Cancer is a disease characterized by the out-of-control growth of abnormal cells, which may invade healthy cells in the body.
As its name suggests, prostate cancer is one that starts in the prostate, a walnut-sized gland in men that's located below the bladder and in front of the rectum.
The prostate surrounds the urethra and produces prostate fluid, which is part of semen.
Prostate cancer often progress very slowly, though in some cases it can be quite aggressive.
In its early stages, it usually doesn't cause any symptoms.
However, there are numerous possible symptoms in the later stages of the disease, including urination issues, painful ejaculation, and constant pain in the back, hips, or pelvis.
After skin cancer, prostate cancer is the most common cancer in American men, affecting one in seven men (about 14 percent), according to the American Cancer Society (ACS).
Though only one in 38 men will die from the disease, it's second only to lung cancer in terms of cancer deaths among men.
The ACS further estimates that there will be some 220,800 new cases of prostate cancer and about 27,540 prostate cancer deaths in the United States in 2015.
Prostate cancer doesn't affect all races and ethnicities equally.
In 2011, African-American men had the highest prevalence rates of prostate cancer, according to the Centers for Disease Control and Prevention (CDC).
White men had the second highest prevalence rates of prostate cancer in 2011, followed by Hispanic, Asian and Pacific Islander, and finally, American Indian and Alaska Native men.
According to the CDC, African-American men were also the most likely to die from prostate cancer, followed by white, Hispanic, American Indian and Alaska Native, and Asian and Pacific Islander.
Various genes oversee the life and death of cells.
For instance, oncogenes help direct the growth and division of cells, while tumor suppressor genes play a key role in keeping cell division in check and promoting apoptosis, or programmed cell death.
Changes or mutations in the DNA of prostate cells may alter the expression or behavior of these and other genes, causing the cells to stay alive longer than they should, and experience accelerated growth and division.
These abnormal cells accumulate to form a tumor, which can invade nearby tissue. The cancer cells can also spread to other parts of the body, or metastasize, causing cancer in other tissues.
Though there are several types of cells in the prostate, almost all prostate cancers develop from gland cells, which produce the prostate fluid.
It's unknown what, exactly, causes the DNA mutations in cells that can lead to prostate cancer.
However, scientists have identified risk factors for the disease.
Aside from race (described above), there are numerous other risk factors for prostate cancer, most notably age and family history.
A man's risk of prostate cancer increases with age. The average age of prostate cancer diagnosis in the United State is 69, and more than 65 percent of all prostate cancer diagnoses occur in men over age 65, according to the Prostate Cancer Foundation (PCF).
Prostate cancer appears to run in families, suggesting a hereditary basis for some cancer development. Men are two to three times more likely to develop prostate cancer if they have fathers, brothers, or sons who have prostate cancer, according to the CDC.
Additionally, men who have mutations in eight specific genes including BRCA1 and BRCA2, which are known to increase women's risk of breast and ovarian cancers have an increased risk of advanced (aggressive) familial pancreatic cancer, according to a 2014 report in the British Journal of Cancer.
Other probable risk factors include obesity and a diet high in saturated fat.
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The prostate is a gland situated between the bladder and penis, just in front of the rectum, or lower end of the bowel.
The urethra, a narrow tube that carries urine and semen out of the body through the penis, runs through the center of the prostate, which is about the size of a walnut and weighs 1 ounce (30 grams).
The word prostate comes from the Greek word prostates, which means one who stands before, aptly describing the position of the gland.
That is, when viewed from below, the prostate "stands before" the bladder.
The prostate gland isnt essential for life, but it is vital for reproduction and is part of the male reproductive system.
The function of the prostate is to produce a slightly alkaline (high pH) fluid that makes up part of the seminal fluid, or semen.
The rest of semen is composed of sperm cells from the testicles, fluid from the seminal vesicles, and secretions from the pea-sized bulbourethral gland.
The prostatic fluid contains substances that are important to the functioning and survival of sperm cells, such as the enzyme prostate-specific antigen (PSA), which thins or loosens up semen, helping the tadpole-like sperm cells swim freely to reach the egg.
During an orgasm, prostate muscles squeeze the gland's stored fluid into the urethra, where it mixes with the sperm cells and other semen components.
This expulsive process also helps propel the semen out of the body during ejaculation.
Prostatitis, or prostate inflammation, is the most common prostate problem for men under age 50, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
There are several types of prostatitis.
