Another 40,000 died from prostate cancer. As the
population ages, these numbers will increase every year.
 What are the symptoms of Prostate Cancer?
How is Prostate Cancer diagnosed?
What are the treatments for Prostate Cancer?
Is there any way to prevent Prostate Cancer ?
The Prostate Gland - What It Is And What It Does
The Prostate Exam - What It Is And How It's Done
The PSA Blood Test - What It Is And What It Does
Causes For A Higher than Normal PSA Level
Guidelines For Having PSA Exams
Associations
In the News...
Internet Resources
- A need to urinate frequently, especially at night
- Difficulty to start to urinate
- Inability to urinate
- Painful or burning urination
- Painful ejaculation
- Blood in urine or semen
- Weak or interrupted flow of urine
- Frequent pain or stiffness in the lower back, hips, or upper
thighs
Some of these symptoms could also be cause by an infection or
another common, non-cancerous condition called Benign Prostatic Hyperplasia (BPH). You
should see a physician if you encounter any of these symptoms.
- Digital rectal exam. The doctor inserts a
gloved, lubricated finger into the rectum and feels the prostate through the rectal wall
to check for lumps or hard areas
- Blood tests: Blood is drawn so that measures
of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) can be found.
- Urine test: The urine is checked for blood or
infection.
- Transrectal ultrasonography: A probe inserted
into the rectum sends out inaudible ultrasound waves that bounce off the prostate. Echoes
are analyzed by a computer uses the echoes to generate an image of the prostate.
- Intravenous pyelogram: Series of X-rays of
the organs of the urinary tract.
- Cystoscopy: A doctor looks into the urethra
(the tube that carries urine out of the body) and the bladder (the organ which stores
urine) through a thin lighted tube.
- Biopsy: If cancer is suspected from any of
the above tests, a doctor will remove a small piece of tissue from the prostate, usually
with a hollow needle. Biopsy is the only way to know with 100% certainty if the tissue has
cancer cells in it.
Standard treatments for prostate cancer may involve one or a
combination of the following::
- Watchful waiting, if the prostate cancer is
at an early stage, especially if the patient is old or has serious health problems.
- Surgery, to remove the entire prostate is
commonly performed for early stage prostate cancer.
- Radiation therapy is an alternative to
surgery in early stages of development, and can also be used after surgery to destroy
remaining cancerous cells. Radiation therapy uses high energy rays to prevent cancer cells
from growing.
- Hormone therapy limit growth of cancer cells
by preventing them from getting the male hormones they need
There is no sure way to prevent prostate cancer, although
studies are under way to see if a low-fat diet can reduce prostate-cancer risk.
Every man at age 40 and over should a digital rectal
examination as part of an annual physical checkup.
In addition, men age 50 and over should have an annual blood
test for Prostate-Specific Antigen, or PSA. Elevated levels of PSA may indicate a need for
additional follow-up. Men with a history of prostate cancer, as well as African-American
men, should have the PSA test starting at age 45.
The prostate is actually a collection of glands and is part
of the male reproductive system. Its function is to produce fluid that becomes part of
semen. The prostate is about the size of a walnut. It is located below the bladder. The
outside of the prostate is a thin capsule of fibrous tissue. Just outside the prostate is
a layer of fat.
The prostate is divided into the right and left sides, called
lobes. The widest part of the prostate, up next to the bladder, is called the base. The
tip opposite the bladder is called the apex. The word anterior is used to describe the
front, and the word posterior is used to describe the back.
Just below the prostate is the wall of the rectum. On each
side of the prostate are blood vessels and nerves that play an important part in making
choices for cancer treatments. The glands right next to the prostate are called seminal
vesicles, and fluid from them drains into the prostate. The vas deferens are tubes from
the testicles which also drain into the prostate.
The prostate surrounds the urethra. The urethra is the tube
that comes from the bladder, passes through the prostate, goes past the urinary sphincter
muscle and through the penis. Its purpose is to carry urine from the bladder to the
outside of the body. The urinary sphincter muscle is a circular muscle that prevents urine
from leaking.
There are lymph nodes clustered along the sides of both walls
of the pelvis. These lymph nodes are part of the lymphatic system. The lymphatic system
cleans all of the cells in the body with lymph fluid. The fluid is filtered through the
lymph nodes. Any impurities, germs and cancers are captured. After the fluid has been
filtered, it is recycled into the bloodstream. There are veins that take blood from the
prostate to the heart. These veins run along side the spinal column.
Because of its anatomical position in the body, continued
growth of the prostate causes problems, called symptoms. As long as your body produces
male hormones, your prostate will continue to grow. Also, cancer in the prostate can cause
the prostate to grow. The position of glands and structures closest to the prostate is
also important, as they are the first places that prostate cancer spreads when it grows
outside of the prostate gland.
The prostate exam is a basic, relatively painless exam, that
is performed by your primary care physician or a urologist. You can expect to have several
of these exams over your lifetime, especially if you are actively watching the health of
your prostate.
