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Prostate Cancer
A D.O.D Telehealth Research
By : Christopher Scott
• What is the prostate?
• The prostate gland is found only in men; therefore, only
men get prostate cancer.
• It is just below the bladder and in front of the rectum.
The urethra, the tube that carries urine, runs through the
• The prostate normally starts out about the size of a
walnut. By the time a man is age 40, the prostate may
already have grown to the size of an apricot; by age 60,
it may be as big as a lemon.
• Most cancers are named after the part of the body where
the cancer first starts. Prostate cancer starts in the
prostate gland.
The Prostate
• Main duties of the prostate gland
• One of the prostate's main duties is to create the
seminal fluid which mixes with and carries
sperm out of the penis upon ejaculation.
• The prostate also helps to pump the semen
and sperm with sufficient power out of a man's
body on its way to fertilizing a woman's egg.
• The prostate functions as a gland and contains
muscle fibers which contract and relax
What is prostate cancer?
Except for skin cancer, cancer of the prostate is the
most common malignancy in American men.
It was estimated that nearly 221,000 men in the
United States will be diagnosed with prostate cancer in
In most men with prostate cancer grows very slowly.
The majority of men with low-grade, early prostate
cancer (confined to the gland) live a long time after
their diagnosis.
Even without treatment, many of these men will not die
of the prostate cancer, but rather will live with it until
they eventually die of some other, unrelated cause.
Nevertheless, nearly 29,000 men have died of
prostate cancer in 2003.
• Prostate cancer
• Prostate cancer is the number-two cancer killer in men.
• Unfortunately, once the cells that make up prostate cancer have
grown inside the prostate for a long enough time to reach a critical
mass in size and number of cells, the cancer can spread outside of
the prostate gland to other parts of the body.
• Like boiling water in a pot bubbling over, prostate cancer
"pours" out of the prostate gland into the surrounding tissue.
• Once free of the prostate, the cancer cells can find new homes in
the bones, liver, brain, lungs, spinal cord, or elsewhere.
• When that happens, the cancer that was simply annoying becomes
deadly. More than 20% of all prostate cancers in the U.S. have
moved beyond the prostate gland before they are detected.
• What causes prostate cancer?
• While researchers still do not know the exact answer to this
question, they have identified some risk factors. These include
environment, genetics and family history.
• Incidence increases with age
More than 70% of all prostate cancers are diagnosed in men over
age 65. Information regarding first-degree relatives (i.e., father,
brother) has shown an over 2- to 11-fold increase in the risk of
prostate cancer in men who have a history of this disease in their
• The death rate for prostate cancer is more than 2 times higher in
African-American men than in Caucasian men. Because of
additional risk, earlier screening for prostate cancer is recommended
for African-American men.
• According to the American Cancer Society, men aged 50 and older,
and those over the age of 45 who are in high-risk groups, such as
African-American men and men with a family history of prostate
What are some of the symptoms of prostate cancer?
9 of the most common symptoms are:
Need to urinate frequently, especially at night.
Difficulty starting to urinate or hold back urine.
Inability to urinate.
Weak or interrupted flow of urine.
Painful or burning urination.
Difficulty having an erection.
Painful ejaculation.
Blood in urine or semen (this can also be a symptom of prostatitis, an inflammation of
the prostate)
Frequent pain or stiffness in the lower back, hips or upper thighs.
Note: Early prostate cancer often does not cause symptoms.
Who is at risk for prostate cancer?
All men are at risk. The most common risk factor is
More than 70 percent of men diagnosed with prostate
cancer each year are over the age of 65.
Dramatic differences in the incidence of prostate
cancer are also seen in different countries, and there is
some evidence that a diet higher in fat, especially
animal fat, may account for some of these
Genetic factors also appear to play a role, particularly
for families in whom the diagnosis is made in men
under 60 years of age. The risk of prostate cancer
rises with the number of close relatives who have the
How is prostate cancer diagnosed?
The diagnosis of prostate cancer can be confirmed
only by a biopsy.
During a biopsy, a urologist (a doctor who specializes
in diseases of urinary and sex organs in men, and
urinary organs in women) removes tissue samples,
usually with a needle.
This is generally done in the doctor’s office with local
anesthesia. Then a pathologist (a doctor who identifies
diseases by studying tissues under a microscope)
checks for cancer cells.
