Prostate Cancer Overview
Prostate cancer occurs in the prostate — a walnut-shaped gland that only men have. The gland produces semen – the fluid that nourishes and transports sperm.
Approximately 1 in 7 men will be diagnosed with prostate cancer during their lifetimes. Prostate cancer is more common among men older than 65 years of age and among African American men. There are screening tests for prostate cancer, including a blood test, which looks for a prostate-specific antigen, a (PSA) test or a digital rectal exam, where the doctor inserts a gloved finger into the rectum to feel for hard lumps.
Types of Prostate Cancer
|Type||Adenocarcinoma||Small cell carcinoma|
|Other Information||Most common type – about 95% of all prostate cancers.Potential to spread beyond the prostate into other organs, lymph nodes and bones||Rare – less than 5% of all prostate cancers.Hard to detect in its early stages since it forms in specialized cells within the prostate|
Doctors Who Treat Prostate Cancer
As prostate cancer is diagnosed, treated and managed, you may encounter the following team of doctors and specialists. Having a team of doctors or specialists with varied expertise will help diagnose prostate cancer more accurately, manage the condition more effectively, and help maintain your quality of life. Read more in this prostate cancer patient education guide.
Internist - a medical doctor who focuses on the prevention and treatment of diseases in adults.
Urologist - a medical doctor who specializes in diseases of the urinary tract, which includes the prostate.
Pathologist - a medical doctor who looks at tissue samples under a microscope to identify cancer cells that may be present. If there are prostate cancer cells in your sample, the pathologist also assigns a Gleason score, which measures how likely the cancer is to grow and spread.
Surgical Oncologist (Cancer surgeon) - a medical doctor who cuts into someone’s body and removes the diseased parts. In patients with prostate cancer, the surgeon removes the prostate, some surrounding tissue, the seminal vesicles, and the lymph nodes near it.
Medical Oncologist - a medical doctor who specializes in treating cancer patients with medicines known as chemotherapy.
Radiation Oncologist - a medical doctor who specializes in treating cancer patients with radiation.
How to Prepare for Your Prostate Cancer Doctor Visit
Having made your appointment with a urologist, there are certain steps that you need to take in order to get the most benefit from your doctor visit:
- Ask your doctor or the office nurse what you need to do before your appointment. Do you need to fast or avoid eating certain foods? For how long? Do you need to wear a short-sleeved shirt? Do you need to take a pill or drink something the night before?
- Ask a family member or friend to come with you to take notes so you can concentrate on what the doctor is telling you. That way, you won’t have to worry about remembering everything the doctor tells you.
- Write down all the drugs you are currently taking, including prescription medications, over-the-counter medications, vitamin and mineral supplements, and herbs. Bring the list with you.
- Write down your medical history, including any problems with urinating that you have and when the problems started. Bring the medical history with you.
- Make a copy of the front and back of your health insurance card on a single sheet of paper.
Questions to Ask Your Doctor About Prostate Cancer
From your initial diagnosis throughout your treatment and care, you will have questions about your prostate cancer. Below is a list of questions to discuss with your doctor so you can make informed decisions about your condition.
Questions About My Diagnosis
- What is my PSA level? Does it mean I have prostate cancer?
- What new symptoms can I expect? What symptoms are serious enough that I should call you right away?
- What is a biopsy? Will I be asleep during the biopsy? Will it hurt? How long will it take to recover?
Questions About My Treatment
- What treatments are available for prostate cancer? What are the potential side effects of each treatment?
- I have heard that some men don’t get treated right away. If I have prostate cancer, shouldn’t I get it taken out as soon as possible?
- When can we start treatment?
- Will I have to stay on treatment for the rest of my life?
- Is there a special diet or vitamin supplements that would help prevent the prostate cancer from coming back?
Questions About My Lifestyle & Family
- I have heard that surgery can lead to impotence. What is the likelihood that it will happen to me? Is there anything that can be done to prevent that?
- I have heard that surgery can lead to an inability to control urination (urinary incontinence). What is the likelihood that it will happen to me? Is there anything that can be done to prevent that?
- Can I drink alcoholic beverages or would it make my condition worse?
- If I continue to smoke, will that make my prostate cancer come back?
- Is there an online or in-person prostate cancer support group I could join?
