Adenocarcinoma of the Prostate

Overview, Causes, & Risk Factors

Prostate cancer is a tumor that grows in the prostate gland in men. The prostate gland is part of the reproductive system. It stores seminal fluid, the substance that mixes with sperm to form semen.

What is going on in the body?

Normally, the prostate is a firm, walnut-shaped gland at the base of a man's bladder. It surrounds the urethra, the tube that carries urine from the bladder to the outside of the body. A man with prostate cancer has a tumor in the prostate gland. In some cases, prostate cancer can grow slowly for many years. Other times, it may grow rapidly and spread swiftly to other parts of the body. It may also spread its cells throughout the lymph system or bloodstream and along nerve pathways.

What are the causes and risks of the disease?

No one knows what causes prostate cancer. Hormones, such as testosterone, control the growth of the prostate gland. They may contribute to prostate cancer. Viruses or chronic infections may contribute to prostate cancer. Researchers have recently identified a gene that is linked to some cases of prostate cancer. So far, prostate cancer has not been linked to common cancer-causing substances in the environment.

Following are some of the risk factors.

Advanced age. Prostate cancer is seen mostly in men over the age of 55.

Diet. Fruits, vegetables, and fatty fish may lower a man's risk for prostate cancer. A high fat diet may increase the risk.

Ethnic background. Prostate cancer occurs most often in African and northern European ethnic groups. It is less common in American Indian and Asian men.

Family history of cancer. A man's risk is higher if his father or brother had prostate cancer.

Men who have had a vasectomy, who smoke, or who have been exposed to a metal called cadmium may also be at an increased risk.

Symptoms & Signs

What are the signs and symptoms of the disease?

Some men with prostate cancer have no symptoms. Others notice symptoms such as the following:

blood in the urine or semen

dribbling when urinating

erectile dysfunction

frequent urination, especially at night

painful urination and/or ejaculation

a smaller stream of urine

an urgent need to urinate

If the cancer has spread to other parts of the body, the man may have painful bony sites. He may also have occasional nerve paralysis or loss of bladder function.

Diagnosis & Tests

How is the disease diagnosed?

Diagnosis of prostate cancer begins with a medical history and physical exam. The healthcare provider will do a digital rectal exam. This involves inserting a gloved finger into the man's rectum to feel the prostate.

The PSA test, and a more refined version of it, may help in diagnosing prostate cancer. High levels of PSA suggest, but cannot prove, that a man has prostate cancer. However, very high levels of PSA can diagnose the disease. Normal ranges for PSA increase with age and are different according to race.

If prostate cancer is suspected, a biopsy may be done. During the biopsy, a needle is inserted into the prostate gland to obtain a small sample of tissue. The healthcare provider may order a transrectal ultrasound. This test uses sound waves to examine the inside of the gland. It can be used to guide the healthcare provider during a biopsy. If several areas of the prostate are in question, a number of biopsies may be done. The tissue is sent to a lab where it will be checked for cancer.

Prostate cancer is graded and staged for aggressiveness based on how far it has spread throughout the body.

Stages A and B are cancers confined to the prostate gland.

Stage C cancer has spread to other tissues near the prostate gland.

Stage D cancer has spread to lymph nodes or sites in the body a distance away from the prostate.

CT scans and bone scans help in staging. Sometimes staging only becomes clear at the time of surgery.

Prevention & Expectations

What can be done to prevent the disease?

As yet, prostate cancer cannot be completely prevented. Prostate screening with exams and blood tests helps with early diagnosis. The American Cancer Society, also called ACS, recommends that a digital rectal exam be offered every year to men 50 years of age or older who have a life expectancy of at least 10 years. A digital rectal exam involves a healthcare provider inserting his or her finger into a man's rectum to check if the patient's prostate is enlarged.

The ACS also recommends that a prostate-specific antigen test, also called a PSA blood test, be offered every year to men 50 years of age or older who have a life expectancy of at least 10 years. ACS recommends that screening start at the age of 45 years for African American men or men with a family history of prostate cancer.

Good dietary choices may also help prevent prostate cancer. The diet should be low in fat. Fruits, vegetables, and fatty fish help lower a man's risk for prostate cancer.

What are the long-term effects of the disease?

Long-term effects of prostate cancer depend on its stage and the type of treatment used. Some men who have slow-growing cancer can be monitored without treatment. Others live for a long time with prostate cancer that has spread to other sites in the body. Cancer that has spread is not curable in most cases. Unless other illnesses occur first, cancer that has spread usually causes death.

What are the risks to others?

Prostate cancer is not contagious and poses no risk to others. Prostate cancer does run in families. Brothers or sons of men who develop cancer should be aware of their family history. They should be screened for the disease as they grow older, as recommended by the ACS.

Treatment & Monitoring

What are the treatments for the disease?

The proper management of the many stages of prostate cancer is controversial. Depending on the grade and stage of the cancer, some options are as follows:

chemotherapy

cryosurgery to freeze cancer cells

external radiation to the prostate and pelvis

hormone therapy

radioactive implants put directly into the prostate, which slowly kill cancer cells

surgery to remove part or all of the prostate and surrounding tissue

surgical removal of the testicles to block testosterone production

watchful waiting and monitoring only

Hormone therapy or chemotherapy is used mostly for men with advanced stage D disease. Hormone therapy includes use of the following:

antiandrogens, such as flutamide and bicalutamide, that block the action of testosterone

corticosteroids, such as prednisone

GnRH agonists, also known as LHRH analogues, such as goserelin and leuprolide, which reduce the body's production of testosterone

medicines that stop the production of testosterone, such as ketoconazole and aminoglutethimide

Treatment for men with prostate cancer that has spread through the body is usually confined to making them as comfortable as possible. Often the prostate is not removed. A cure for prostate cancer is not available. Researchers continue to search for a cure.

What are the side effects of the treatments?

Following are some common side effects of radiation or surgery for prostate cancer:

depression

erectile dysfunction

swelling of the extremities

urinary incontinence

Occasionally, radiation or surgery may cause the following:

bladder inflammation

bone marrow suppression

inflammation of the lining of the small intestine

lowered blood counts

severe swelling in the legs and feet

Depending on exact treatment, hormone therapy may cause the following conditions:

erectile dysfunction

fatigue

a higher risk of blood clots in the leg

nausea

osteoporosis, or bone thinning

swelling in the breasts

Often given intravenously, chemotherapy has certain common side effects, such as:

bleeding disorders

higher risk of infections

lowered blood counts

vomiting

Cryosurgery or radiation implants can be painful and expensive. However, these treatments may preserve sexual function.

What happens after treatment for the disease?

After treatment, men are regularly monitored for side effects and a recurrence of the cancer.

How is the disease monitored?

The following are used to monitor the disease:

bone scans

chest X-rays

CT scans of the pelvis

digital rectal exams

PSA tests, which are sensitive and specific for recurrence of cancer

ultrasound of the prostate

Any new or worsening symptoms should be reported to the healthcare provider.