• Signs and Symptoms of Prostate Cancer
• When symptoms finally appear, they often are similar to
those caused by prostate enlargement:
• When cancer grows through the prostate capsule, it
invades nearby tissues. It also may spread to the lymph
nodes of the pelvis, or it may spread throughout the
body (metastasize) via the bloodstream or the
lymphatic system.
• Prostate cancer tends to metastasize to the bone. As a
result, bone pain, particularly in the back, can be another
symptom of prostate cancer.
• What can go wrong with the prostate gland?
• Three main types of problems
• Infection - called prostatitis
• Enlargement
• Cancer
• Can afflict the prostate.
• Prostatitis is fairly common in men from the teen years
• What is an Enlarging Prostate?
• In many men, the prostate begins to grow when they are in their
50s, and it may continue to grow for the rest of their lives. An
enlarged prostate is usually an “enlarging prostate” for most men
over age 50, which means that if your prostate has started to grow, it
may continue to grow.
• As the prostate grows, it puts pressure on the urethra—the tube
that carries urine and semen out of the body. This increasing
pressure on the urethra can lead to bothersome urinary symptoms
and future problems such as surgery on your prostate.
• This condition is known as Enlarging Prostate, or benign prostatic
hyperplasia (BPH). Although prostate cancer can also cause the
prostate to grow, Enlarging Prostate is not a cancerous
condition —it is not the same as prostate cancer, and it does not
lead to cancer.
• Enlarging Prostate is not life threatening, but you and your doctor
need to keep an eye on it so that it does not get worse.
Know the symptoms of Enlarging Prostate
If you have an enlarging prostate, you may find that you likely have one or
more of the following symptoms:
It is difficult to start urinating.
It is difficult to empty your bladder completely, and because of this, urine
may dribble after you are done.
The stream of your urine is weak and may start and stop.
You urinate more often, especially at night.
You feel the need to urinate more often.
You get sudden strong urges to urinate.
You feel bothered about the difficulty your urinary problems are causing you.
• What is prostatitis?
• To put it simply, prostatitis is inflammation of the prostate gland.
Here are some of the main classifications of prostatitis:
• What are the symptoms of prostatitis?
• Each type of prostatitis has a slight variation in signs and symptoms:
• Acute bacterial prostatitis
– Fever and chills
– Pain in lower back or rectum
– Urinary symptoms
• Chronic bacterial prostatitis
– Relapsing urinary tract infections
– Painful urination or other voiding problems
– Genital pain
• Nonbacterial prostatitis
– Urinary symptoms such as difficult or painful urination
• How is prostatitis diagnosed?
• Since the prostate lies in front of the rectum,
your doctor will most likely perform a digital
rectal examination (DRE) by inserting a gloved,
lubricated finger into the rectum.
• By doing this, he or she will be able to feel the
prostate and determine if it is enlarged or if it
has lumps or other abnormalities.
• The physician may also check for possible
infection or other prostate or urinary tract
• How is prostatitis treated?
• Acute and chronic bacterial prostatitis is
routinely treated with antibiotics.
• If you have nonbacterial prostatitis, your
doctor might prescribe medications to reduce
the difficulty in urination or anti-inflammatory
drugs for pain.
• Lifestyle changes (diet, stress management)
may be suggested by your doctor
• The PSA test and others: screening for prostate cancer
• There are four major tests for prostate cancer, including the wellknown PSA test. These tests fall into two categories: those that
screen for the disease, and those that help the doctor determine the
stage of the disease when it is found. Screening tests for prostate
cancer include:
• Prostate-specific antigen test (PSA test.) The PSA test analyzes
a blood sample drawn. It checks the sample for PSA, a substance
the prostate gland naturally produces to help liquefy semen. A
small amount of PSA naturally enters the bloodstream. If higherthan-normal levels of PSA occur (above a level of 4 ng/ml), it may
indicate prostate infection, inflammation (prostatitis), enlargement of
the prostate gland—or cancer.
• Digital rectal exam (DRE). The prostate is located next to the
rectum. A doctor performs a digital rectal exam by inserting a gloved,
lubricated finger into the rectum to examine the prostate. If the
doctor finds any abnormalities in the texture, shape or size of the
gland, more tests may be needed.
• Urine test. A urine test checks the urine for abnormalities that may
indicate a problem. The test does not detect prostate cancer, but it
can help detect or rule out other conditions with similar symptoms.
