How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
Will Treatment Cause Erectile Dysfunction
When youre sexually excited, nerves cause tissues in your penis to relax, allowing blood to flow into the organ. The nerves that control erection are very delicate. Surgery or radiation for prostate cancer may damage them enough to cause ED. When you have ED, you cant get or keep an erection.
Radical prostatectomy is a surgery to remove the prostate gland. When your surgeon removes the gland, they may damage the nerves and blood vessels that run along it. If theyre damaged enough, you wont be able to get an erection following the procedure.
Today, doctors can do nerve-sparing surgery, which helps prevent permanent ED. Your surgeon can still touch those nerves and blood vessels, causing ED as a temporary side effect. Many men have trouble getting an erection for a few weeks, months, or even years after their procedure.
Radiation therapy also damages blood vessels and the nerves that control erection. Up to half of men who have radiation for prostate cancer experience ED afterward. In some men, this symptom will improve with time. Sometimes radiation side effects dont appear until a few months after the treatment. If ED starts late, it may not be as likely to go away.
A few treatments can help with ED until youre able to have erections on your own again.
Additional treatments include the following:
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Are Prostate Problems Always A Sign Of Prostate Cancer
Not all growths in the prostate are cancerous, and not all prostate problems indicate cancer. Other conditions that cause similar prostate cancer symptoms include:
- Benign prostatic hyperplasia : At some point, almost every man will develop benign prostatic hyperplasia . This condition enlarges the prostate gland but doesnt increase cancer risk. The swollen gland squeezes the urethra and blocks the flow of semen and urine. Medications, and sometimes surgery, can help.
- Prostatitis: Men younger than 50 are more prone to prostatitis, inflammation and swelling of the prostate gland. Bacterial infections are often the cause. Treatments include antibiotics or other medications.
What Is The Prostate
The prostate is a small gland in the pelvis and is part of the male reproductive system.
About the size of a walnut, it’s located between the penis and the bladder, and surrounds the urethra.
The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.
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What You Can Do Now
Sexual side effects from prostate cancer treatment are often temporary, especially if your doctor used nerve-sparing surgery. While your body recovers, you can try a few things to maintain your sex life:
- Let your doctor know about any sexual problems youre having right away. Although it can be hard to talk about sex, being open and honest will help you get the treatment you need.
- See a therapist. Couples therapy can help you and your partner understand and deal with sexual issues.
- Take care of yourself by exercising, eating a well-balanced diet, reducing stress, and getting enough sleep. Looking and feeling your best will give your self-esteem and mood a boost.
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the ‘stage’ of your prostate cancer . The stage of the cancer will determine which types of treatments will be necessary.
A widely used method of staging is a number staging system. The stages are:
- stage 1 the cancer is very small and completely within the prostate gland
- stage 2 the cancer is within the prostate gland, but is larger
- stage 3 the cancer has spread from the prostate and may have grown into the tubes that carry semen
- stage 4 the cancer has spread into the lymph nodes or another part of the body, including the bladder, rectum or bones about 20 to 30% of cases are diagnosed at this stage
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
Read further information:
- Cancer Research UK: the stages of prostate cancer
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What Are The Different Types Of Prostate Cancer Surgery
The most common one is called a radical prostatectomy. In this procedure, the entire prostate gland is removed, along with some of the surrounding tissue. In some cases, nearby lymph nodes are removed as well. There are several surgical approaches for this, including traditional open surgery. We can also use minimally invasive procedures, such as laparoscopic surgery and robot-assisted laparoscopic surgery.
A critical aspect of a radical prostatectomy is tailoring it to the individual features of each mans cancer. One size does not fit all. This means the exact same procedure is not appropriate for every person. The location, size, and other features of the cancer are considered to design an operation that is appropriate for the person.
In a laparoscopic radical prostatectomy, a surgeon inserts a tiny camera called a laparoscope through a small cut in the abdomen. The camera gives doctors a magnified, high-definition picture of the prostate gland. With that image as a guide, the surgeon can remove the prostate, seminal vesicles, and lymph nodes using special tools.
To do a robot-assisted procedure, a surgeon sits at a console that has a screen as well as hand, finger, and foot controls. The surgeons hand, wrist, finger, and foot movements control the robotic instruments inside the patient in real time.
Should I Use Supplements Or Herbal Remedies
Some people like to use dietary supplements or herbal remedies, but theres little evidence theyre helpful for men with prostate cancer. Some may even be harmful.
Dietary supplements
Theres little evidence that supplements are helpful for men with prostate cancer. Some supplements may interfere with your treatment for prostate cancer, so let your doctor or nurse know if youre taking any.
Most people should be able to get all the nutrients they need by eating a balanced diet, without taking supplements. If you do choose to take supplements, dont take more than the recommended daily allowance for each nutrient because large doses could be bad for your health.
Some men may need to take specific supplements. For example,
- Vitamin D. Between October and March, try to take 10 micrograms of vitamin D supplements every day. This is because during these months, there is not enough sunlight in the UK for your body to produce enough vitamin D.
