What Is Prostate Cancer
The prostate is a small gland located underneath the bladder in men and is part of the reproductive system. Some men develop prostate cancer, usually later in life. If cancer develops on your prostate gland, it will likely grow slowly. In rare cases, the cancer cells may be more aggressive, grow quickly, and spread to other areas of your body. The earlier your doctor finds and treats the tumor, the higher the chances are of finding curative treatment.
According to the Urology Care Foundation, prostate cancer is the second most common cause of all cancer-related deaths among American men. About 1 in 7 men will be diagnosed with the disease in their lifetime. Approximately 1 in 39 men will die from it. Most of these deaths occur among older men.
This Program Is Available To Males In The Us And Canada With One Of The Following Diagnoses:
Stage IIa, age at diagnosis 55 years or under
Stage IIb or IIc at any age
Stage III at any age
Stage IV at any age
Postmortem samples are not permitted through the program at this time
Gleason 6, age at diagnosis 55 or under
Gleason;7 or greater at any age
Metastatic disease at any age
Gleason;undetermined, suspected low risk or above at any;age
Are Mutations Passed On To Children
In our numbered pairs of chromosomes, we inherit usually one copy that is normal from one parent, and one copy that might be mutated. When those chromosomes split, when we pass on half our genes to each child, there is a;random 50/50 chance of passing on that mutation.
The parents, children and siblings of a person with a;hereditary form of prostate cancer are recommended to;be tested for that mutation.
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Genetic Testing For Prostate Cancer: What Men And Their Families Should Know
Its fairly common knowledge that mutations in genes such as BRCA1 and BRCA2 can play a role in breast and ovarian cancers. But some of these same genetic mutations as well as mutations in genes such as CHEK2, HOXB13, and ATM also can increase a mans risk of developing prostate cancer.
After skin cancer, prostate cancer is the most common cancer among men in the U.S. More than 207,000 men receive a prostate cancer diagnosis each year including nearly 14,000 Texans and more than 30,000 die of the disease.
A 2019 study of 3,600 men with prostate cancer found that 17% had inherited genetic mutations that may have contributed to their cancer. Of those men, 31% of the mutations were in the BRCA genes.
The knowledge that the same genetic mutations that increase the risk of breast, ovarian, colon, and pancreatic cancers can also cause prostate cancer is helping inform how we prevent and, in some cases, treat the disease with genetic counseling and testing playing a key role.
As the science of genetics has advanced, more health insurance plans are beginning to cover genetic counseling and testing, removing a once-common barrier. Subsequently, there has been a push to identify men with prostate cancer or a family history of cancers who may be at risk of a hereditary predisposition.
Risk Factors You Cant Control
Age: The risk of developing prostate cancer increases with age. One in 10,000 men younger than 40 will be diagnosed with prostate cancer, but one in 15 men in their 60s will be diagnosed with the disease.
Family history: Being born with a gene mutation is one of the unavoidable risks of prostate cancer. Two of them include the BRCA1 and BRCA2 gene mutations. BRCA and other inherited mutations, including HOXB13 and DNA mismatch repair genes, may explain why prostate cancer runs in families. Having a father or brother with prostate cancer may double a mans risk, especially if that relative was diagnosed before age 55.
Hormones: The level of male sex hormones, called androgens, may be higher in some men than others. Higher levels of androgensmainly testosteronehave been linked to a higher risk of prostate cancer. Men who use testosterone therapy are at a higher risk of developing prostate cancer, as an increase in testosterone stimulates the growth of the prostate gland.
Prostatic intraepithelial neoplasia : This condition may be associated with increased risk of prostate cancer. PIN is a condition in which prostate gland cells look abnormal when examined with a microscope. Its not necessarily linked with any symptoms. Nearly half of men will be diagnosed with PIN before age 50.
Race: Studies show that African-American men are about 70 percent more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.
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Prostate Cancer Risk Factors
A risk factor is anything that raises your risk of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
Researchers have found several factors that might affect a mans risk of getting prostate cancer.
Is Cancer Increasing Or Decreasing
From 1999 to 2019, cancer death rates went down 27%, from 200.8 to 146.2 deaths per 100,000 population. Healthy People 2030 set a target of 122.7 cancer deathsexternal icon per 100,00 population. Cancer death rates went down more among males than among females but were still higher among males than females .
NOTES: Deaths were classified using the International Classification of Diseases, 10th Revision. Cancer deaths were identified using underlying cause-of-death codes C00-C97 . Rates were age-adjusted to the 2000 US standard population.
National Center for Health Statistics, National Vital Statistics System, Mortality Data.
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Another Red Flag: Metastatic Cancer
Be aware that metastatic prostate cancercancer that has spread beyond the prostate glandis also a reason to consider genetic testing for hereditary prostate cancer. Heres why:
Research shows that inherited gene mutations are present in approximately 12 percent of all men with prostate cancer that has spread, Obeid said.
