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Prostate Cancer Symptoms Symptoms - Questions and Answers
By the National Institute of Health
- What is the prostate?
- Cancer risk factors?
- Prostate cancer symptoms
- Prostate cancer screening tests
- How is prostate cancer diagnosed?
- How is Prostate cancer treated?
- Choosing a treatment
- More prostate information
What is the prostate?
The prostate is a gland in the male reproductive system. The prostate makes and stores a component of semen and is located near the bladder and the rectum. The prostate surrounds part of the urethra, the tube that empties urine from the bladder. A healthy prostate is about the size of a walnut. If the prostate grows too large, the flow of urine can be slowed or stopped.
What is cancer of the Prostate?
Except for skin cancer, cancer of the prostate is the most common malignancy in American men. It is estimated that nearly 221,000 men in the United States will be diagnosed with prostate cancer in 2003. In most men with prostate cancer, the disease 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 will die of prostate cancer in 2003.
Who is at risk for prostate cancer?
All men are at risk. The most common risk factor is age. More than 70 percent of men diagnosed with prostate cancer each year are over the age of 65. African American men have a higher risk of prostate cancer than white men. 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 differences. 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 disease.
What are the symptoms of prostate cancer?
Prostate Cancer Symptoms often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include:
- Frequent urination, especially at night
Inability to urinate
Trouble starting or holding back urination
A weak or interrupted flow of urine
Painful or burning urination
Blood in the urine or semen
Painful ejaculation
Frequent pain in the lower back, hips, or upper thighs
These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.
What other prostate conditions can cause symptoms like these?
As men get older, their prostate may grow bigger and block the flow of urine or interfere with sexual function. This common condition, called benign prostatic hyperplasia (BPH), is not cancer, but can cause many of the same symptoms as prostate cancer. Although BPH may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. An infection or inflammation of the prostate, called prostatitis, may also cause many of the same symptoms as prostate cancer. Again, it is important to check with a doctor.
Can prostate cancer be found before a man has symptoms?
Yes. Two tests can be used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate specific antigen (PSA). Together, these tests can detect many silent prostate cancers, those that have not caused symptoms.
At present, however, it is not known whether routine screening saves lives. The benefits of screening and local therapy (surgery or radiation) remain unclear for many patients. Because of this uncertainty, the National Cancer Institute is currently supporting research to learn more about screening men for prostate cancer. Currently, researchers are conducting a large study to determine whether screening men using a blood test for PSA and a DRE can help reduce the death rate from this disease. They are also assessing the risks of screening. Full results from this study, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial or PLCO, are expected by 2015.
How reliable are the screening tests for prostate cancer?
Neither of the screening tests for prostate cancer is perfect. Most men with mildly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the DRE can miss many prostate cancers. The DRE and PSA test together are better than either test alone in detecting prostate cancer.
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.
Prostate Cancer Symptoms is described by both grade and stage.
- Grade describes how closely the tumor resembles normal prostate tissue. Based on the microscopic appearance of tumor tissue, pathologists may describe it as low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. In both systems, the higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.
Stage refers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland to the seminal vesicles. Stage IV means the cancer has spread to lymph nodes and/or to other tissues or organs.
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 nerve-sparing surgery that may prevent damage to the nerves needed for an erection.
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. These patients have regular examinations. If there is evidence of cancer growth, active treatment may be recommended.
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.
Where can a person find more information about prostate cancer and its treatment?
The NCI has several other resources that readers may find helpful, including the following:
The Prostate Cancer Home Page provides links to NCI resources about prevention, screening, treatment, clinical trials, and supportive care for this type of cancer. This page can be found on the NCI's Cancer.gov Web site at http://cancer.gov/prostate/ on the Internet.
Prostate Cancer (PDQ®): Treatment includes information about prostate cancer treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. This summary of information from PDQ, the NCI's comprehensive cancer information database, is available at http://cancer.gov/
cancerinfo/pdq/treatment/
prostate/patient/ on the Internet.
Know Your Options: Understanding Treatment Choices for Prostate Cancer is designed to help a man and his family understand what a diagnosis of prostate cancer means and what treatment choices are available. This resource can be found at http://cancer.gov
/CancerInformation/
understanding-
prostate-cancer-treatment on the Internet.
Sources of National Cancer Institute Information
Cancer Information Service (toll-free)
Telephone: 1–800–4–CANCER (1–800–422–6237)
TTY (for deaf and hard of hearing callers): 18003328615
NCI Online
Internet
Use http://cancer.gov to reach the NCI's Web site.
LiveHelp
Cancer Information Specialists offer online assistance through the LiveHelp link on the NCI's Web site.
Prostate Cancer Symptoms Resources
MedLine
Prostate cancer symptoms
University of Maryland
Signs and symptoms of prostate cancer
NOAH
Symptoms / Diagnosis Directory
Bupa Health Information Prostate cancer treatment, symptoms and causes
MEDLINEplus : Prostate cancer Symptoms / Diagnosis Directory
National Library of Medicine MEDLINE General prostate cancer information
NOAH: Prostate cancer
NY Online Access to Health
Open Directory Project Prostate Cancer Genitourinary (Other versions: Google AOL)
Health on the Net Foundation, Geneva, Switzerland Prostatic neoplasms
ClinicalTrials.gov : Prostatic neoplasms
Univ Nottingham, United Kingdom, OMNI Prostatic neoplasms
Yahoo Prostate cancer
US Government Healthfinder Prostate cancer
Prostate Cancer Institute Self evaluation
Northwesten Memorial Hospital Prostate cancer symptoms diagnosis, staging
Association For International cancer Research Prostate FAQ's
UAB Health System Prostate Signs and symptoms
Pictures of Prostate Cancer
MEDLINEplus Health Encyclopedia : Prostate cancer
A.D.A.M. / National Library of Medicine Male genital pathology index
Edward C. Klatt, WebPath, Univ Utah
Understanding treatment choices for prostate cancer
Federal citizen information center
Prostate cancer is much more fatal if a man's PSA level rises rapidly before the cancer is even diagnosed
"The study is pretty definitive," says researcher Dr. Anthony D'Amico, a radiation oncologist at Brigham and professor of radiation oncology at Harvard Medical School. "It's not the level of PSA that matters, it's the change from year to year."
