Prostate Cancer

Prostate cancer is a cancer that begins in the prostate. The most common type of prostate cancer is called adenocarcinoma. There are more rare types of prostate cancer but most cases, > 95%, are adenocarcinomas. Adenocarcinomas of the prostate begin in the gland cells of the prostate.

The average man in the United States has a risk for prostate cancer of approximately 15.3%. Most cases are diagnosed after the age of 50. Eighty percent of cases are diagnosed in men after the age of 65. It is unknown why, but black men have a higher risk for prostate cancer than men of other races. The risk is not only higher for prostate cancer in general but also for prostate cancer diagnosed at an earlier age and a more aggressive (faster growing) prostate cancer. Mutations, or harmful changes, in some genes are associated with an increased risk for prostate cancer.

General Risk Factors

Hereditary

  • A family history of prostate cancer

Prostate Cancer Risk

Associated Genes

BRCA1, BRCA2, TP53, NBN

Health History

  • Exposure to Agent Orange (a chemical used during the Vietnam War)

Prevention

As with the vast majority of cancers, there is no confirmed way to completely prevent the development of prostate cancer. A diet high in fruits, vegetable, beans, and peas may decrease the risk for prostate cancer in men. This is a healthy diet for anyone, regardless of prostate cancer risk. It can also reduce blood pressure and the risk of heart disease.

Symptoms and Screening Methods

Symptoms of prostate cancer can include frequent urination, interrupted or weak urine flow or straining to empty the bladder, blood in the urine, blood in the seminal fluid, pain during urination, discomfort when sitting, pain in the back, hips, thighs, or shoulders, unexplained weight loss, and fatigue. These symptoms could frequently be due to noncancerous conditions.

A blood test to measure the level of prostate-specific antigen (PSA) is one test used to screen for prostate cancer. PSA is made by the prostate gland cells and can be found in the blood. PSA levels can be higher than normal in the blood if a man has prostate cancer. Things other than prostate cancer can also cause a higher PSA level in the blood. A digital rectal exam (DRE) is another way to screen for prostate cancer. During this test, a health care provider inserts a gloved finger into the rectum to feel for any abnormalities on the prostate that could be suggestive of cancer. Currently, the American Cancer Society (ACS) recommends that men at average risk for prostate cancer discuss the benefits and limitations of screening for prostate cancer and decide on a plan for screening with their health care provider beginning at age 50. Men at a higher risk for prostate cancer due to race, family history, or a genetic change in a gene known to be associated with an increased risk for prostate cancer should have this discussion and screening earlier (between the ages of 40 and 45 depending on risk factors). If the PSA or DRE tests suggest the possibility of prostate cancer, a health care provider will need to perform other tests to make a diagnosis or rule out prostate cancer. These other tests can include a transrectal ultrasound, biopsy (tissue sample), and other imaging exams.

Screening Methods for Prostate Cancer (ACS)
Screening Method Age to Begin Frequency
Prostate-specific antigen test (PSA) Discuss the benefits and limitations of this screening with a health care provider at age 50 To be determined by a health care provider
Digital rectal exam Discuss the benefits and limitations of this screening with a health care provider at age 50 To be determined by a health care provider

Health care providers may recommend these screening methods more strongly for some patients or may recommend that patients have a discussion of these screening methods earlier than age 50 based on a patient’s medical history or family history of prostate cancer.

Treatment

If prostate cancer is diagnosed following any of the tests above, treatment will depend on the stage of the cancer (how far the cancer has grown or spread). Treatment can include some combination of surgery, chemotherapy, radiation, vaccine therapy, and hormone therapy. Learn more about prostate cancer treatments here.

References

  1. American Cancer Society: Prostate Cancer (http://www.cancer.org/cancer/prostatecancer/index)
  2. American Society of Clinical Oncology: Prostate Cancer (http://www.cancer.net/cancer-types/prostate-cancer)
  3. Goldgar DE, Easton DF, Cannon-Albright LA, Skolnick MH. Systematic population-based assessment of cancer risk in first-degree relatives of cancer probands. J Natl Cancer Inst. 1994 Nov 2;86(21):1600-8. PubMed PMID: 7932824.
  4. Kicinski M, Vangronsveld J, Nawrot TS. An epidemiological reappraisal of the familial aggregation of prostate cancer: a meta-analysis. PloS One. 2011;6(10):e27130. Doi: 10.1371/journal.pone.0027130. Epub 2011 Oct 31. PubMed PMID: 22073129; PubMed Central PMCID: PMC3205054.
  5. National Cancer Institute: Prostate treatment (http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient)
  6. Presti. JC et al. NCCN Clinical Practice Guidelines in OncologyR: Prostate Cancer Early Detection. Version 1.2014.
  7. Surveillance, Epidemiology and End Results Program, National Cancer Institute (seer.cancer.gov)
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