The prostate exam is often called a rectal exam, prostate exam, or digital rectal exam.
Digital comes from the word digit, meaning finger, and has nothing to do with digital
imagery, sound, or computers. The examination is done by the physician inserting a gloved,
lubricated finger into the rectum. Fortunately, the wall of the rectum is thin enough that
cancers can be felt on the back side of the prostate.
The physician is feeling to "see" if there are any
areas that are not smooth or are not soft. The prostate should feel symmetrical, that is,
both lobes should feel the same. There should not be any hard nodules or firm areas. If an
abnormal area is felt, there may be a reason for it other than cancer, such as previous
surgery or a past infection in the prostate. There are growths that are not cancer that
can cause nodules or areas that are not smooth.
To rule out the abnormal area as cancer your physician will
probably have you go though additional testing. Also, only the back side and not the
entire prostate gland can be felt through the rectum. The digital exam is like feeling the
back of your head and trying to decide what your face looks like. For these reasons the
PSA blood test is often done in addition to the prostate exam if there is a reason to
think cancer may be present.
The PSA Blood Test and the digital rectal exam combined
provide the best information needed to determine whether or not prostate cancer is
present. A PSA test alone can help detect prostate cancer before it can be felt.
Especially, prostate cancer that occurs in areas of the prostate that cannot be reached by
a digital rectal exam.
PSA stands for Prostate Specific Antigen. The PSA blood test is testing for the presence
of an enzyme that is produced by the cells of the prostate gland. It is produced by both
normal prostate cells and cancerous prostate cells. Significant amounts of PSA are not
found anywhere else in the body.
A small amount of PSA is released into the blood stream all of the time. If the prostate
becomes irritated, more PSA leaks into the bloodstream and can be measured by taking a
blood sample. The PSA is a very good test for identifying cancer of the prostate as well
as other non-cancerous problems.
Normal Ranges for a PSA test are from 0.0 to 4.0. PSA levels can go up into the 100's.
When cancer is diagnosed, the PSA levels are often consistently in the 10's or 20's. A PSA
level that is extremely high almost always means advanced prostate cancer is present. If
PSA test results are in the higher levels, other test are usually ordered to determine if
the cancer has spread into the lymph nodes or the bones.
If your PSA test results are in the normal range and your
prostate exam was normal, you can feel pretty sure that everything is probably normal and
cancer is not present in the prostate. However, this is only a snap shot in time. One exam
does not mean you can go for the rest of your life without an exam. As a matter of fact,
you should keep records of your exam results and compare them. Keeping records will allow
you to watch for trends, such as slight increases, over time. A sudden change in your exam
results may mean a problem. There are guidelines discussed later that show you how often
to have your prostate checked.
Having a higher than normal PSA level does not mean that you
have cancer! It is simply a warning signal. The PSA blood test can tell you that you have
a problem with your prostate gland, but it can't tell you exactly what the problem is.
Cancer is only one of the problems it could be. A high PSA level can be caused by those
items shown below. If your first reading is high, and your digital rectal exam is normal,
your doctor will probably try treating you with medicine first and then a repeat PSA about
6 weeks after treatment. Six weeks may seem like a long time to wait, but enough time has
to pass to make sure the repeat test is as accurate as possible.
- Urinary tract infection
- Urinary catheter in the bladder
- Urinary retention
- Stones in the prostate
- Cancer of the prostate
- Recent prostate surgery or biopsy
- Noncancerous enlargement of the prostate
- Infection of the prostate
The following are general guidelines only! You should talk
with your doctor about your personal needs for this or any other medical test.
If you are not at high risk, you should begin having a PSA
blood test by age 50. If you are over age 80, there is no consensus on recommended
guidelines for annual PSA tests. Following your doctor's advice is probably the best
course of action for you.
If you are at risk for prostate cancer you should have a PSA
and digital rectal exam more often than someone that is not at high risk. Being at high
risk means you are more likely to get prostate cancer than someone who is not at high
risk. You are at high risk if you have a family history of prostate cancer. That means,
you are at high risk if your grandfather, father, or a brother have had prostate cancer.
You should have a PSA blood test by age 40, and one every year thereafter.
African-American men have a higher risk of getting prostate
cancer than other men. African-American men should have a PSA blood test every year
beginning by age 40.
American Cancer Society
On Guam: 477-9451/2
1599 Clifton Road, NE., Atlanta, GA 30329
National: 1-800-ACS-2345
Supports education and research in cancer prevention, diagnosis and treatment.
Cancer Information Service
1-800-4-CANCER
National Prostate Cancer Week, September 20-27
Family history of breast cancer may
increase risk of prostate cancer (8/25)
New Cancer Therapies
Media reports frequently oversimplify the battle against cancer and suggest that a cure is
just around the corner. The reality, however, is much more complex.
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