- Calcium. If youre on hormone therapy, your doctor might recommend calcium supplements.
Herbal remedies
Some men like to take herbal medicines to help manage their prostate cancer or the side effects of treatment. For example, some men drink sage tea to help with hot flushes. But there is very little evidence that herbal remedies can help to treat prostate cancer or reduce side effects.
Herbal supplements being tested
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Psa Tests And Screening
Testing for cancer when you have no symptoms is called screening. There is no national screening programme in Ireland, as theres little evidence that screening would reduce deaths from prostate cancer. It also could mean men having unnecessary treatment for very slow-growing prostate cancer, which could cause side-effects that affect their lives more than the cancer would.
If youre worried
Talk to your GP about:
- Your risk of prostate cancer eg if you have close family members with prostate cancer
- The pros and cons of prostate cancer screening
- What the tests involve
- The decisions you might have to make if your PSA was raised
- How these decisions might affect your life. Eg having treatment and getting side-effects
Should I use a home PSA test kit?
Prostate problems are best diagnosed by your GP, who can take your medical history and carry out a physical examination, as well as doing the PSA test.
Remember – your PSA level can be raised for other reasons it doesnt mean you have prostate cancer. Its also possible to have cancer and a normal PSA level. Read more about understanding PSA test results.
Diagnosing prostate cancer
Your family doctor will talk to you about your symptoms. He or she may do some tests. For example:
Digital rectal examination Inserting a gloved finger into your back passage to see if your prostate feels normal. It can be a little uncomfortable but it doesnt take long.
Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men and anyone with a prostate aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men and anyone with a prostate of African-Caribbean African descent. It’s less common in men and anyone with a prostate of Asian descent.
Men and anyone with a prostate who have first-degree male relatives affected by prostate cancer are also at a slightly increased risk.
Read more about the causes of prostate cancer
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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.
Ask Your Prostate Surgeon The Right Questions
The choice of prostate cancer treatment depends on such factors as age and general health, as well as a patients risk categorization determined by their Gleason score. The Gleason score, a way of estimating how likely the cancer is to spread, is determined based on a biopsy sample. Gleason risk groups range from low/very low to intermediate to high/very high.
First, you need as much information as possible about your prostate cancer. Yale Medicine has an Active Surveillance Program that uses advanced imaging and real-time ultrasound to monitor and biopsy suspicious lesions. Many patients in the program who have a low-grade form of prostate cancer never need surgery, Dr. Sprenkle says.
For men who do need surgery, there are at least three questions they should be sure to ask the surgeon, he adds. The first is which surgical approach is going to provide the best control of the cancer? The second is which approach will have the fewest side effects? The third is which approach tends to have the swiftest recovery, the quickest hospital stay, and fastest return to function?
“Its better to focus on finding the right surgeon rather than the approach or type of surgery,” says Yale Medicine urologist Preston Sprenkle, MD.
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What Happens When Prostate Cancer Is Left Untreated
While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their healthcare providers monitor their cancer.
Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, healthcare providers will initiate cancer treatment only if cancer starts growing.
Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.
This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your healthcare provider and family.
What Are Common Risk Factors For Prostate Cancer
As I mentioned earlier, I most commonly see prostate cancer in men over 60. And like many other types of cancer, prostate cancer risks increase as you get older. Other risk factors can include:
- A family history of prostate cancer If you have a close family member, such as a father or brother, with prostate cancer, youre 2 to 3 times more likely than other men to develop prostate cancer .
- Genetics Many of my patients often ask if prostate cancer is hereditary. Hereditary prostate cancer does exist, but only 5 to 10 percent of all prostate cancers are hereditary due to a single inherited gene mutation.
- Race Black men are at a higher risk of prostate cancer than men of other races, and were not sure why.
- Obesity Obese men who are diagnosed with prostate cancer may be more likely to have an advanced cancer thats more difficult to treat.
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How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasn’t spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
When To See A Doctor
Consult with your doctor if you experience any of the symptoms discussed on this page particularly if they have been going on for a while. You will need a thorough work-up to determine the underlying cause, which may or may not be prostate cancer.
Its important to understand that other diseases or disorders can share these same symptoms. Benign prostatic hyperplasia , also called enlargement of the prostate, and are quite common. Men with these benign conditions can experience symptoms more often and more severely than men with prostate cancer.
Erectile dysfunction is relatively common, especially as one ages, and can also have causes unrelated to prostate cancer, such as smoking or cardiovascular disease. Experiencing a lower amount of fluid during ejaculation can be related to something as simple as diet or dehydration.
Its important to keep track of your symptoms, determining whats normal or abnormal for your own body. If you are worried about a particular symptom, or if its interfering with a relationship, you should discuss your concerns with your primary care physician.
Prostate Cancer | Bills Story
After being diagnosed with prostate cancer, Bill Shipp, a championship swimmer, came to The Johns Hopkins Hospital seeking a second opinion. Watch his story.
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