• Transrectal ultrasound. If the doctor has concerns, he or she may
use transrectal ultrasound to further evaluate the prostate. This
involves inserting a small probe into the rectum. The probe
emits sound waves to produce a picture of the prostate gland
• Grading & Staging
• Once prostate cancer is discovered, the tumor is graded and
staged. The grade estimates how aggressive a prostate cancer
is; how fast it is growing and the likelihood of its spreading.
• The staging estimates the size and location of the cancer
(including how far it has spread). Grading and staging will help
determine what type of treatment, if any, is most appropriate.
• Grading
• The grade indicates how different the cancer cells
appear from normal cells, when seen through a
microscope. Sometimes you will hear the grade referred
to as the Gleason grade. A Gleason grade ranges from
1 through 5.
• Prostate cancers often have areas with different grades.
Therefore, a grade is assigned to each of the two areas
that make up most of the cancer.
• These two grades are added together to yield a Gleason
score of between 2 and 10. Low Gleason grades and
scores indicate slow-growing cancer. High grades and
scores indicate a cancer likely to grow aggressively.
• Staging
• Staging is the assessment of the size and location of prostate
cancer (that is, how far the cancer has already spread).
• Staging is necessary for the patient and physician to decide what
type of treatment is most appropriate.
• There is more than one system for staging prostate cancer. The
TNM system is used most often and gives three key pieces of
• T refers to the Tumor. There are actually two types of T
classifications for prostate cancer. The clinical stage is based on
digital rectal exam, needle biopsy and transrectal ultrasound
findings. The pathologic stage is based on what the doctor finds
when the entire prostate gland, both seminal vesicles and, in some
cases, nearby lymph nodes are removed and examined.
• N describes how far the cancer has spread to nearby lymph Nodes.
• M shows whether the cancer has spread (Metastasized) to other
organs of the body
T Stages (Tumor)
The tumor cannot be felt or
seen with imaging such as
transrectal ultrasound.
The cancer is found
incidentally during a
transurethral resection
(TURP) for benign
prostatic enlargement and
is present in less than 5
percent of the tissue
The cancer is found
through TURP and is
present in more than 5
percent of the tissue
The cancer is found by
needle biopsy done
because of an elevated
PSA level.
The cancer can be felt
through a digital rectal
exam (DRE).
The cancer is in one side of the prostate.
The cancer is in both sides of the prostate.
The cancer has begun to spread outside
the prostate and may involve the seminal
The cancer extends outside the prostate
but not to the seminal vesicles.
The cancer has spread to the seminal
The cancer has spread to tissues next to
the prostate (other than the seminal
vesicles), such as the bladder's external
sphincter (muscles that help control
urination), the rectum and/or the wall of the
• N Stages (Lymph nodes)
• N0
The cancer has not spread to any lymph nodes.
• N1
The cancer has spread to one or more regional
(nearby) lymph nodes in the pelvis.
• M stages (Metastasis)
• M0
The cancer has not spread beyond the regional
• M1
The cancer has spread to distant (outside of the
pelvis) lymph nodes, bones or other organs such
as the lungs, liver or brain.
A-D Staging System
Stage A is early cancer. The tumor is
located within the prostate gland and
cannot be felt during a DRE.
In Stage B, the tumor is
considered to be within the
prostate and can be felt during a
In Stage C, prostate cancer is more advanced.
Stage C indicates that the tumor has spread outside
the prostate to some surrounding areas, but not to
other organs. This stage of cancer can usually be
detected by a DRE.
In Stage D, the cancer has spread to the
nearby organs and usually to distant
sites, such as the bones or lymph nodes.
How is localized prostate cancer treated?
Three treatment options are generally accepted for men with localized prostate
cancer: radical prostatectomy, radiation therapy, and surveillance (also called
watchful waiting).
Radical prostatectomy is a surgical procedure to remove the entire
prostate gland and nearby tissues. Sometimes lymph nodes in the
pelvic area (the lower part of the abdomen, located between the hip
bones) are also removed.
Radical prostatectomy may be performed using a technique called nervesparing surgery that may prevent damage to the nerves needed for an
Radiation therapy involves the delivery of radiation energy to the prostate.
The energy is usually delivered in an outpatient setting using an external
beam of radiation. The energy can also be delivered by implanting
radioactive seeds in the prostate using a needle.
Surveillance, taking a wait-and-see approach, may be recommended for
patients with early-stage prostate cancer, particularly those who are older or
have other serious medical conditions.
