Urological Oncology ... Prostate Cancer

Prostate Cancer

In General………

Prostate cancer is one of the most common medical conditions seen by physicians in the United States. Not surprisingly, it is the second most common type of cancer diagnosed among men in this country. Only skin cancer is more common.

So What is the Prostate………….

The prostate is an important part of a male’s reproductive system. It is a glandular organ located in front of the rectum and underneath the bladder. The prostate surrounds the urethra, which is the tube that carries urine from the bladder through the penis to the outside world. A normal prostate is about the size of a walnut. However, if the prostate gland grows too large, it may compress the urethra, which could slow or even stop the flow of urine from the bladder through the penis.

The prostate is a gland that makes the alkaline (non acidic) portion of seminal fluid. During ejaculation, the seminal fluid helps carry sperm out of the man's body as part of semen.  Male hormones, technically known as androgens are the biochemicals that make the prostate grow. The testicles are the main source of male hormone production. Although there are many different subtypes of male hormones, the most predominant subtype is  known as testosterone. The adrenal gland also makes testosterone, but in small amounts.

Cancer Cells

Cells are the building blocks of all living things. When groups of like cells grow together, they make up sheets known as tissues. Tissues make up the organs of the body. Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, but the body knows to make just enough new cells to take their place. The membranes of our cells contain sensors that stop the growth of that cell. However, sometimes, this process goes wrong. Sensors in the cell membrane don’t tell the cell to stop dividing and making new cells. Consequently, new cells continue to form  even when the body doesn't need them. The buildup of extra cells form a lump of tissue which then becomes a mass of tissue that is commonly known as a tumor.  Prostate tumors can be benign (not cancerous) or malignant (cancerous). Cancer cells can spread by breaking away from the prostate tumor. They enter blood vessels or lymphatic vessels, which branch into all the tissues of the body. The cancer cells can attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis.

Normal (Non Cancer) Cells

Benign Prostatic Hyperplasia (BPH) is a benign growth of prostate cells. It is NOT cancer. The prostate grows larger and squeezes the urethra. This prevents the normal flow of urine. BPH is a very common problem. In the United States, most men over the age of 50 have symptoms of BPH. For some men, the symptoms may be severe enough to need treatment.

Risk Factors

When you're told you have prostate cancer, it's natural to wonder what may have caused the disease. But no one knows the exact causes of prostate cancer. Doctors seldom know why one man develops prostate cancer and another doesn't. However, research has shown that men with certain RISK FACTORS are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for prostate cancer:
Age over 65: Age is the main risk factor for prostate cancer. The chance of getting prostate cancer increases as you get older. In the United States, most men with prostate cancer are over 65. This disease is rare in men under 45.

Family History: Your risk is higher if your father, brother, or son had prostate cancer.

Race: Prostate cancer is more common among black men than white or Hispanic/Latino men. It's less common among Asian/Pacific Islander and American Indian/Alaska Native men.

Cellular Prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk of prostate cancer. These prostate cells look abnormal under a microscope.

Subcellular Genome changes: Researchers have found specific regions on certain chromosomes that are linked to the risk of prostate cancer. According to recent studies, if a man has a genetic change in one or more of these regions, the risk of prostate cancer may be increased. The risk increases with the number of genetic changes that are found.

Who Should Be Screened for Prostate Cancer?

If William Shakespeare lived in the Age of Prostate Cancer, he may have asked “To screen or not to screen” that is the question. However, the answer of whether or not to screen is a personal and complex one. It’s important for each man to talk with his doctor about whether prostate cancer screening is right for him.
Although there is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening, most urologists are strong proponents. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. To say nothing of the almost 100 percent “cure rate” when the disease is picked up early.

Those who recommend against regular screening note that because most prostate cancers grow very slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems.

Ultimately, decisions about screening should be individualized based on a man’s level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer.
When to start screening is generally based on individual risk, with age 40 being a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate cancer at a young age). For otherwise healthy men at high risk (positive family history or African American men), starting at age 40-45 is reasonable.

Guidelines differ for men at average risk. Some recommend an initial PSA and DRE at age 40, and others recommend starting at age 50. In general, all men should create a proactive prostate health plan that is right for them based on their lifestyle and family history.

When to stop screening is also controversial. Some groups propose 75 as a reasonable cut-off age. Other groups suggest this is an individual decision based on life expectancy and overall current health.