Some Men with Low PSAs Have Prostate Cancer
Most Cancers Found Are Not Likely to Be Clinically Significant
Men with low PSA (prostate specific antigen) levels on screening tests can still have prostate cancer, according to a study* released today by scientists from the National Cancer Institute (NCI), part of the National Institutes of Health, and the Southwest Oncology Group, an NCI-funded network of researchers. In this study, prostate cancers were detected by biopsy in men with normal PSA levels.
"The good news is that the vast majority of these cancers were low and intermediate grade, which often are not clinically significant," said Leslie Ford, M.D., associate director for clinical research in NCI's Division of Cancer Prevention, who participated in the research.
"This was the first systematic study of men with PSA levels from 0 to 4 nanograms per milliliter (ng/ml). It shows that cancer of the prostate can be present in men with 'normal' PSAs," said Ian Thompson, M.D., University of Texas Health Science Center at San Antonio, who led the study. Doctors often use the value of 4.0 ng/ml or greater as the trigger for further investigation, such as a prostate biopsy. A PSA level below 4.0 is generally considered normal.
Prostate Cancer Symptoms clinicians often say that men are much more likely to die with prostate cancer than from it. According to recent autopsy studies, many men over age 50 have early, undiagnosed prostate cancer. Clinicians concur that most early cancers remain harmless, though some may progress to clinically significant disease.
The 2,950 men in this study were from the "control arm" of the Prostate Cancer Prevention Trial (PCPT), an NCI-funded study that found in 2003 that the drug finasteride reduced by 25 percent a man's chances of getting prostate cancer.
Men in the control arm were given a placebo, or sugar pill, instead of finasteride and, like the men on the finasteride arm, received annual prostate screening for seven years with a PSA test and a digital rectal exam (DRE). All men in PCPT entered the trial at age 55 or above, had an initial PSA level of 3 ng/ml or less, and a normal DRE. All were asked to undergo an end-of-study prostate biopsy. The report released today focused on men at low risk of having prostate cancer––the 2,950 men on the placebo arm who had normal DREs and PSAs less than or equal to 4 ng/ml for the seven-year study duration.
Since the late 1980s, PSA tests have been widely used in the United States in an attempt to detect prostate cancer at an early stage. However, PSA testing has never been proven to reduce the risk of dying from prostate cancer. Not all prostate cancer detected by PSA screening is clinically relevant and, therefore, screening carries a risk of "over-diagnosing" the disease, which could lead to unnecessary surgery or radiation therapy. Thus, PSA testing is not a universally recommended screening procedure. An ongoing NCI study is addressing the issue of whether PSA screening reduces the risk of death from prostate cancer.
"The main study finding was that 15 percent of the men in the PCPT control arm had a positive end-of study biopsy despite having PSA levels below 4 ng/ml and normal DREs throughout the study," said Thompson.
Importantly, the study also found that only 2.3 percent of men in the PCPT control arm with PSA levels of 4 ng/ml or less had high-grade cancers. For men with a PSA of 2 or lower, the chance of having a high-grade cancer was even lower––1.4 percent. Grade was measured by Gleason score, a system that ranks tumors from 2 to 10 based on their appearance under the microscope. High-grade tumors––Gleason scores of 7 to 10––often grow more quickly and may be more likely to spread than lower-grade tumors.
Gleason scores of the highest grades––8 or 9––were found in only seven participants, or 0.2 percent of men in the PCPT control arm. Most of the men with prostate cancer, 349 of them (78 percent), had Gleason scores of 5 or 6.
"Most of these men would not have been diagnosed if they had not taken part in this study, since biopsies are not routinely performed in men with such low PSA levels," said Ford.
"We need better methods to distinguish the harmless, slow-growing cancers from the more aggressive ones," continued Ford. "If more biopsies are performed at lower PSA levels, more cancers will be found and treated. But some men would undergo treatment, and the risks associated with it, for tumors that would never have been clinically significant."
Treatment for prostate cancer can sometimes lead to impotence, urinary incontinence, and other problems, causing a substantial health burden for men.
"Lowering the PSA threshold for proceeding to prostate biopsy would increase the risks of overdiagnosing and overtreating clinically unimportant disease," said Thompson.
NCI-funded researchers are looking for ways to determine which men harbor aggressive tumors. The NCI Early Detection Research Network (EDRN) has a Prostate Collaborative Group, which is applying a variety of strategies to find ways to detect prostate cancer early. Some scientists are using the new tools of genomics and proteomics to look at how gene expression patterns and proteins in the blood may differ in men with aggressive tumors vs. those with slow-growing ones.
"There is a great need for methods, beyond tumor grade, to better predict which men have prostate cancers requiring treatment," said Thompson.
Prostate Cancer Symptoms is the most common cancer in men, after skin cancer. It estimated that approximately 230,110 men in the United States will be diagnosed with the disease this year, and about 30,000 men will die from it.
* Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level less than or equal to 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004; 350(22):2239-2246