Prostatitis caused by bacteria is known as bacterial prostatitis, and it can be acute (short-term) or chronic.
Non-bacteria microbes may cause chronic prostatitis, also known as chronic pelvic pain syndrome, which may develop as a result of chemicals in the urine, a urinary tract infection, or pelvic nerve damage.
Symptoms vary depending on the type of prostatitis, but can include urination problems, pain, fever, and body aches, among other things.
Some people develop asymptomatic inflammatory prostatitis, in which the prostate is inflamed but doesn't produce any symptoms or require treatment.
Prostate enlargement is the most common prostate problem for men over 50 years old, according to the NIDDK.
It's not well understood what causes prostate enlargement, also known as benign prostatic hyperplasia (BPH), but research suggests age-related hormonal changes may be to blame.
In men with BPH, the prostate presses into and pinches the urethra.
This pressure can negatively affect the urine-holding bladder, which is connected to the urethra, by weakening it and preventing it from emptying completely.
Prostate enlargement can cause a number of related urination symptoms, including increased urinary frequency and urgency, weak or interrupted urine stream, and urine with an unusual color or smell.
Aside from prostatitis and BPH, another common prostate issue is prostate cancer.
Excluding skin cancer, prostate cancer is the most common type of cancer affecting American men, and one of the leading causes of cancer deaths in American men, according to the American Cancer Society.
The risk of developing prostate cancer is higher for men who are over age 65, African American, and have a family history of the disease.
Most often, prostate cancer develops slowly, but some men develop an aggressive form of prostate cancer.
Symptoms generally develop as the disease progresses, and include urination issues, erectile dysfunction, bloody semen, and bone pain.
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Though most cases of prostate cancer have a good prognosis, the disease is the second leading cause of cancer deaths in American men, according to the Centers for Disease Control and Prevention (CDC).
As with other cancers, early detection and treatment may be important for surviving prostate cancer, at least for advanced forms of the disease.
Today, the most common screening test for prostate cancer is the prostate-specific antigen or PSA blood test, which measures the levels of the PSA enzyme in the blood.
The prostate is a walnut-sized gland, situated between the bladder and penis, that's part of the male reproductive system.
Its main function is to produce fluid that partly makes up semen, which helps transport and protect sperm produced by the testicles.
The prostatic fluid contains various substances that help sperm cells function and survive, one of which is PSA.
This enzyme thins or loosens up semen, allowing sperm cells to swim freely while in the female body.
Some of the PSA produced by prostate cells also makes its way into the blood.
Both normal prostate cells and cancer cells make PSA.
This suggests that elevated levels of the enzyme in the blood could signify prostate cancer, since prostate cancer is, after all, an out-of-control growth of abnormal prostate cells; more cells equal more PSA.
In the United States, the PSA test was initially introduced in 1987 and quickly became a widespread early screening tool for prostate cancer, according to a 2014 report in the Journal of the American Medical Association (JAMA).
Most healthy men have PSA levels in the blood less than 4 nanograms per milliliter (ng/mL), so the chance of having prostate cancer (or other prostate issues) increases as PSA concentrations increase.
In the past, doctors would use a "cutoff" level of 4 ng/mL during PSA screening tests, though some doctors would use a cutoff point of 2.5 ng/mL if their patient had higher levels, they would recommend a prostate biopsy to look for prostate cancer.
However, men with low PSA levels can have prostate cancer, and men with high PSA levels may not have prostate cancer, because numerous factors can affect PSA production.
Specifically, factors that can increase PSA levels include:
Additionally, obesity and certain medications can cause low PSA levels.
In recent years, the routine use of PSA screening tests in men without symptoms or in those who are high risk (with a family history of the disease, for example) has become controversial.
The tests accurately detect prostate cancer 25 percent of the time, according to the U.S. Preventive Services Task Force (UPSTF), an independent panel of experts that makes evidence-based recommendations about clinical preventive services.
Still, it may be difficult to tell if tumors found from follow-up biopsies will remain relatively benign or become lethal, potentially resulting in overtreatment and its associated harms.
In 2012, the UPSTF found little benefit and significant harm to routine PSA-based screening for prostate cancer, and subsequently recommended against these tests.
According to the UPSTF, studies suggest that PSA screening and early cancer treatment only prevents 0 to 1 death per 1,000 men screened.
However, nearly 90 percent of men with PSA-detected prostate cancer in the U.S. undergo early, potentially harmful treatment, the UPSTF states.
