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 more than 95% are adenocarcinomas. Adenocarcinomas of the prostate begin in the gland cells of the prostate.1,2,3
In the United States, the average man has a 12.1% lifetime risk for prostate cancer.4 More than 90% of cases are diagnosed after age 55.4 Black men have a higher risk for prostate cancer as well as a high risk for prostate cancer diagnosed at an earlier age and more aggressive (faster growing).1,2,4 Mutations, or harmful changes, in some genes are associated with an increased risk for prostate cancer.1,2
General Risk Factors
- Exposure to Agent Orange (a chemical used during the Vietnam War)
- Family history of cancer – having family members with prostate cancer raises the risk of prostate cancer, even in absence of a known hereditary cause
- Diagnosis of a genetic prostate cancer predisposition syndrome
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.
Early prostate cancers often have no symptoms. Symptoms of more advanced prostate cancer can include frequent urination, interrupted or weak urine flow or straining to empty the bladder, blood in the urine or semen, pain during urination, pain in the back, hips, or other areas of the body if the cancer has spread to the bones. It is important to remember that these symptoms are frequently caused by non–cancerous conditions as well, so further evaluation would be needed to confirm a diagnosis.
A blood test to measure the level of prostate-specific antigen (PSA) can be 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. However, there are many other things, outside of prostate cancer, that can also cause a higher PSA level. A digital rectal exam (DRE) is another way to screen for prostate cancer. During this test, a healthcare provider inserts a gloved finger into the rectum to feel for any abnormalities on the prostate that could be suggestive of cancer. Currently, the National Comprehensive Cancer Network (NCCN) recommends that men at average risk for prostate cancer discuss the benefits and limitations of screening for prostate cancer with their healthcare provider beginning at age 45 to decide on a plan for screening. Men at a higher risk for prostate cancer due to race, family history, or a genetic risk factors known to be associated with an increased risk for prostate cancer should have this discussion and screening earlier, generally between the ages of 40 and 45, depending on their risk factors.
If screening with PSA or DRE suggests the possibility of prostate cancer, a healthcare provider will need to perform other tests to make a diagnosis or rule out prostate cancer. These other tests may include a biopsy (tissue sample), trans–rectal ultrasound, and other imaging exams.
Screening Methods for Prostate Cancer (NCCN)5
|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 45 ||Repeat every 2-4 years, if normal and no additional risk factors
|Digital rectal exam ||Discuss the benefits and limitations of this screening with a health care provider; strongly consider baseline at age 45 ||Repeat every 2-4 years, if normal and no additional risk factors
Healthcare providers may recommend these screening methods more strongly and/or more frequently for some patients or may recommend that patients have a discussion of these screening methods earlier than age 45 based on a patient’s medical history, family history of prostate cancer, or ancestry.
If prostate cancer is diagnosed following any of the tests previously mentioned, 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, cryotherapy, hormone therapy, biologic therapy, and immunotherapy. Some prostate cancers can grow and spread quickly, but many grow slowly. If a prostate cancer is believed to be slow growing, active surveillance may be considered. Active surveillance is closely following the prostate cancer using the exams and screening tests previously discussed. If the cancer continues to grow, then treatment will be provided.
AVOID THE FOLLOWING
- Foods that contain fats include meats, nuts, oils and dairy products, such as milk and cheese
High amounts of dairy
- In studies, men who ate the most dairy products — such as milk, cheese and yogurt — each day had the highest risk of prostate cancer. But study results have been mixed, and the risk associated with dairy products is thought to be small.
- American Society of Clinical Oncology: Prostate Cancer (http://www.cancer.net/cancer-types/prostate-cancer)
- American Cancer Society: Prostate Cancer (http://www.cancer.org/cancer/prostatecancer/index)
- National Cancer Institute: Prostate treatment (http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient)
- SEER Cancer Stat Facts: Prostate Cancer. National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/statfacts/html/prost.html
- Carroll PR et al. NCCN Clinical Practice Guidelines in Oncology®: Prostate Cancer Early Detection. Version 2.2019. Available at http://www.nccn.org.
- Witte JS, et al. HOXB13 mutation and prostate cancer: studies of siblings and aggressive disease. Cancer Epidemiol Biomarkers Prev. 2013 22:675-80.
- Stott-Miller M, et al. HOXB13 mutations in a population-based, case-control study of prostate cancer. Prostate. 2013 73:634-41.
- Beebe-Dimmer JL, et al. The HOXB13 G84E Mutation Is Associated with an Increased Risk for Prostate Cancer and Other Malignancies. Cancer Epidemiol Biomarkers Prev. 2015 24:1366-72.
- Cai Q, et al. Germline HOXB13 p.Gly84Glu mutation and cancer susceptibility: a pooled analysis of 25 epidemiological studies with 145,257 participates. Oncotarget. 2015 6:42312-21.