Why Do Some Men Get Prostate Cancer
Prostate cancer is the most common malignancy diagnosed in men. Prostate cancer is a disease defined by the abnormal growth of cells. These abnormal cells can proliferate in an uncontrolled way and, if left untreated, form tumors which may metastasize or spread to other parts of the body. Prostate cancer has the potential to grow and spread quickly, but for most men, it is a relatively slow growing disease.
For men who suspect that they might have prostate cancer, it is very important to understand the risk factors and symptoms. Knowing where the prostate is located in the body, and the functions of the prostate will explain the impacts of prostate cancer and prostate cancer treatment. Patients diagnosed with prostate cancer need to discuss with their doctors their particular type, aggressive or non-aggressive, of prostate cancer. This will allow the patient, working with their doctor to determine the most effective treatment for their cancer.
The prostate cells produce an enzyme named Prostate Specific Antigen or PSA, found in a man’s blood. PSA is produced exclusively by prostate cells. Elevated levels of the PSA enzyme can be helpful in diagnosing issues with the prostate, like cancer or infection. These elevated levels of PSA can be detected with a simple blood test. For more information, visit our page on PSA.
How Do The Treatment Options Compare
A study known as the ProtecT trial is the most important study on treatments for low-risk prostate cancer so far. ProtecT stands for prostate testing for cancer and treatment. This trial compared three treatment options: active surveillance, external radiotherapy and surgery to remove the prostate. A total of 1,643 men between the ages of 50 and 69 took part in the trial. They all agreed to be randomly assigned to one of the three treatment groups. About two thirds of them had low-risk prostate cancer. The treatment outcomes were recorded over an average of ten years, and then compared with each other at the end of the trial.
The following was found over a period of ten years:
- no difference in mortality rate between the active surveillance, radiotherapy and surgical removal groups,
- a somewhat higher risk of metastases in the active surveillance group,
- a much higher risk of accidental urine leakage in men who had surgery,
- a much higher risk of erection problems in men who had radiotherapy or surgery .
- a somewhat higher risk of accidental stool leakage in men who had radiotherapy.
Based on the results of this trial and other research, we have developed a decision aid that can help men who have low-risk prostate cancer to weigh the pros and cons of the various treatment options for example, together with their friends, family and doctors.
Tools To Help You Decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasnt spread.
It cant tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.
To be able to use the tool you need to know the following about your cancer:
Men undergoing active surveillance for prostate cancer have very low rates one percent or lessof cancer spread or death from prostate cancer, according to a recent study published in The Journal of Urology, an official journal of the American Urological Association .
In the long-term, active surveillance is a safe and viable option for men with low-risk and carefully selected intermediate-risk prostate cancer, according to the report by senior author Peter R. Carroll, MD, MPH, of University of California, San Francisco and colleagues.
During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate-specific antigen screening, prostate exams, imaging and repeat biopsies. If symptoms develop, or if tests indicate the cancer is more aggressive, active treatment such as surgery or radiation may be warranted.
New data on outcomes of active surveillance
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More Active Surveillance But Not Enough
To conduct their study, Dr. Cooperberg and his colleagues looked at data from all men newly diagnosed with prostate cancer in the AUA Quality Registry. This registry collects real-time data from more than 240 participating US urology practices and more than 2,100 urologists.
Overall, of the more than 84,000 patients covered by the study, 20.3% were diagnosed with low-risk disease. The number of men diagnosed with low-risk disease actually fell during the study period, from about 24.6% in 2014 to 14.0% in 2019. That finding is consistent with other recent studies showing a decline in low-risk diagnoses, which researchers have attributed to fewer men being screened via PSA testing.
But even as diagnoses of low-risk disease have dropped, more men with low-risk disease are opting for active surveillance, Dr. Cooperberg reported. In 2014, 26.5% of men with low-risk prostate cancer chose active surveillance. By the end of 2021, 59.6% did.
Rates of active surveillance also increased among men diagnosed with intermediate-risk prostate cancer, which is considered to have a modestly greater likelihood than low-risk prostate cancer of progressing to the point where it could be fatal.