An inherited mutation may have important treatment implications, he said. Drugs known as PARP inhibitors may be beneficial in treating some inherited prostate cancers.
The takeaway: learning you may be genetically vulnerable to prostate cancer may help you make vital decisions to protect your healthand your familys health.
Prostate Cancer Treatment: Prostate Cancer Surgery
Radical prostatectomy is the surgical removal of the prostate gland. Usually, this treatment is performed when the cancer is located only in the prostate gland. New surgical techniques help avoid damage to nerves, but the surgery may still have the side effects of erectile dysfunction and impaired urinary control. However, these side effects may gradually improve in some patients. Surgeons today may use robotic technique to assist in the operation.
Tips: Coping With Incontinence
Urinary incontinence is a common complication for men following prostate cancer surgery, and this problem can persist even five years after the surgery takes place. In one survey of 111 men published in 2003, 69% reported incontinence after prostate surgery. Most of these men used pelvic muscle exercises to help. Many used containment devices, including pads, special underwear, and sanitary napkins to manage incontinence.
Here are some post-surgical incontinence tips:
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Family History And Genes
Your risk of prostate cancer is higher if you have a close relative, such as a brother or father, who has had prostate cancer.
Some inherited genes can increase your risk of prostate cancer. These inherited genes are rare and account for only a small number of prostate cancers.
The risk increases by up to 5 times in men with the gene BRCA2. And the risk might increase with the BRCA1 gene. These genes also cause breast and ovarian cancers.
Men with a rare syndrome called Lynch syndrome have a higher chance of developing prostate cancer and some other cancers. A change in one of the genes that fixes mistakes in DNA causes this syndrome eg. MSH2 and MLH1 genes.;
Researchers are looking into other genes that might also increase the risk of prostate cancer.
Eight To 10 Breast Cancer Genes Are Known To Increase The Risk Of Prostate Cancer If That Same Mutation Is Passed On
The genes that have been identified in men who have;aggressive prostate cancers actually are breast cancer genes, she says. BRCA2, for example, imposes up to a 7% lifetime chance of developing prostate cancer in men. The risk for breast cancer developing in a woman with that gene is much higher, anywhere from 40% to 80% over ones lifetime.
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Identifying Genetic Changes In Cancer
Lab tests called DNA sequencing tests can read DNA. By comparing the sequence of DNA in cancer cells with that in normal cells, such as blood or saliva, scientists can identify genetic changes in cancer cells that may be driving the growth of an individuals cancer. This information may help doctors sort out which therapies might work best against a particular tumor. For more information, see Biomarker Testing for Cancer Treatment.
Tumor DNA sequencing can also reveal the presence of inherited mutations. Indeed, in some cases, the genetic testing of tumors has shown that a patients cancer could be associated with a hereditary cancer syndrome that the family was not aware of.
As with testing for specific mutations in hereditary cancer syndromes, clinical DNA sequencing has implications that patients need to consider. For example, they may learn incidentally about the presence of inherited mutations that may cause other diseases, in them or in their family members.
When To Consider Genetic Counseling For Prostate Cancer
Experts recommend that men with a family history suggesting an increased risk of prostate cancer engage in shared decision-making with their physicians about genetic counseling and testing. Genetic testing can educate you about your inherited risk of prostate cancer, and it also can inform your family members that they may have genetic mutations that increase their cancer risk. Here are 7 factors that warrant a referral to a certified genetic counselor:
Journal of Clinical Oncology, Feb. 1, 2018).
This article originally appeared in Cleveland Clinic Mens Health Advisor.
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Being Overweight Or Obese
Obese means being very overweight with a body mass index of 30 or higher. And being overweight means having a BMI of between 25 and 30.
Try to keep a healthy weight by being physically active and eating a healthy, balanced diet.
There is some evidence that being active might help to lower your risk of developing prostate cancer.
Being overweight or obese increases your risk of advanced prostate cancer. Researchers have found a link between being obese or overweight and cancers being higher grade .
Risk Factors In Aggressive Vs Slow
In the past few years, weve learned that prostate cancer really is several diseases with different causes. More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.
For example, while smoking has not been thought to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer. Likewise, lack of vegetables in the diet is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.
Body mass index, a measure of obesity, is not linked to being diagnosed with prostate cancer overall. In fact, obese men may have a relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume. However, obese men are more likely to have aggressive disease.
Other risk factors for aggressive prostate cancer include:
- Tall height
- Lack of exercise and a sedentary lifestyle
- High calcium intake
- Agent Orange exposure
Research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease. You can learn more about how dietary and lifestyle changes can affect the risk of prostate cancer development and progression in PCFs Health and Wellness: Living with Prostate Cancer guide.
