Prostate Cancer: Patient Handout

Prostate cancer is the most common form of cancer among men in the United States, other than skin cancer. In 2004, approximately 230,110 new cases of prostate cancer will be diagnosed and 29,900 men will die of the disease, according to the American Cancer Society. Prostate cancer is the second leading cause of cancer deaths of men in the United States, after lung cancer, and the sixth leading cause of death of men overall.

Medical experts do not know how to prevent prostate cancer. But they are studying many factors. They know that not smoking, maintaining a healthy diet, staying physically active, and seeing your doctor regularly contribute to overall good health.

Prevalence of prostate cancer

For the general population, a man in his lifetime has about a 16% chance (1 in 6) of being diagnosed with prostate cancer and a 3% chance (1 in 33) of dying from prostate cancer.

More than 70% of all diagnosed prostate cancers are found in men aged 65 years or older. Basically, the older you are, the greater the risk for getting prostate cancer.

Risk of prostate cancer

While all men are at risk for prostate cancer, some factors increase risk.

Family history. Men with a father or brother who has had prostate cancer are at greater risk for developing it themselves.

Race. Prostate cancer is more common in some racial and ethnic groups than in others, but medical experts do not know why. Prostate cancer is more common in African-American men than in white men. It is less common in Hispanic, Asian, Pacific Islander, and Native American men than in white men.

Symptoms of prostate cancer

Many men with prostate cancer often have no symptoms. If symptoms appear, they can include:

  • Blood in the urine
  • The need to urinate frequently, especially at night
  • Weak or interrupted urine flow
  • Pain or burning feeling while urinating
  • The inability to urinate
  • Constant pain in the lower back, pelvis, or upper thighs

If you have any of these symptoms, see your doctor as soon as possible. Keep in mind that these symptoms are also caused by other prostate problems that are not cancer, such as an infection or an enlarged prostate.

Prostate cancer screening

The two most common tests used by physicians to detect prostate cancer are the digital rectal examination (DRE) and the prostate-specific antigen (PSA) test. For DRE, which has been used for many years, the physician inserts a gloved finger into the rectum to feel for prostate gland irregularities. The PSA test is a blood test that measures the prostate-specific antigen, an enzyme produced only by the prostate.

Although there is good evidence that PSA screening can detect early-stage prostate cancer, evidence is mixed and inconclusive about whether early detection improves health outcomes. In addition, prostate cancer screening is associated with possible harms. These include anxiety and follow-up procedures based on frequent false-positive test results, as well as complications that may result from treating prostate cancers that, if left untreated, might not have affected the man's health.

Because currently available evidence is insufficient to determine whether the potential benefits of prostate cancer screening outweigh its potential harms, there is no scientific consensus that such screening is beneficial.

The Centers for Disease Control and Prevention (CDC) promotes informed decision making, which occurs when an individual understands the nature and risks of prostate cancer; understands the risks, benefits, and alternatives to screening; participates in decision making at a level he desires; and makes a decision consistent with his preferences and values or defers the decision to a later time.

CDC also supports shared decision making, which is a process carried out between a patient and his health care professional in the clinical setting where both parties share information and the patient understands the nature and risks of prostate cancer; understands the risks, benefits, and alternatives to screening; participates in decision making at a level he desires; and makes a decision consistent with his preferences and values or defers the decision to a later time.

Follow-up testing

Most men who go for further testing do not have cancer. If a PSA test or DRE suggests a problem, your doctor most likely will refer you to a urologist (a doctor who has special training in prostate-related problems). Additional testing is necessary to determine if the problem is cancer or something else.

The urologist may perform a transrectal ultrasound —a small probe inserted into the rectum that bounces sound waves off the prostate, producing a video image. Transrectal ultrasound does not provide enough specific information to make it a good screening tool by itself, but some doctors find it useful as a follow up to a suspicious DRE or PSA test.

If the urologist suspects cancer, tiny samples of the prostate may be removed with a needle. This is called a biopsy. A biopsy is usually performed in the urologist's office. The samples are examined under a microscope to determine if cancer cells are present.

Treating prostate cancer

Many factors affect the decision whether or not to treat the disease: the patient's age, whether the cancer has spread, the presence of other medical conditions, and the patient's overall health.

When prostate cancer has been found in its early stages and has not spread beyond the prostate, a doctor and his patient may consider the following options.

Watchful waiting—monitoring the patient's prostate cancer by performing the PSA test and DRE regularly, and treating it only if and when the prostate cancer causes symptoms or shows signs of growing.

Surgery (radical prostatectomy)—removing the prostate.

External radiation therapy—destroying cancer cells by directing radiation at the prostate.

Internal radiation therapy (brachytherapy)—surgically placing small radioactive pellets inside or near the cancer to destroy cancer cells.

Hormone therapy—giving certain hormones to keep prostate cancer cells from growing.

Cryotherapy—placing a special probe inside or near the prostate cancer to freeze and destroy the cancer cells.

More advanced prostate cancers that have spread beyond the prostate can be complex to treat and may be incurable. Patients should discuss with their doctor the best course of action.

Do these treatments have side effects?

Side effects from prostate cancer treatment depend mainly on the type of treatment, the patient's age, and his overall health. Men can experience pain, discomfort, and other mild-to-severe side effects that may be temporary or may last a long time. Two important side effects are impotence and incontinence. When a doctor explains the treatment options, he or she can discuss how mild or severe side effects might be, and how long they might last. Also, a doctor may be able to perform surgery or prescribe drugs to relieve some side effects.

Source: Prostate Cancer Control Initiatives. The Centers for Disease Control and Prevention. Available at: www.cdc.gov/cancer/prostate/index.htm. Accessed Feb. 15, 2006.