Patients

BACKGROUND

Prostate cancer is the second most prevalent cancer among men. We often think of it as "an old man's disease" since it can be a slow growing cancer that is not detected until later in life. Although in some instances prostate cancer can also grow rapidly in younger and older men, and can be life-threatening. Each year, in the United States alone, approximately 200,000 men are diagnosed with prostate cancer and close to 30,000 men will die from the disease. However, if caught in the early stages and treated appropriately, the risk of dying from prostate cancer can be greatly reduced.

WHAT IS THE PROSTATE AND PROSTATE CANCER?

The prostate is a small walnut-sized gland located just below the urinary bladder and surrounds the urethra (the tube that carries urine out through the penis). Its main function is to provide seminal fluid to the sperm. Throughout a man's lifetime the prostate slowly increases in size. Excessive prostate growth, called BPH (Benign Prostate Hyperplasia), may cause bothersome and even painful symptoms but is not life threatening.

Prostate cancer is the growth of malignant cells that exhibit uncontrolled division. At first the cancer develops within the prostate, but as it grows it begins to invade surrounding tissue and other organs. It may even spread through the bloodstream to other parts of the body, most often to the bones.

DETECTION AND DIAGNOSIS

The traditional screening procedure for detecting prostate cancer is by DRE (digital rectal exam). The doctor inserts a gloved lubricated finger into the rectum to check the prostate size and feel the back wall and sides of the prostate for bumps or other abnormalities. The exam is quick and generally painless and can be a good indicator that further tests are necessary.

An additional screening method that has revolutionized prostate cancer detection is a simple blood test to check PSA (Prostate Specific Antigen) level. PSA is an enzyme produced by prostate cells, whether normal or cancerous. An abnormal prostate, including one with cancer, will secrete more PSA. Since the normal range of PSA is 0.0 - 4.0 ng/ml, a level between 4 and 10 may raise suspicion that a patient has prostate cancer. However, an elevated level of PSA does not necessarily mean that you have prostate cancer. Other factors that can raise the PSA level are: inflammation or infection of the prostate, non-cancerous prostate growth (BPH), recent urinary catheterization or procedure, recent prostate biopsy or surgery, stones in the prostate or bladder surgery.

If the DRE or PSA level indicates that cancer may be present, your doctor will perform an ultrasound and biopsy of the prostate. A lubricated ultrasound probe is inserted in the rectum and sound waves emitted by the probe provide images of the entire prostate. Biopsies of the prostate are taken with tiny hollow needles inserted through the thin rectal wall. Biopsy is the only definitive way to diagnose the presence of prostate cancer.

The following criteria are used to characterize prostate cancer: grade of the tumor (Gleason score, where the higher the number the more aggressive the cancer), stage of the tumor (T1-T4, where the higher the number the more the cancer has spread) and volume of the prostate.

WHAT YOU CAN DO TO PREVENT PROSTATE CANCER

Screen for prostate cancer by having an annual digital rectal exam and PSA blood test from age 50. If you are African American or have a family history of prostate cancer you should have these annual tests from age 40.