Overview of Prostate Cancer
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What is prostate cancer?
Prostate cancer is the most common cancer (excluding skin cancer) among American men. The American Cancer Society estimates more than 232,000 new cases of prostate cancer are diagnosed annually in the United States and over 30,000 men will die of this disease each year.
The prostate is a gland found only in men. The normal prostate is about the size of a walnut. It is just below the bladder and in front of the rectum. The tube that carries urine (the urethra) runs through the prostate. The prostate contains cells that make some of the seminal fluid. This fluid protects and nourishes the sperm.
How does prostate cancer develop and spread?
Almost all prostate cancers are adenocarcinomas, meaning they develop from the prostate gland's cells. Once the cancer extends beyond the confines of the prostate, it may spread locally, directly affecting tissues and organs near the prostate. The cancer cells may also spread elsewhere in the body. If it spreads, prostate cancer tends to go first to the lymph nodes in the pelvis, where it may continue to grow. If prostate cancer cells reach the pelvic lymph nodes, they are more likely to spread to other locations and organs of the body, particularly the bones, which can cause pain in the hips, spine, ribs or other areas.
A special note about cancer that has spread to the bones: Even if cancer has spread to the bone, the bone is not weakened. X-rays often show that the bone appears denser and even harder. These are called blastic metastases. Sometimes, the cancer will dissolve the bones and severely weaken them. These are called lytic (from "lysis," meaning to dissolve) metastases.
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When should you be screened?
- Doctors at Fox Chase suggest men with no family history of prostate cancer should get their baseline (first) PSA and DRE tests at age 50.
- African-American men with no family history of prostate cancer should get their baseline PSA and DRE tests at age 40. This is because African-American men are at greater risk for developing prostate cancer for reasons not completely understood by the medical community.
- Men who have a first-degree relative (son, brother or father) with prostate cancer should get baseline PSA and DRE tests at age 40. African-American men with a family member who has prostate cancer should be screened at age 40 unless the family member was diagnosed at an age younger than 49. A doctor can help these men determine when to get their initial screening.
Based on the results of these tests, your doctor will make recommendations about how often you should be tested.
How is prostate cancer diagnosed?
Prostate cancer treatment is more effective when the cancer is diagnosed early. Doctors at Fox Chase use two screening tools to detect prostate cancer.
- Digital Rectal Examination (DRE) - Your doctor inserts a gloved finger into the rectum to detect any lumps in the prostate.
- PSA Test - Measures the amount of prostate-specific antigen, or PSA, in the blood. PSA is a protein produced by the prostate and can indicate the presence of cancer.
Some men with elevated (higher than normal) PSA levels may have a common, noncancerous condition called benign prostatic hyperplasia (BPH).
If a patient's prostate feels abnormal to the physician performing the DRE and the patient has an elevated PSA level (greater than or equal to 4.0 ng/ml), he is at risk of having prostate cancer. If either test is abnormal, your doctor may recommend a biopsy, which can provide a definitive diagnosis.
What is a prostate biopsy?
A core needle biopsy is the main method used to diagnose prostate cancer. A diagnostic radiologist with expertise in prostate biopsies performs this outpatient procedure, after local anesthesia has been administered. A sample of tissue is removed and then examined under a microscope. The doctor inserts several narrow needles (usually through the wall of the rectum) into the prostate gland, using transrectal ultrasound (TRUS) to guide the needles to the prostate. Each needle then removes a cylinder of tissue, or core, usually about 1/2-inch long and 1/16-inch across. The tissue samples are sent to the laboratory where a pathologist checks the tissue under a microscope to see if cancer is present. If cancer is present, the pathologist will also assign it a Gleason grade.
Because the prostate is much larger than the biopsy needles, the biopsy can sometimes miss the cancerous tissue if the needles don't pass through the cancer. This is known as a "false negative" result. If your doctor strongly suspects you may have prostate cancer (due to a very high PSA level, for example) despite a negative biopsy result, a repeat biopsy may be needed.