The variability in the use of active surveillance is alarming, Dr. Parnes said. It likely reflects, at least to some degree, entrenched patterns of care among some urologists. For some, I suspect their feeling is, I treat cancer, and this is cancer. Im not having this conversation , he said.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
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Localized Prostate Cancer: Low
Low-risk prostate cancer often grows very slowly, or doesn’t grow at all. Because of this, a treatment approach known as “active surveillance” can be considered as an alternative to radiotherapy or surgery. In this approach, the tumor is monitored regularly and only treated with radiotherapy or surgery if it grows.
Prostate cancer is described as low-risk if it is only found in the prostate and it is highly likely to grow only very slowly, or not at all . The medical criteria for low-risk prostate cancer are:
- The cancer is found in only one of the two sides of the prostate.
- The cancer takes up less than half of the affected prostate lobe.
- The cancer cells havent mutated much and arent very aggressive.
- The cancer hasnt spread to any lymph nodes or led to the growth of tumors in other parts of the body.
Even if the can be worrying: Low-risk prostate cancer grows only very slowly, or sometimes doesn’t grow at all. So the chances of recovery are very good. Over a time period of 10 years, only 1 out of 100 men who have low-risk prostate cancer will die of this disease. In other words: 99 out of 100 men will not die of prostate cancer in the 10 years after it is diagnosed.
There are various ways to deal with low-risk prostate cancer. All of the options have their pros and cons. So it’s a good idea to get enough information and discuss the options with your doctors before making a decision.
What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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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.
Talk To Your Cancer Care Team
Your team is an important source of advice. Some men may benefit from having a low-risk tumor treated right away, even if they might have side effects. Discuss your treatment options and quality-of-life issues with your team.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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What Are The Risks
Often, prostate cancer is low-risk.
Many prostate cancers are found with a prostate-specific antigen blood test. Often these cancers are low-risk. This means:
- The tumour is small.
- It is contained within the prostate.
- The PSA blood test is not very high .
For most with low-risk prostate cancer, the tumour is probably growing so slowly that it will not become life-threatening. Usually a man with low-risk prostate cancer passes away of something else, even if he doesnt get treatment for prostate cancer.
Active surveillance may help your quality of life.
With this approach, you have regular checkups, including a PSA test and rectal exam. Youll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.
Active surveillance is a good choice for many with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.
Treatment can have side effects.
Side effects from surgery or radiation may include:
- Impotencenot getting erections that are firm enough for intercourse.
- Leaking urine. There may be complete loss of bladder control, but this is less common.
- Frequent, urgent, bloody, or painful bowel movements.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Initial Treatment Of Prostate Cancer By Stage And Risk Group
The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.
For prostate cancers that haven’t spread , doctors also use risk groups to help determine if more tests should be done and to help guide treatment options. Risk groups range from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups.
Other factors, such as your age, overall health, life expectancy, and personal preferences are also important when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.
You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here. Taking part in a clinical trial of newer treatments is also an option for many men with prostate cancer.
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How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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Often Prostate Cancer Is Low
Many prostate cancers are found with a PSA blood test. Often these cancers are low-risk. This means:
- The tumor is small.
- It is contained within the prostate.
- It is probably growing so slowly that it will not become life-threatening.
Usually a man with low-risk prostate cancer dies of something else, even if he doesnt get treatment.
Differential Diagnosis Of Adenocarcinoma In Needle Biopsy Tissue
Numerous entities, both benign and malignant, should be considered in the differential diagnosis of prostatic adenocarcinoma. Indepth discussion of these entities is beyond the scope of this review.
Recent reviews have highlighted the benign lesions or pseudoneoplasms that may mimic prostatic adenocarcinoma., Atypical adenomatous hyperplasia and atrophy are the benign conditions that are most likely to be misdiagnosed as prostatic carcinoma.,, Crowded benign glands may also be mistaken for prostatic adenocarcinoma. The pathologist should always consider the possibility of a benign mimicker of prostatic carcinoma, particularly atrophy, but also all other entities , before making a diagnosis of adenocarcinoma of the prostate.
A descriptive diagnosis which may be rendered if the histological or immunohistochemical findings are thought to be worrisome but not fully diagnostic of carcinoma, is atypia,, also known as atypical suspicious for carcinoma or atypical small acinar proliferation. Such a diagnosis is given in about 45% of all prostate needle biopsy specimens.,
The main nonprostatic, secondary malignancy to think about before diagnosing prostatic carcinoma in needle biopsy of the prostate is urothelial carcinoma involving the prostate.,
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