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Understand Your Genetic Risks
So, is prostate cancer hereditary? The answer may lie in the dozens of genetic mutations, or variants, that have been associated with varying degrees of prostate cancer risk, as well as the additional suspect genes that are being researched. Having one of these genetic defects does not mean you will get prostate cancer, but it does increase the likelihood, which is probably why some families have a history of prostate cancer.
FOR FURTHER INFORMATION
Is prostate cancer genetic? The National Cancer Institute offers a report called Genetics of Prostate Cancer. to access that information.
For instance, if a woman in your family developed breast cancer caused by mutations in the BRCA1 and BRCA2 genes, you may face a greater risk of prostate cancer. Moreover, some evidence suggests that men with BRCA-related prostate cancers, especially those tied to BRCA2, are more likely to present with more advanced and aggressive disease, and they also might have worse survival outcomes after prostate cancer surgery.
In one study, researchers found that 8 percent of men with BRCA1 mutations and 5 percent with BRCA2 mutations were diagnosed with prostate cancer, rates higher than those in the general population .
Another analysis found that 71 percent of BRCA2 prostate cancer patients presented with higher-risk disease at the time of their diagnosis, had poorer survival rates, and were four times more likely than men without the genetic mutation to present with metastatic disease .
How Your Genes Can Raise Risk For Prostate Cancer
Researchers have found a handful of genes that, when they have certain changes in them , can play a role in prostate cancer risk.
These are the ones doctors know the most about:
BRCA1 and BRCA2. Normally these genes, called tumor suppressor genes, help prevent cancer. But inherited mutations can keep them from doing their job. Risk-raising mutations are more likely to cause breast and ovarian cancer. But in men, these changes — especially changes in BRCA2 — can lead to prostate cancer.
MSH2, MSH6, MLH1, and PMS2. When these genes work as they should, they help your cells fix problems that might otherwise lead to cancer. Inherited changes in any one of these genes causes Lynch syndrome. This inherited cancer syndrome raises your risk for colorectal, prostate, uterine, and other cancers.
CHEK2, ATM, PALB2, and RAD51D. These genes also help your cells fix themselves when things go wrong. Mutations in them can raise your risk for prostate cancer.
RNASEL. This gene helps cells die when something goes wrong in them. That way they donât do too much damage in your body. When the gene doesnât work right, because of an inherited mutation, abnormal cells could survive and become prostate cancer.
HOXB13. This gene plays a part in the development of your prostate gland. Rare mutations can raise risk for prostate cancers that happen at a young age, usually before age 55.
Research is in progress to find other gene changes that could raise risk for prostate cancer.
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Could You Have A Faulty Gene
Red flags that you may have inherited a gene that raises prostate cancer risk include:
- Multiple family members diagnosed with prostate cancer, especially before age 55.
- A family history of prostate cancer coupled with breast, ovarian, colon, or pancreatic cancer.
A simple blood test can help determine if you carry a worrisome gene. So be sure to share your familys cancer history with your doctor, Obeid advised. If appropriate, your doctor can refer you to a genetic counselor to help you decide if testing is right for you and to help you understand the results.
If genetic testing does reveal that you have an inherited risk of prostate cancer, early screening with a digital rectal exam and PSA blood tests could help doctors find any prostate cancer that develops; and, if cancer is ever suspected, your doctor may recommend that a biopsy be performed.;For men with an increased genetic risk for prostate cancer, biopsies may be recommended at a lower PSA level than usually is for those with no inherited risk.;
Your family members might also want to consider genetic testing because they may have inherited the same abnormal gene.
Whats The Impact Of Updated Prostate Cancer Genetic Testing Recommendations
The National Comprehensive Cancer Network issued updated prostate cancer guidelines that include new information about the role of genetic testing for those with prostate cancer1. These updates expand the criteria to include more people with prostate cancer or people with family histories of prostate cancer who may be eligible for and benefit from genetic testing.
The NCCN now recommends consideration of genetic testing for the following1:
- All men with high-risk, very high-risk, regional, or metastatic prostate cancer.
- All men with any stage prostate cancer and a family history consisting of one of the following:
- Brother, father or multiple family members diagnosed with prostate cancer at <60 years of age.
- Family member with a known genetic mutation.
- More than one relative with breast, ovarian or pancreatic cancer.
- More than one relative with colorectal, endometrial, gastric, ovarian, pancreatic, small bowel, urothelial, kidney or bile duct cancer.
Not every person with aggressive prostate cancer or a family history of cancer will have a genetic mutation. In most people, the underlying cause of a persons cancer is unknown. We call this sporadic cancer, meaning that chance events occurred resulting in cancer but there was no underlying predisposing gene mutation. It is estimated that about 90 percent of men have sporadic cancer.
1National Comprehensive Cancer Network. Prostate Cancer . https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 1/12/2019.
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