For instance, up to 5 in 1,000 men will die within one month of prostate cancer surgery.
Additionally, radiotherapy and surgery can result in long-term health issues, including urinary incontinence and erectile dysfunction in up to 300 of every 1,000 men treated.
Other advisory committees and authors of review articles, including the 2014 JAMA report, also recommend against routine PSA screening.
No agency has recommended the use of the tests without considerable discussions of its pros and cons, according to the National Cancer Institute.
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About one in seven men in the United States develop prostate cancer, making it the most common cancer among American men after skin cancer, according to the Centers for Disease Control and Prevention (CDC).
Prostate cancer is usually though not always a very slow-growing cancer that takes a long time to start affecting the body.
Most often, it only causes symptoms when it grows to pinch the urethra (the thin tube that carries urine and semen out of the body) or invade the sphincter or other body parts.
In fact, some men with prostate cancer don't show any signs or symptoms of their illness, the CDC notes.
As the cancer grows in the prostate, it can cause various localized and related symptoms, including:
If the tumor presses on to the spinal cord, it can cause a weakness or numbness in the extremities, or result in bladder or bowel incontinence.
If the cancer spreads to the bones, it can cause frequent or recurrent pain or stiffness in the back, hips, or pelvis areas.
If it spreads to remote organs, it may cause general malaise, fatigue, and unexplained weight loss.
Other prostate diseases, including prostatitis (prostate inflammation) and benign prostatic hyperplasia (BPH, or enlarged prostate), can cause similar urinary and sexual symptoms and signs, so it's important to see your doctor if you are experiencing these health issues.
As with any health condition, a diagnosis of prostate cancer typically begins with your doctor discussing your personal and family medical history.
Your doctor will also ask about your symptoms, particularly any urinary and sexual problems, as well as if you have any bone pain or stiffness.
Your doctor will then conduct a physical exam, which will include a digital rectal exam, in which he will feel your prostate for any hard, lumpy, or abnormal tissue by inserting a gloved, lubricated finger into your rectum (the prostate is in front of the rectum).
A prostate-specific antigen (PSA) blood test may come next. This test measures the blood concentrations of the enzyme PSA, which is produced by prostate cells (healthy and cancerous) and is a part of the fluid that partly makes up semen, which helps transport and protect sperm produced by the testicles.
Healthy men are thought to have a certain range PSA concentration in their blood, and this level increases during prostate cancer (though numerous other factors can affect blood PSA levels).
If you have PSA levels indicative of prostate cancer, your doctor will perform a transrectal ultrasound, a type of ultrasound conducted with a finger-width tube inserted into the rectum.
The final, definitive diagnostic measure is the prostate biopsy a hollow needle is repeatedly inserted into the prostate through the wall of the rectum to collect about a dozen samples of tissues, which are then studied and tested.
Based on the analysis of your prostate biopsy, you will be assigned a score of 2 to 10, which describes the appearance of any cancer cells in your prostate. This number is known as a Gleason score.
A low Gleason score of 2 to 4 means the cells resemble normal prostate cells, and any cancer is unlikely to spread.
A score of 5 to 7 represents an intermediate risk.
A high Gleason score of 8 to 10 means the cells look very different from normal prostate cells, and the cancer is more likely to be aggressive and spread.
If you have prostate cancer, your doctor may conduct more tests to determine the stage and spread of your cancer.
These tests include bone scans, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.
The stage of cancer depends on several factors, including:
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Prostate cancer is, most often, a slow-growing cancer.
For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn't necessary.
In these cases, doctors may recommend active surveillance. That is, they'll keep an eye on the development of the tumor using various tools and tests, including:
Treatments the most common of which are surgery, radiation therapy, and hormone therapy may be started if symptoms develop or if the cancer appears to be growing and getting worse (or if treatment is specifically requested).
Cancers isolated to the prostate are often treated with a type of surgery called radical prostatectomy, in which the entire prostate gland, surrounding tissues, and seminal vesicles are removed.
There are two main approaches to radical prostatectomy.
During a retropubic prostatectomy, surgeons remove everything through an incision in your lower abdomen.
Your surgeon may also remove your nearby lymph nodes to see if the cancer has spread to other areas of your body through your lymphatic system.
During the second type of surgery, a perineal prostatectomy, surgeons make the incision in the perineum, the area between the scrotum and anus.
A second incision in the abdomen may be necessary to remove lymph nodes.
This operation is shorter than the retropubic prostatectomy, but has a higher risk of post-op erection problems, according to the American Cancer Society (ACS).