Common Tests or Labs to Diagnose Prostate Cancer
Your internist will likely make a tentative diagnosis of prostate cancer based on your symptoms and a digital rectal exam. During a digital rectal exam, the doctor feels for irregularities (bumps; soft or hard spots) in the prostate through the wall of the rectum. If the internist feels a mass in the prostate, he or she will likely refer you to a urologist.
The urologist may order the following tests to either rule out or to make a definite diagnosis of prostate cancer:
|Test||Why Test?||What Happens?||Result|
|Prostate Specific Antigen (PSA)||PSA levels in the blood are likely to rise if the prostate is not working properly for several possible reasons.||Blood is drawn through a syringe, typically from the arm.||If the level of PSA in your blood is high, the doctor will likely order other tests to find out whether cancer is present or not.|
|Prostate Biopsy||To confirm the diagnosis of prostate cancer.||This test involves taking pieces of the prostate with a needle. The urologist uses ultrasound to guide the needle to the prostate tumor to remove the sample. A pathologist then examines the sample with a microscope.||If the sample tissue has prostate cancer cells in it, the pathologist will describe what type of cancer it is and how likely it will be to grow or spread. The urologist will discuss treatment options with you.|
|Bone scan||Prostate cancer cells can spread (metastasize) to the bone. Your PSA value, Gleason score, and stage of disease determine whether you need this imaging test.||Radioactive material is injected in arm, which will be taken up by bone, making cells visible within 2-4 hrs.
A special camera is then used to identify suspicious areas.
|Your urologist may refer you to a medical oncologist for chemotherapy.
|MRI or CT scan||To determine if and where prostate cancer cells have metastasized||MRIs and CT scans are usually performed at an outpatient center or hospital; anesthesia is not needed||Your urologist may refer you to a medical oncologist for chemotherapy.
Accepted and Experimental Treatments for Prostate Cancer
Prostate cancer that develops later in life and is slow to grow may not shorten a man’s life expectancy, and the doctor and patient may decide that treatment is not necessary.
However, if a course of action is necessary, there are several treatment options available for prostate cancer. Read more in this prostate cancer patient education guide.
|Treatment Method||How it works|
|Watchful waiting (observation, expectant management)||If your prostate cancer is a type that grows slowly and is unlikely to spread to other organs, no active treatment may be necessary. Regular follow-up (PSA tests, rectal exams, and possibly biopsies) will be scheduled to make sure your cancer is not growing or spreading.|
|Surgery (Radical prostatectomy with lymph node dissection)||This operation removes the prostate gland, surrounding tissue, the seminal vesicles, and the lymph nodes located in the pelvis.|
|Hormone therapy||Androgen deprivation therapy uses medicines that deprive prostate cancer of testosterone, the hormone they need to grow. Without testosterone, prostate cancer cells either die or grow more slowly.|
|Chemotherapy||Chemotherapy uses drugs to kill rapidly growing cells, including prostate cancer cells. You may be offered chemotherapy if your prostate cancer doesn’t respond to hormone therapy or if it has spread to other organs (metastasized). Chemotherapy may be given through a vein in your arm, into a muscle, or as a pill, depending on what type and stage of prostate cancer you have.|
|Radiation therapy||Radiation therapy uses high-powered energy to kill cancer cells. The radiation may be delivered from a machine outside your body (external beam radiation) or by radioactive seeds placed into your body to deliver a low dose of radiation over a long period of time (brachytherapy).|
|Immunotherapy (biologic therapy)||Immunotherapy uses the patient’s own immune system to fight the cancer. The therapeutic vaccine, sipuleucel-T (a form of immunotherapy), treats advanced, recurrent prostate cancer. With this treatment your own immune cells are first genetically engineered to fight prostate cancer, and then injected back into your body.|
|Targeted therapy is a treatment that finds and attacks specific cancer cells without harming healthy cells. Monoclonal antibodies (a form of targeted therapy infused through a vein) are made from immune system cells. These antibodies attach to and damage or kill the prostate cancer cells.|
|Bisphosphonate drugs reduce the number of prostate cancer cells and ease pain when prostate cancer has spread to the bone.|
|Treatment Method||How it works|
|Cryosurgery||During cryosurgery (also called cryoablation) small needles are inserted into the prostate guided by ultrasound images. A very cold gas is placed in the needles to freeze the tissue, followed by a second gas to reheat the tissue. Alternating freezing and thawing kills the prostate cancer cells.|
|Proton Beam Radiation Therapy||This treatment targets prostate cancer with streams of external radiation using high-energy protons (small, positively charged particles).|