Prostate Cancer USMD

About Prostate Cancer

What Is Prostate Cancer?
What Is the Prostate?
Symptoms of Prostate Cancer
Testing for Prostate Cancer
Diagnosis of Prostate Cancer
Staging Prostate Cancer
Risk Factors
Statistics of Prostate Cancer


What Is Prostate Cancer

Prostate cancer is the process in which cells begin to grow abnormally and crowd out healthy cells. As the abnormal cells multiply, they form a malignant (cancerous) growth or tumor. Prostate cancer is the most common cancer in men after skin cancer. More than 190,000 men in the U.S. will be diagnosed with prostate cancer every year. However, only a small percentage will die from the disease.

How do I know if I have prostate cancer?

Thanks to better screening methods and greater awareness, prostate cancer is being detected much earlier. That is giving men more options for treatment and leading to better survival rates and an improved quality of life. The American Cancer Society estimates that some 2 million men who have been diagnosed with prostate cancer are leading active lives today.

At USMD Prostate Cancer Center, new advancements in prostate testing and biopsies are being used to pinpoint the type, stage and location of prostate cancers with outstanding accuracy. New 3D ultrasonic prostate biopsy technologies are employed to deliver this accuracy and offer a new convenient option for patients who undergo the biopsy procedure.

  • More on Prostate Cancer Testing
  • More on Prostate Cancer Diagnosis

Not all growths in the prostate are cancerous; some can be benign or non-cancerous. A non-cancerous growth is called benign prostatic hyperplasia (BPH) disease. BPH is a very common condition in men over age 50. It requires treatment, but it is not malignant.

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What Is the Prostate?

The prostate is a small walnut-size gland in men that is part of the reproductive system. It helps produce seminal fluid, the fluid that carries semen out of the body during ejaculation. The nerves that control erection and ejaculation are also found in the prostate.

The prostate is located in front of the rectum, which is why it can be felt during your annual physical exam at your doctor's office. It is also positioned under the bladder, where it surrounds the upper part of the urethra. The urethra is the long tube through which urine and semen flow out of the penis. If the prostate becomes enlarged or inflamed, it can put pressure on the urethra and interfere with the normal urine flow.

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Symptoms of Prostate Cancer

Prostate cancer could be considered a “silent” cancer because there are few if any symptoms until the cancer has multiplied considerably. For this reason, early detection through appropriate screening is so vital, especially among men ages 50 and older. The risk of developing prostate cancer increases with age and is more prevalent in men over 65.

If you develop the following symptoms that persist for more than a few days, be sure to call your physician to schedule a check-up. These symptoms do not mean you have cancer, but it is important to evaluate their cause. Possible symptoms of prostate cancer include:

  • Dull pain in the lower pelvic area
  • Frequent urination, especially at night
  • Blood in the urine or semen
  • Pain or burning during urination
  • Weak urine flow or difficulty urinating
  • Painful ejaculation
  • General pain in the lower back, hips or
    upper thighs (not related to sports)
  • Unexplained loss of appetite or weight
  • Persistent pain in the bones

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Testing for Prostate Cancer

Because symptoms for prostate cancer may not be apparent until the cancer is at a more advanced stage, regular screening is recommended. There is some controversy over when regular screening should begin and at what age. Most medical experts recommend yearly testing starting at age 50. Men with a strong family history and men who are at high risk due to other factors (such as African-American heritage) may want to consider beginning screening at age 40 or 45.

There are two primary screening tests used to detect prostate cancer today: the digital rectal examination (DRE) and the prostate specific antigen (PSA) test. Both cause little to no discomfort and are administered at USMDPCC.

Digital Rectal Exam

During a DRE, you may bend over or lie on your side on an examining table with your knees drawn up. This allows your physician to gently insert a gloved, lubricated finger into the rectum. The physician can then feel the prostate to identify any abnormalities in size, contour, consistency and texture of the gland. The exam also allows your physician to identify whether blood is present in the stool and whether there may be any areas of concern in the rectum, either could be interpreted as cancer in the rectum or colon.

Prostate Specific Antigen

A simple blood test can evaluate the level of a particular protein that is a normal by-product of the prostate gland. The protein, called prostate specific antigen (PSA), is present in small amounts in the blood of all men. A higher than normal level could signal the possibility of prostate cancer. On the other hand, the PSA could be elevated due to infection, inflammation or benign enlargement of the prostate, or due to urinary retention.