How does a patient decide what is the best treatment
option for localized prostate cancer?
Choosing a treatment option involves the patient, his
family, and one or more doctors. They will need to
consider the grade and stage of the cancer, the man’s age
and health, and his values and feelings about the potential
benefits and harms of each treatment option.
Often it is useful to seek a second opinion, and patients
may hear different opinions and recommendations.
Because there are several reasonable options for most
patients, the decision can be difficult.
Patients should try to get as much information as possible
and allow themselves enough time to make a decision.
There is rarely a need to make a decision without taking
time to discuss and understand the pros and cons of the
various approaches
Doctors cannot always explain why one person gets cancer and another does not.
However, scientists have studied general patterns of cancer in the population to learn
what things around us and what things we do in our lives may increase our chance of
developing cancer.
Anything that increases a person’s chance of developing a disease is called a
risk factor;
Anything that decreases a person’s chance of developing a disease is called a
protective factor. For example, although you can choose to quit smoking, you
cannot choose which genes you have inherited from your parents.
Both smoking and inheriting specific genes could be considered risk factors for
certain kinds of cancer, but only smoking can be avoided. Prevention means avoiding
the risk factors and increasing the protective factors that can be controlled so that
the chance of developing cancer decreases.
Although many risk factors can be avoided, it is important to keep in mind that
avoiding risk factors does not guarantee that you will not get cancer. Also, most
people with a particular risk factor for cancer do not actually get the disease. Some
people are more sensitive than others are to factors that can cause cancer. Talk to
your doctor about methods of preventing cancer that might be effective for you.
Resources for prostate diseases
Dealing with prostate disease involves you, your family and your physician. The following Web
sites include more information about prostate disease and treatment options. Some of the
organizations mentioned can put you in contact with prostate disease support groups. Some
even offer meetings where you can discuss the latest treatments for prostate disease with other
people diagnosed with prostate disease. Sometimes guest physicians are invited to the
meetings to discuss treatment options.
TAP Pharmaceuticals Products Inc. cannot assure the accuracy or timeliness of the information
available at the following Web sites and information resources.
American Association for Cancer Research
The American Association for Cancer Research provides research grants and publishes several
medical journals.
American Cancer Society
(800) 227-2345
The American Cancer Society (ACS) can be a starting point for dealing with family members
and other issues that may arise after a prostate cancer diagnosis. The site also includes
information about the ACS and statistics about prostate cancer incidence rates.
American Foundation for Urologic Disease
(800) 242-2383
This organization is dedicated to the prevention and cure of urologic diseases such as prostate
cancer through research, education and public awareness. The site includes research facts,
educational material and advocacy information.
(800) 422-6237
This is a useful gateway into the National Cancer Institute for information. From here you can
access a portion of the contents of PDQ — the Physician Data Query database — which
provides detailed information about specific cancers written for both medical professionals and
Center for Prostate Disease Research (CPDR)
The CPDR is a prostate cancer research program funded by the U.S. Army that conducts
research nationwide at U.S. Army, Navy and Air Force hospitals. The Web site explains the
program and provides education and research updates.
Doctor's Guide
This site contains the latest medical news for healthcare professionals, patients, family and
friends of those diagnosed with enlarged prostate (BPH - benign prostatic hyperplasia) or
prostate cancer.
National Coalition for Cancer Survivorship
(888) 937-6227
The National Coalition for Cancer Survivorship is a grassroots network of individuals and
organizations working on behalf of people with all types of cancer.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The NIDDK, under the auspices of the National Institutes of Health, provides a site with
answers to questions about BPH, talks about the lifestyle of a patient with BPH, and provides
additional reading
• Prostate Cancer Foundation
(800) 757-2873
The Prostate Cancer Foundation, an organization dedicated to finding a cure
for prostate cancer, is the largest private source for research funding for
prostate cancer. They offer information on prostate cancer, treatment options
and clinical trials.
• The Prostate Pointers
Here you will find helpful patient education material on prostate cancer,
compiled from a wide variety of medical sources.
(800) 808-7866
US TOO helps survivors of prostate cancer and prostate disease and their
families lead healthy and productive lives. This organization offers
fellowship, shared counseling and discussion sessions in both formal and
informal settings.
• Book Resource:
Ellsworth P, Heaney J, Gill C. 100 Questions & Answers About Prostate
Cancer. Boston, Mass: Jones and Bartlett Publishers; 2003.