Take The Journey

Overview

Normally, cells within the prostate grow, divide, interact, and die to make sure the prostate functions properly. Prostate cancer occurs when the prostate cells stop functioning normally. The cells form unnecessarily or don’t die as they should, creating a build-up of cells known as a tumor.

Incidence

Among American men, prostate cancer is the most common cancer (excluding skin cancer), with estimates of 217,730 men diagnosed in 2010. An estimated 32,000 men are projected to die from prostate cancer in United States this year.  Each year, about 8,000 cases of prostate cancer are diagnosed at an advanced stage. Further, the National Cancer Institute predicts a 17 percent increase in prostate cancer deaths in 2010 compared to 2009.

Risk Factors

• Older than age 65
• Father, brother or son who had prostate cancer
• African Americans are at higher risk than Caucasians and Hispanics. Prostate cancer is less common in Asians, Pacific Islanders, American Indians and Alaskan Natives
• Pre-cancerous prostate changes, which can be a precursor to cancer
• Genetic (chromosomal) abnormalities, such as a certain altered or missing gene 

Diagnosis

There are certain symptoms that may be associated with prostate cancer, including:

• Trouble passing urine or a frequent urge to urinate, especially at night
• Weak or interrupted urine stream
• Pain, burning or blood when urinating
• Painful ejaculation or blood in the semen
• Nagging pain in the back, hips or pelvis

Screening tests may help detect prostate cancer before symptoms are present, including:

• Digital rectal examination (DRE): A physician inserts a lubricated, gloved finger into the rectum to check for hard or lumpy areas in the prostate.
• Prostate specific antigen (PSA): PSA, a protein produced by the prostate that is released in very small amounts into the bloodstream, can signal a prostate problem.

Follow-up testing may be performed to pursue a diagnosis.

• Transrectal ultrasound: A rectally-inserted ultrasound probe checks the prostate for abnormal areas.
• Transrectal biopsy: Needles are inserted into the prostate through the rectum to obtain small tissue samples to confirm or rule out prostate cancer.

Disease progression may be monitored through assessment of a patient's clinical symptoms, their physical exam findings, blood tests (such as the Prostatic Specific Antigen, or "PSA, " blood counts, and chemistry panels), plain x-rays or multi-dimensional radiographic imaging (such as CT Scanning and MRI), and/or radio-labeled imaging studies (such as bone scans).

Staging

Staging determines the extent, or spread, of prostate cancer:

• Stage I: The tumor is confined to the prostate
• Stage II: The tumor is more advanced than Stage I, but doesn’t extend beyond the prostate.
• Stage III: The tumor extends beyond the prostate and may have invaded the seminal vesicles (tubular glands above the prostate), 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), and may have spread to the lymph nodes, bones or to other parts of the body. This is known as advanced prostate cancer.

A Gleason score is used to describe how closely cancer cells look like normal cells, with cancer being less aggressive the closer it looks to normal. On a scale from 2–10, cancers with lower Gleason scores (2–4) tend be less aggressive, and cancers with higher scores (7–10) more.

Advanced Prostate Cancer

If the tumor is Stage III or IV and has spread to the nearby lymph nodes or beyond the seminal vesicles, it is called metastatic, or advanced, prostate cancer.

Locally advanced prostate cancer is thought of as a tumor that has spread outside the prostate capsule to the immediately surrounding area.

Metastatic disease means the cancer has spread to lymph nodes or other sites such as the bone, lung and liver.

Detection and Diagnosis

First, a pathologist examines a sample of the tumor under a microscope to determine the source and whether it has spread outside of the prostate.  Generally, cancer cells look like abnormal versions of cells in the tissue where the cancer began. Using specialized diagnostic tests, a pathologist is often able to tell where the cancer cells came from.

Metastatic cancer may be found before or at the same time as the primary prostate tumor, or months or years later. When a new tumor is found in a patient who has been treated for cancer in the past, it is more often a metastasis than another primary tumor.

Prostate cancer most commonly spreads to the bones, typically the spine, pelvis and rib cage.  Bone metastases occur in approximately 90 percent of men with advanced disease. Advanced prostate cancer may be accompanied by painful symptoms, usually involving the urinary tract or bones, along with weakness, fatigue and weight loss.

Sometimes a person’s primary cancer is discovered only after the metastatic tumor causes symptoms. For example, a man whose prostate cancer has spread to the bones in his pelvis may have lower back pain caused by cancer that has spread to his bones. This may occur before he experiences any symptoms from the primary tumor in his prostate.

The long term prospects for men with Stage III prostate cancer depend on the extent of the disease. Once the cancer has broken through the prostate capsule, chances that the disease will progress in the next 10 years are 50 percent.  It has been estimated that, at diagnosis, 16% of men will present with advanced disease.

Treatment Decisions

Men with prostate cancer should speak with their physician about treatment options.

A healthcare team takes many factors into consideration to determine each person’s individualized treatment plan for prostate cancer. These can include a man’s life expectancy, age, co-morbidities (additional health risks), his preference regarding treatment and the potential side effects of treatments. As opposed to early stage prostate cancer, men who have advanced disease have different options. These may include chemotherapy, radiation therapy, hormone therapy (androgen deprivation therapy/ADT) and immunotherapy.