The PSA was first developed in 1991 and is now used routinely in combination with the DRE to help identify early stage prostate cancer. The tests are not perfect and false positives can result. However, they are still the among the best available screening methods available today. New developments in the PSA testing process include PSA density, velocity, age-specific reference ranges and have further refined the accuracy of the PSA test.

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Diagnosis of Prostate Cancer

If the results of your PSA blood test and digital rectal exam show an increased potential for prostate cancer, you have several treatment options. In most cases, abnormal test results are not cancerous– rather, they are related to benign conditions like benign prostatic hyperplasia.

However, depending on the age of the patient and other factors determined by the physician, a biopsy may be recommended.

In general, the American Urologic Association recommends that men with a PSA greater than 4.0 or a significant PSA increase over the previous 12 months, combined with a suspicious digital rectal exam and perhaps a family history of prostate cancer, should undergo further evaluation for prostate cancer with a biopsy.

What to Expect During a Biopsy

A biopsy is a minimally invasive outpatient procedure in which a tissue sample is taken from the prostate gland. During the procedure, a local anesthetic can help minimize any discomfort you may have. The patient lies on his side on an exam table while a lubricated ultrasound probe is inserted into the rectum. Sound waves produced by the ultrasound create images of the prostate, helping the physician determine whether there are any abnormalities in the gland’s size or shape. Then the prostate is anesthetized with a long, slender needle inserted into the probe and using a spring-loaded device, the physician takes multiple tissue samples of the prostate. This entire procedure takes approximately half an hour.

The Gleason Grading Scale

Tissue samples from the biopsy are sent to the laboratory for evaluation by a pathologist. Lab results can show if cancer is present in the cells and if it is, the progression of the cancer. While early stage or low-grade cancer cells may look only slightly different, high-grade cancer cells will have a dramatically altered appearance from normal, healthy cells. The Gleason grading system is used to determine the degree of change in the cells’ appearance.

The Gleason “score” helps the physician decide how aggressive the prostate cancer cells are and what the next steps should be in diagnosing the cancer. If there is a concern that the prostate cancer has spread to nearby tissue or organs, other imaging tests such as an MRI, CT Scan or bone scan may be scheduled.

Age is a Factor

Many prostate tumors grow very slowly over a long period of time. Because of that, treatment options may vary in younger men versus men over age 70. In many cases, older patients who do not have obvious symptoms and who's cancer is not limited to the prostate may opt not to have immediate treatment. The physician will instead recommend Active Surveillance, which means that you will be evaluated at frequent intervals at USMDPCC.

However, there is always the concern that the prostate cancer cells can spread to other parts of the body and become life-threatening. The spread of cancer to other tissues or organs is called metastasis. Regular screening and follow-ups with your physician hopefully will prevent the prostate cancer from reaching this stage.

Treatment for younger men may be more aggressive. USMD Prostate Cancer Center is at the leading edge of advances in prostate cancer treatment that improve survival rates and minimize side-effects. Decisions on treatment are made in a consultation with your physician based on a number of factors– including your age, Gleason grading score and your lifestyle needs.

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Staging Prostate Cancer

Once a diagnosis of prostate cancer is confirmed, the course of treatment will depend on the extent or “stage” of the disease. A slow-growing cancer that is detected early when it is still confined to the prostate gland will have different treatment options than a more advanced cancer that has spread to nearby tissues or even other organs in the body.

A combination of the Gleason score from the pathology report, along with laboratory tests, imaging exams such as ultrasound and possibly a biopsy of the lymph nodes, will help the physician determine the stage of disease.

Gleason Score is the sum of two grades. Grades range from 3 for cancer cells that look almost normal to 5 for very abnormal cells that have spread througout the prostate. Cells with a grade 1-or 2 aren't thought to be cancerous. The primary grade is the most common pattern, and the secondary grade is second most common. The Gleason Score for prostate cancer range from 6 to 10. Higher Gleason scores mean the cancer is more likely to grow and spread more quickly. A higher primary grade also means more aggressive cancer. For Example: a gleason score of 7 summed from primary and secondary grades of 4+3 is worse than a grade of 3+4.