Radical prostatectomies may also be performed laparoscopically, or with thin fiber optic instruments inserted into the body through multiple tiny incisions.
This procedure typically results in less post-op pain, shorter hospital stays, and quicker recovery, the ACS notes.
Possible side effects or complications of prostate cancer surgery include:
Additionally, up to 5 in 1,000 men die within one month of prostate cancer surgery, according to the U.S. Preventive Services Task Force (UPSTF).
Radiation therapy, in which cancer cells are destroyed and prevented from growing using high-energy X-rays or other types of radiation, is typically used when:
The therapy may be conducted with a machine outside of the body, or with radioactive substances that are surgically placed into or near the cancer (brachytherapy).
Radioactive substances, particularly radium-223, may also be injected in the veins to treat cancer that has spread to the bones, a treatment called alpha emitter radiation therapy.
Side effects of radiation therapy include an increased risk for bladder and gastrointestinal cancer, erectile dysfunction, and urinary, bowel, and bladder problems.
Hormone therapy is not a stand-alone therapy, and is usually used to help treat cancer that has spread beyond the prostate, cancer that has come back after other treatments, and high-risk cancers that may recur after treatment.
It works by removing or blocking the action of hormones that can cause cancer cells to grow. Treatments include:
Numerous side effects can result from hormone therapy, such as:
Numerous other treatments may also be used to treat prostate cancer, each of which has its own benefits, harms, and side effects.
These include:
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After lung cancer, prostate cancer causes the most cancer-related deaths among American men.
Experts estimate it will kill 27,540 men in the United States in 2015, according to the American Cancer Society (ACS).
Despite these daunting statistics, prostate cancer has a fairly good prognosis.
In fact, most men who die while they have the disease actually die from other causes, i.e., they die with (but not from) prostate cancer.
Prostate cancer kills only about one in 38 men who have the disease, the ACS notes.
A man's cancer stage is one of the most important factors in predicting how long he will survive with the disease.
There are four prostate cancer stages, which refer to how quickly and how far the cancer has spread.
The stages are based on guidelines set by the American Joint Committee on Cancer (AJCC).
To determine your prostate cancer stage, your doctor will perform a number of tests, including:
If you have stage I prostate cancer, the tumor is confined to your prostate, and may even be too small to feel during a digital rectal exam. Your PSA and Gleason scores, if known, are relatively low.
Stage II is more advanced than stage I, meaning that your tumor may be a bit larger and your PSA and Gleason scores may be higher. However, the cancer still hasn't spread beyond your prostate.
With stage III, the tumor has spread beyond the outer layer of your prostate and may have invaded the seminal vesicles. The cancer cells havent made it to the lymph nodes.
You have stage IV if your cancer has spread beyond the seminal vesicles to nearby structures, such as the bladder, rectum, and wall of the pelvis. It may also have spread to your lymph nodes and other distant parts of your body, such as your bones.
Prostate cancer survival statistics are generally discussed in terms of the five-year survival rates the percentage of people who will live at least five years after being diagnosed.
The statistics are based on men who were first diagnosed and treated at least five years ago.
Theyre generally framed in terms of relative survival rates, which take into account causes of death unrelated to the cancer.
The National Cancer Institute keeps track of cancer survival statistics through its SEER (Surveillance, Epidemiology, and End Results program) database, which groups cancers into local, regional, and distant stages.
Local stage corresponds to AJCC stages I and II, and refers to cancers that haven't spread beyond the prostate.
Regional stage refers to cancer that's invaded nearby areas, and corresponds to AJCC stage III, as well as stage IV that hasn't spread to distant parts of the body.
Distant stage corresponds to the rest of the AJCC stage IV cancers, which have spread to distant parts of the body.
The five-year relative survival rates for local, regional, and distant stages are 100 percent, 100 percent, and 28 percent, respectively, according to the SEER database.
The five-year survival rate for unknown or un-staged prostate cancer is 74 percent.
The five-year relative survival rate for all stages combined is nearly 100 percent according to the ACS.
Additionally, the 10-year and 15-year relative survival rates for all stages are 99 percent and 94 percent, respectively.
A person's actual prognosis may differ depending on his age, health, treatment, and other factors.
It's also important to note that since the statistics are based on men who were diagnosed and treated at least five, 10, or 15 years ago improvements in prostate cancer and treatment may result in a better outlook than what's suggested by the survival rates.
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