Definition

The prostate is a walnut-sized gland in men. It surrounds the urethra. The prostate makes a fluid that is part of semen. Prostate cancer is a disease in which cancer cells grow in the prostate gland.

Prostate Cancer

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The sooner prostate cancer is treated, the better the outcome. Call your doctor right away if you think you have this condition.

Causes

The cause of prostate cancer is unknown.

Risk Factors

Factors that may increase the risk of prostate cancer include:

    
  • Age: 55 or older
  • Race: Black
  • Family history of prostate cancer, especially father or brother
  • Family history of prostate cancer diagnosed at a young age
  • A high-fat diet

    • Symptoms

    Symptoms may include:

        
  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Not able to urinate
  • Weak or interrupted urine flow
  • Painful or burning urination
  • Difficulty having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

    • These symptoms may be caused by other conditions, such as benign prostatic hyperplasia (BPH) or an infection.

    Diagnosis

    Your doctor will ask about symptoms and medical history. A physical exam will also be done. Your doctor may order tests, such as:

        
  • Digital rectal exam
  • Urine test
  • Blood tests
  • Other tests, such as:    
  • Transrectal ultrasonography
  • Intravenous pyelogram
  • Cystoscopy
  • Prostate biopsy

    • Treatment

    Once prostate cancer is found, tests are done to find out if the cancer has spread and, if so, to what extent. Treatment depends on how far the cancer has spread. You will work with a team of specialists to develop a treatment plan for you.

    Treatment options include:

    Watchful Waiting

    This involves your doctor monitoring the cancer to see if it is growing. Watchful waiting may be appropriate if you:

        
  • Have early stage prostate cancer that is growing slowly
  • Are of an advanced age
  • Have serious health problems (risks of treatment outweigh the benefits)

    • Surgery

    Types of surgery that may be needed include:

        
  • Pelvic lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer
  • Radical retropubic prostatectomy—removal of the entire prostate and nearby lymph nodes through an incision in the abdomen
  • Radical perineal prostatectomy—removal of the entire prostate through an incision between the scrotum and the anus
  • Transurethral resection of the prostate (TURP)—removal of part of the prostate with an instrument inserted through the urethra (may be done to relieve symptoms)

    • Since prostate cancer surgery may cause side effects, like erectile dysfunction, urinary incontinence, and fecal incontinence, there may be other surgery techniques that may be a good option for you. Some examples include nerve-sparing surgery, robotic surgery, and laparoscopic surgery.

    Radiation Therapy

    Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Examples include:

        
  • Conformal radiation therapy—conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
  • Intensity-modulated radiation therapy (IMRT)—IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

    • Hormone Therapy

    If prostate cancer has spread or has returned after being treated, hormone therapy may be used. The goal of hormone therapy is to lower the levels of male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth. Examples of hormone therapy include:

        
  • Luteinizing hormone-releasing hormone (LHRH) analogs (such as goserelin, histrelin, leuprolide, triptorelin)—these drugs cause testosterone to drop to a very low level.
  • Luteinizing hormone-releasing hormone (LHRH) antagonists (such as degarelix)—these also reduce the testosterone level, but do so faster and without the surge of testosterone that happens with the LHRH analogs.
  • Anti-androgens (such as bicalutamide, flutamide, nilutamide)—these drugs work by interfering with the body's ability to use androgens.
  • Other types of hormone therapy, such as:    
  • Estrogen therapy—rarely used now unless other treatments are not working
  • Ketoconazole—affects the production of androgens
  • Abiraterone—may be used in cases where prostate cancer does not respond to other treatments
  • Orteronel (experimental drug)—affects the production of androgens
  • Enzalutamide—affects the production of androgens
  • Abiraterone—may be used in advanced stages of prostate cancer

    • In some case, a type of surgery called orchiectomy may be needed. This involves removing the testicles, which stops androgens from being produced.

    Other Treatment Options

    Other options may include:

        
  • Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells
  • Chemotherapy—if prostate cancer has spread and other treatments have not been effective, chemotherapy may be used. There are range of chemotherapy drugs available, such as:    
  • Docetaxel (this is usually the first chemotherapy drug that is tried)
  • Cabazitaxel
  • Mitoxantrone
  • Estramustine
  • Doxorubicin
  • Immunotherapy—Immunotherapy is a drug treatment that aims to build your immune system so that you can better fight cancer cells. Sipuleucel-T is a type of immunotherapy that is approved to treat prostate cancer that has spread.
  • Targeted therapies—Targeted therapies focus on the cancer cells, rather than attacking both the cancer cells and the healthy cells. Some examples include:    
  • Selective endothelin A receptor antagonist (SERA)—interferes with the process that cancer cells go through to grow
  • Anti-angiogenic drugs—blocks the formation of new blood vessels, which stops the growth of the cancer cells
  • Tyrosine kinase inhibitors (such as Imatinib)—blocks the protein that triggers the cancer cells to multiply
  • High-intensity focused ultrasound—This treatment involves using an endorectal probe (a probe that is inserted into the rectum) to destroy cancer cells with ultrasound energy.

    • Prevention

    To reduce your risk of prostate cancer, take the following steps:

        
  • Eat a healthy diet. Your diet should be high in fruits, vegetables, and fish, and low in red meat.
  • Ask your doctor about taking certain medicines. For example, daily aspirin therapy and 5-alpha reductase inhibitors may reduce your risk of prostate cancer.