USMD Prostate Cancer Center follows the American Urological Association “T” staging system for prostate cancer:

T1 – the tumor is visible or can be seen with imaging.
T1a – the cancer was found during treatment for benign prostate enlargement but is present in less than five percent of the tissue and has a low-grade Gleason score.
T1b – the cancer was found during treatment for benign prostate enlargement but is present in more than five percent of the tissue and has a higher grade Gleason score.
T1c – the cancer was diagnosed from a biopsy due to an elevated PSA lab test.
T2– the tumor can be felt during a digital rectal exam but appears to be confined to the prostate.
T2a – the cancer is found in one half or less of the left or right side only of the prostate.
T2b – the cancer is found on both sides of the prostate.
T3 – the cancer has begun to spread outside the prostate and may include the seminal vesicles.
T3a – the cancer has spread outside the prostate but not to the seminal vesicles.
T3b – the cancer has spread to the seminal vesicles.
T4 – the cancer has spread to nearby organs.

No matter what stage your diagnosis may be, USMD Prostate Cancer Center is determined, our goal for you the patient is to guide you toward the best possible course of treatment for your condition. Combining years of experience and the latest technologies available today, USMDPCC is dedicated to providing you the highest chance for success in your battle against this disease.

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Risk Factors

Risk factors are circumstances or actions that increase your potential for developing cancer. Some risk factors are modifiable, such as smoking, diet and exercise. Others, including age, race and family history are certainly beyond your control. It is important to remember that even if you have one or more risk factors, it does not mean you will absolutely develop prostate cancer. However, you should discuss with your physician about whether you would benefit from earlier and more frequent screening.

The risk factors for prostate cancer include (but are not limited to):

Age. The incidence of prostate cancer increases for men age 65 and over. Prostate cancer is rare in men younger than age 40, but clinical studies reveal that one in six men between ages 60 and 79 will be effected.

Race. Men of African-American heritage are at higher risk for prostate cancer vs. men of Caucasian, Hispanic or Asian dissent. African-American men are also more frequently diagnosed with advanced stage disease and they have lower survival rates.

Family History. The risk of prostate cancer increases significantly when a first-degree relative (a father, brother or uncle) has been diagnosed with the disease, especially at a young age.

Lifestyle Factors. Some research has shown a link between a high-fat diet and prostate cancer.

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Statistics of Prostate Cancer – American Cancer Society Statistics

  • 241,740 men will be diagnosed with prostate cancer in the U.S. in 2012
  • 28,000 men in the United States will die of Prostate Cancer in 2012
  • 1 in 6 men will be diagnosed with prostate cancer in their lifetime
  • 1 in 36 men will die of prostate cancer
  • Roughly 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.
  • Prostate cancer is the second leading cause of cancer-related death in American men, behind only lung cancer.
  • Prostate cancer accounts for about 10% of cancer-related deaths in men.
  • Relative 5-year survival rate of prostate cancer sufferers is nearly 100%.
  • Relative 10-year survival rate of prostate cancer sufferers is 93%.
  • Relative 15-year survival rate of prostate cancer sufferers is 79%.

Today, the latest methods of detection and treatment mean that many prostate cancers are now found earlier and can be treated more effectively. Thanks to the development of breakthrough technologies, newer techniques and more fulfilling results, many patients can enjoy better outlooks than the figures stated above as treatment technologies progress!

USMD Prostate Cancer Center is dedicated to providing you, the patient, with the best possible outcome when treating prostate cancer. Our team of physicians employs the latest state-of-the-art technologies and techniques used to help you achieve success in your battle against this disease.

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Doctors, scientists and medical research cannot always explain why some people develop prostate cancer while others do not. There is no known cause or cure for the disease, but some scientists have studied general patterns of cancer in the population to learn what environmental elements and lifestyle habits may increase our chance of developing cancer.

Although genetics might play a role in deciding why one man might be at higher risk than another for developing prostate cancer, many years of clinical research suggest that maintaining a healthy lifestyle, including proper nutrition and regular exercise regimen, may decrease your chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease.

Some risk factors for developing cancer can be avoided, while others are unpredictable. Although one may choose to exhibit a healthier diet and exercise routine, they cannot choose which genes they inherit from their parents. Both lifestyle choices and inheriting certain genes can increase the chance of developing prostate cancer. Genetics may play a more substantial role in the existence of the condition than health and lifestyle.

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