Risk Factors

Several factors influence the risk of developing prostate cancer:

• Age: The chance of developing prostate cancer gets higher as a man ages. In the United States, most men with prostate cancer are over age 65.
• Family history of prostate cancer: A man's risk is higher if his father, brother, or son had prostate cancer, especially if the relative had the cancer at a young age. Learn more about hereditary cancer risk from our Family Cancer Assessment Clinic.
• 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.
• Certain prostate changes: Men known to have prostatic intraepithelial neoplasia (PIN) may have a higher risk of prostate cancer. PIN means abnormal prostate cells were found when examined under a microscope.
• Certain genetic changes: Some research studies have shown a higher risk of prostate cancer among men with changes in certain genes, such as BRCA1 and BRCA2.

Prevention studies

Researchers are studying if certain drugs and nutritional supplements may help prevent prostate cancer. Contact the Cancer Learning Center for more information about these studies or how to reduce the risk of developing cancer.

Symptoms

A man with prostate cancer may not have any symptoms. For men who do have symptoms, these are the most common:

• Urinary problems, including the following:
  • Inability to pass urine
  • Trouble starting or stopping the urine flow
  • Needing to urinate often, especially at night
  • Weak urine flow
  • Urine flow that starts and stops
  • Pain or burning during urination
• Difficulty having an erection
• Blood in the urine or semen
• Frequent pain in the lower back, hips, or upper thighs

Most often, these symptoms are not due to cancer. A man with any of these symptoms should see his health care provider so the problem can be diagnosed and treated as early as possible.

Screening and Diagnosis

Doctors can check for signs of prostate cancer before any symptoms develop. Doctors use one or both of the following tests to screen for prostate cancer:

• Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall. The prostate is checked for hard or lumpy areas.
• Blood test for prostate-specific antigen (PSA): Doctors draw blood to check the level of PSA, a protein released by prostate cells. The level of PSA is higher when the prostate is enlarged or stimulated. Usually, inflammation or enlargement of the prostate (called benign prostatitic hyperplasia) causes a high PSA level. Prostate cancer may also cause a high PSA level.

These tests can find a problem in the prostate. However, they can't show whether the problem is cancer. If a man has abnormal test results, the doctor may also order an ultrasound and biopsy:

• Transrectal ultrasound: The doctor inserts a probe into the rectum to check the prostate for abnormal areas. The probe sends out sound waves that people cannot hear. The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
• Transrectal biopsy: The doctor removes prostate tissue to look for cancer cells. A biopsy is the only way to know for sure if cancer is present. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is used to guide the needles. Doctors then check the tissue samples for cancer cells by examining them under a microscope.

Staging

If a biopsy shows cancer, the doctor needs to learn the stage (extent) of the disease to help choose the best treatment. Staging is the process of finding out whether the cancer has spread and, if so, to what parts of the body.

Some men may need tests that make pictures of areas inside the body (called imaging tests):

• Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, or swollen lymph nodes.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.

Grading

If cancer cells are found, a doctor called a pathologist studies the tissue samples from the prostate to find out the grade of the tumor. The grade tells how much the cancer cells differ from normal prostate cells. It also tells how fast the tumor is likely to grow.

One system uses grades 1 through 4 (G1 to G4). Tumors with higher grades tend to grow faster and are more likely to spread than those with lower grades (for example, G4 is more likely than G1, G2, or G3 to grow quickly and spread). Doctors use tumor grade along with the patient's age and other factors to suggest treatment options.

Another system of grading is a Gleason score. Gleason scores range from 2 to 10. A high Gleason score (such as 9 or 10) means the tumor is more likely to grow quickly and spread.

Stages of Prostate Cancer

Stage I: The cancer can't be felt during a digital rectal exam, and it can't be seen on a sonogram. The cancer is found when prostate surgery is done for another reason, usually for benign prostate swelling. The cancer is only in the prostate.

Stage II: The tumor is more advanced or a higher grade than stage I, but the tumor doesn't extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.

Stage III: The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven't spread to the lymph nodes.

Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.

Recurrent prostate cancer: Cancer that has come back after it has been treated. The cancer may come back in the prostate or in other parts of the body.

Treatment

At Huntsman Cancer Institute, prostate cancer is treated by a team of specialists, including urologists (doctors who specialize in diseases of the urinary system), surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Prostate cancer treatment options include the following:

• Watchful waiting
• Surgery
• Radiation therapy
• Hormone therapy
• Chemotherapy
• Clinical trials

Patients may have a combination of treatments. The treatment that's right for each patient depends on the patient's age, the grade of the tumor, the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, and the patient's overall health.

Watchful waiting

Watchful waiting (also called active surveillance or expectant management) means the health care team closely monitors the prostate but does not give any treatment unless exam results show the disease is growing. During watchful waiting, patients will be given certain exams and tests on a regular schedule. This option is used to find early signs that the condition is getting worse. Only men diagnosed with early-stage prostate cancer use this option.

Surgery

Surgery to remove the prostate is called a prostatectomy. There are several surgery options available at Huntsman Cancer Institute:

• Retropubic prostatectomy: This is surgery to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time.
• Perineal prostatectomy: This is surgery to remove the prostate through an incision made in the perineum (the area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen.
• Laparoscopic prostatectomy: This is surgery to remove the prostate and nearby lymph nodes using long, narrow instruments that are inserted into the abdomen through several small incisions. A video camera inside one of the instruments allows the surgeon to see.
• Robotic-assisted laparoscopic prostatectomy: This type of prostatectomy uses the daVinci Robotic System. Surgeons use a computer console in the operating room to control instruments that access the patient's prostate through five small incisions in the abdomen. The benefits of this surgery may include the following:
  • Less nerve and bladder damage
  • More complete tumor removal
  • Smaller incisions
  • Faster recovery time

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area. Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

• External radiation: The radiation comes from a large machine outside the body. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the prostate.
• Internal radiation (brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. The seeds are implanted into the prostate through a needle. The seeds give off radiation that destroys the prostate. The following factsheets explain this procedure, and what patients can expect once the seeds are implanted:
  
  • Permanent Prostate Seed Implant
  • Discharge Instructions: Prostate Radiation Implant

Hormone therapy

This treatment uses drugs or surgery to stop the production of hormones that feed prostate cancer growth. A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for recurrent prostate cancer.

Male hormones (called androgens) can cause prostate cancer to grow. The testicles are the male body's main source of the hormone testosterone. The adrenal gland makes other hormones and a small amount of testosterone.

Doctors may suggest a treatment that can block natural hormones:

• Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
• Antiandrogens: These drugs can block the action of male hormones such as testosterone. Other drugs can prevent the adrenal gland from making testosterone.
• Surgery: Removing the testicles (called an orchiectomy) is another type of hormone therapy for prostate cancer.

Chemotherapy

This treatment uses drugs to kill and control cancer throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or to ask any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.