Basics of Prostate Cancer

Disclaimer: This information was prepared by a layperson, not a medical professional. It is not intended as medical advice. Although the information is believed by the author to be accurate, it should not be relied upon as a sole source of information.

What is the prostate?

The prostate is a walnut-sized gland that surrounds part of the urethra, the tube that carries urine and sperm out of the body. The prostate is part of the male reproductive system. Its main job is to make seminal fluid, the milky substance that carries sperm.

What is prostate cancer?

Prostate cancer is the most common cancer, except for skin cancers, in men. It is a malignant tumor of the prostate. In most men, the cancer grows very slowly. In fact, many men with the disease will never know they have it. Early prostate cancer is confined to the prostate gland itself. The majority of patients with this type of cancer can live for years with no problems.

Prostate cancer is characterized by both grade and stage. The grade indicates how quickly a cancer is growing -- the higher the grade, the more likely it is that the cancer is aggressive"that it will grow and spread rapidly. The size and extent of the tumor determine its stage.

Grading is done according to the Gleason scale. Gleason grades run from 1 to 5. The two most prevalent grades are added together to get a sum, or Gleason score. Thus, a patient is told he has a Gleason of 3+4=7, for example, indicating the most prevalent grade was 3, followed by 4. Gleason scores of 2 to 4 are considered very low, and indicate cancer that is probably not very aggressive. Scores of 5-6 are mildly aggressive. A score of 7 indicates moderately aggressive disease (with Gleason 7, it matters if the composite is 3+4 or 4+3. 3+4 is more like Gleason 6, while 4+3 behaves more like Gleason 8.) Gleason 8 through 10 indicates highly aggressive disease.

What causes prostate cancer?

As with many cancers, the cause of prostate cancer is unknown. But doctors do know it is more common in African American men and men with a family history of the disease. Risk factors thought to be associated with prostate cancer include age, race, family history/genetics, diet high in red meat, obesity, and history of prostatitis (a benign inflammation). There is a possibility that sexually transmitted diseases increase the risk of prostate cancer. In the United States, the National Academy of Sciences and Veterans Administration (VA) concluded that exposure to Agent Orange increased susceptibility to prostate cancer (and melanoma), and therefore the U.S. government agreed to provide disability to any Vietnam veteran who develops prostate cancer.

The male sex hormone testosterone also contributes to its growth.

How Many Men Get Prostate Cancer?

About 235,000 men in the United States are diagnosed annually with prostate cancer, and approximately 27,500 die of it each year. Despite this fact, there is no universally agreed-upon plan for its diagnosis and management. Overall, about one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 34 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer.

What are the symptoms?

Most of the time, there are no symptoms with early prostate cancer. Symptoms usually only appear with advanced disease. These symptoms include blood in the urine, impotence, fecal or urinary incontinence, and bone pain.

What is the outlook?

While the number of men diagnosed with prostate cancer remains high, survival rates are also improving. Almost 100% of men with prostate cancer survive at least five years after their diagnosis, 93% survive at least 10 years, and two-thirds survive longer than 15 years.

Because prostate cancer is a slow-growing disease, many men with this disease will die from other causes before they die from prostate cancer. Evidence also indicates that many patients detect their prostate cancer at an earlier stage because of annual screening.

How is prostate cancer treated?

Prostate cancer can be treated in many different ways. In some men, active surveillance can be employed"the man is closely monitored by a physician with the intent to treat if the cancer becomes dangerous. In most men, however, active surveillance is not appropriate, and the man must decide, with his doctor, which treatment is best. There is no single "one size fits all" treatment for prostate cancer.

For localized, potentially curable prostate cancer, treatments include:

Surgery (traditional, laparoscopic, or laparoscopic with robot assistance)

Radiation. Radiation can include seeds (brachytherapy) or external beam. External beam radiation can come in the form of photons (X-rays) or protons. Sometimes various forms of radiation are combined. IMRT and IGRT are methods of delivering photon radiation in a way that "paints" the cancerous tissue with radiation while largely sparing healthy tissue. Protons deliver their energy in a precisely-defined 3D space. Other radiation technologies include CyberKnife and tomotherapy.

HIFU (High Intensity Focused Ultrasound). HIFU is not yet approved by the FDA in the United States, except in clinical trials, but it is available outside the U.S. in many locations. HIFU heats and destroys the tumor with ultrasound.

Each form of treatment carries its own unique risks and benefits which should be discussed with the doctor.

If primary treatment fails, in some cases it may still be possible to cure the patient with another form of therapy. This is called salvage therapy. Salvage therapy is an attempt to rescue a patient after a failed primary treatment. It is common, for example, to use radiation as salvage after surgery fails. Salvage therapy is not done if there is evidence that the cancer has spread beyond the local area.

Systemic Disease
For cancer that is no longer localized, systemic therapy is employed. At the time of this writing, there is no cure for advanced prostate cancer, but it can usually be stalled for some time by use of hormone therapy (androgen deprivation) and/or chemotherapy. The length of time a man benefits from systemic therapy varies from case to case. Normally, a man can expect to respond to hormone therapy for several months to a few years. In some cases, however, men do not respond, or they respond only for a brief period. In other cases, prostate cancer can be stalled for over a decade. When hormone therapy is no longer effective, chemotherapy is often used. Although chemotherapy is not as effective against prostate cancer as some other cancers, it can often lead to extended survival time.

At the time of this writing, several new therapies for advanced prostate cancer are in late stages of testing. Patients with advanced disease should discuss the appropriateness of clinical trials with their doctors.

More Information:

Websites:

American Cancer Society"All About Prostate Cancer: http://www.cancer.org/docroot/CRI/CR...area=LRN&dt=36

National Cancer Institute Prostate Cancer Homepage: http://www.cancer.gov/cancertopics/types/prostate

Prostate Cancer Foundation: http://www.prostatecancerfoundation.org/

Prostate Cancer Infolink: http://prostatecancerinfolink.net/

Prostate Cancer Research Institute: http://prostate-cancer.org

WebMD Prostate Cancer Basics: http://www.webmd.com/prostate-cancer...-cancer-basics

Books

Lange, Paul H., and Christine Adamec. Prostate Cancer for Dummies.

Myers, Charles "Snuffy". Beating Prostate Cancer: Hormonal Therapy and Diet.

Scardino, Peter. Dr. Peter Scardino's Prostate Book: The Complete Guide to Overcoming Prostate Cancer, Prostatitis and BPH .

Strum, Stephen, and Donna Pogliano. A Primer on Prostate Cancer: The Empowered Patient's Guide.

Walsh, Patrick C., and Janet Farrar Worthington. Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. 2nd edition.