What is Prostate Cancer?
What is Prostate Cancer?Prostate cancer occurs when cells in the prostate—a gland that makes the seminal fluid that transports sperm—grow abnormally, forming malignant tumors. It is one of the most common cancers in men. Although prostate cancer often grows slowly, aggressive forms of the disease do occur and require prompt treatment to prevent its spread to other organs. Recognizing the symptoms of prostate cancer and the significance of different stages of the disease can help patients make informed decisions about their care.
Stages of Prostate Cancer
StagesDoctors who treat cancer patients use staging to determine and describe how far the disease has spread or progressed. Patients who are diagnosed will be evaluated as having one of the following four prostate cancer stages:
- Stage I - Cancer has been found in the prostate gland on a digital rectal exam or an ultrasound
- Stage II - The tumor is still restricted to the prostate gland. The patient has a higher PSA level than those with Stage I cancer.
- Stage III - Cancerous cells may have spread beyond the prostate to other tissues close to the gland. These tissues and organs can include the rectum, bladder, and/or the wall of the pelvis.
- Stage IV - Prostate cancer may have spread to the lymph nodes and/or parts of the body that are distant from the prostate gland
Types of Prostate Cancer
TypesProstate cancer is also assessed by type. Adenocarcinomas are by far the most common kind of prostate cancer. Types of prostate cancer include:
- Adenocarcinomas - Tumors that arise in the cells of the gland. There are two kinds of adenocarcinomas, acinar adenocarcinoma (conventional adenocarcinoma), the more frequently occurring subtype, and prostatic ductal adenocarcinoma, a more aggressive disease that occurs specifically in the cells lining the tubes and ducts of the gland.
- Small cell carcinoma - An aggressive type of prostate cancer that forms in the cells of the neuroendocrine system; these cells are responsible for making and releasing hormones
- Neuroendocrine tumors - Other than small cell carcinomas
- Prostate sarcoma - A form of cancer that develops in tissue that is adjacent to the prostate glands (e.g. muscle and nerves) and spreads to the prostate
- Transitional cell carcinomas - Prostate cancer that spreads to the prostate from the urethra or the bladder. Rarely this type of cancer originates in the prostate and spreads to the bladder or urethra.
Symptoms & Signs of Prostate Cancer
SymptomsIn some cases, newly diagnosed men will not have any noticeable signs of prostate cancer. A routine prostate exam or a blood test for PSA (prostate-specific antigen, a possible marker of prostate cancer) as part of a general wellness visit may be the first signal to your doctor that more evaluation is needed.
Similarly, some patients with prostate cancer will not report any symptoms of the disease. When prostate cancer symptoms do occur, they can include:
- Difficulty starting urination, a weak stream, or urination that starts and stops
- Urinary urgency
- Frequent urination
- Painful urination, may be described as a burning sensation
- Blood in the urine
- Blood in the semen
- Pain on ejaculation
- Persistent lower back, hip or pelvis pain
It's important to note that some of the symptoms associated with prostate cancer also occur with benign (noncancerous) conditions, such as infection of the prostate or age-related enlargement of the prostate.
Advanced prostate cancer symptoms
Like their counterparts with milder forms of the disease, men with advanced prostate cancer may not have any symptoms or may experience the same discomfort or difficulties with urination or ejaculation. However, advanced prostate cancer symptoms may also include:
- Fatigue
- Unexplained weight loss
- Bone pain
- Swelling in the legs
What Causes Prostate Cancer?
CausesResearchers have not been able to identify the exact cause of prostate cancer, but evidence shows that changes in genetic material (DNA)—also called mutations—may play a role. Men who develop prostate cancer may have inherited these genetic changes or they may develop them over the course of their lifetime.
Inherited changes to the DNA may play a role in about 1 out of 10 cases of prostate cancer. One theory about changes to the DNA that occur during the patient's lifetime is that inflammation in the prostate may turn normal cells cancerous. Researchers are also considering whether radiation or exposure to cancer-causing chemicals (which are linked to other cancers) may lead to acquired mutations in the prostate cells, but this has not been proven.
Risk Factors
Risk FactorsHaving risk factors for prostate cancer doesn’t mean that you will definitely develop the disease. In fact, some people who develop prostate cancer have no risk factors for the disease at all.
Risk factors linked to prostate cancer include:
- Family history - A man with a brother or father who has had cancer has more than twice the risk of those without this medical history
- Race/ethnicity - Although the reason for these findings is unclear, African-American men and Caribbean men of African ancestry are at elevated risk. (African-American men are also more likely to develop prostate cancer at an earlier age, have a more serious form of the disease and to die from prostate cancer.) Asian-American and Hispanic/Latino men are at reduced risk when compared with non-Hispanic whites.
- Age - Prostate cancer is usually diagnosed in men over 65. The disease is rare in men 40 and under and risk increases after age 50.
- Geography - Locations with a higher rate of prostate cancer include North America, Australia, northwestern Europe and the Caribbean islands. Prostate cancer is less common in South America, Asia, Africa and Central America. Lifestyle factors, such as diet, may play a role in this phenomenon.
- Obesity - Some research suggests that men who are obese are at greater risk of developing prostate cancer than men who are not overweight. Moreover, findings suggest that in obese patients, prostate cancer is more aggressive and more likely to recur after treatment.
Additional factors may contribute to prostate cancer risk, but their role in developing the disease has not been confirmed. These include: diet, smoking, chemical exposure, prostate inflammation, having had a vasectomy, and sexually transmitted diseases.
How to Prevent Prostate Cancer
PreventionSome lifestyle changes may help prevent prostate cancer. You may be able to reduce your risk by following these guidelines:
- Maintain a healthy weight
- Follow a healthy diet:
- Eat a diet rich in fruits and vegetables
- Consume green tea and soy products: Green tea contains a component believed to interfere with the development of prostate cancer, and soy has been shown to lower PSA levels
- Do not eat charred meat: Research suggests that meat cooked at high temperatures can produce a cancer-causing chemical
- Get sufficient vitamins and minerals through foods: Vitamin D, which may be particularly protective, can also be acquired by 10 minutes of daily sun exposure without sunscreen
- Exercise on a regular basis to keep weight in check and help maintain a healthy immune system
- Drink less alcohol and stop smoking. Both habits can contribute to cancer risk
- Stay sexually active. Some evidence suggests that more frequent ejaculation, alone or with a partner, may reduce substances that cause inflammation
- Ask your doctor about drug therapy. Some men at high risk for developing prostate cancer are advised to take drugs known as 5-alpha reductase inhibitors, the same medication used to treat benign (non-cancerous) prostate enlargement. However, evidence suggests that although these drugs reduce overall risk, they may increase the risk of developing high-grade prostate cancer. Your doctor can review the risks and benefits of starting these medications.
Trust NewYork-Presbyterian for Prostate Cancer Care
To learn more about prostate cancer prevention, risk, and treatment, schedule an appointment at one of NewYork-Presbyterian's multiple locations throughout New York City, Westchester, or the Hudson Valley. If you’re dealing with a prostate cancer diagnosis, our highly experienced specialists will review all available treatment options, including the latest developments in care.