Here are some of the questions that are most frequently posed about prostate cancer . While answers to new questions submitted by subscribers are answered by members of the Prostate Cancer Week Medical Advisory Board, the FAQ data base draws heavily on responses developed by the National Cancer Institute. If you have questions that are not answered in our FAQ Archive, feel free to submit them via email to editor@prostatecancerweek.org.

What is the prostate?

The prostate is a male sex gland, part of a man's reproductive system. It produces a thick fluid that forms the majority of the semen. The normal prostate is about the size of a walnut. It is located below the bladder and in front of the rectum. the average prostate in a patient with prostate cancer is about twice the size of a normal prostate.

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What is prostate cancer?

Prostate cancer develops from the growth of cancerous cells within the prostate gland. Cancer of the prostate is the most common malignancy in American men after skin cancer. It is estimated that in 1999 in the United States nearly 179,300 men will be diagnosed with prostate cancer. In the majority of men with prostate cancer, it is very slow growing, and many, if not most, of these men will not die because of the prostate cancer, but rather will live with it until they eventually die of some other cause. Early prostate cancer is localized (confined) to the gland, and the majority of patients with localized prostate cancer have a long survival after diagnosis.

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Who is at risk for prostate cancer?

All men are at risk. The most common risk factor is age. More than 75 percent of men diagnosed with prostate cancer each year are over the age of 65. African American men have a higher risk of prostate cancer than white Americans. Dramatic differences in the incidence of prostate cancer are seen in different countries, and there is some evidence that a diet higher in animal fat may, in part, underlie these differences in risk. Genetic factors also appear to play a role, particularly for families in whom the diagnosis is made in men under 60 years of age. The risk of prostate cancer rises with the number of close relatives who have the disease.

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What are the symptoms of prostate cancer?

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate.

When symptoms do occur, they may include:

• Frequent urination, especially at night.
• Inability to urinate.
• Trouble starting or holding back urination.
• A weak or interrupted flow of urine.
• Painful or burning urination.
• Blood in the urine or semen (the fluid that is released through the penis during orgasm and made up of sperm from the testicles and fluid from the prostate and other sex glands).
• Painful ejaculation (the release of semen through the penis during orgasm).
• Frequent pain or stiffness in the lower back, hips, or upper thighs.

These can be symptoms of cancer, but more often they are symptoms of non-cancerous enlargement of the prostate. It is important to check with a doctor.

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What other prostate conditions can cause symptoms like these?

A variety of conditions may cause the above symptoms. As men get older, their prostate may grow bigger and block the flow of urine or interfere with sexual function. This common condition, called benign prostatic hyperplasia (BPH), is not cancer, but can cause many of the same symptoms as prostate cancer. Although BPH may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. Again, it is important to check with a doctor.

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Can prostate cancer be found before a man has symptoms?

Yes. Two tests are commonly used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam, in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate specific antigen (PSA). Together, these tests can detect many silent prostate cancers, those that have not caused symptoms.

Currently, the National Cancer Institute is supporting research to learn more about screening men for prostate cancer. This research will try to determine whether the blood test for PSA along with digital rectal examination can help reduce the death rate from this disease. It will also assess the risks and benefits of screening. At present, it is unclear whether routine screening of men who are not at unusually high risk will prove to save lives and outweigh the extra surgery, radiation, and complications of therapy for large numbers of patients, many of whom do not have aggressive or life-threatening tumors.

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How reliable are the two tests?

Neither of the screening tests for prostate cancer is perfect. Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the digital rectal exam can miss many prostate cancers.

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How is prostate cancer diagnosed?

The standard method to diagnose prostate cancer is a prostate biopsy, which can be performed in a doctor's office, after a positive serum PSA test or DRE. The urologist obtains tissue samples that are sent to a pathologist, who performs a microscopic examination to identify cancerous prostate tissue.

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How is prostate cancer classified?

Prostate cancer is characterized by both grade and stage. Grade is a term used to describe how closely a tumor resembles normal tissue. Based on the microscopic appearance of a tumor, pathologists (doctors who identify diseases by studying tissues under a microscope) may describe it as low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors.

Staging of prostate cancer means determining the site and location of the disease. Early prostate cancer, stages 1 and 2, is localized to the prostate gland. Stage 3 prostate cancer is locally advanced outside the gland. Stage 4 prostate cancer has spread to other organs or tissues.

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How is localized prostate cancer treated?

There are three generally accepted options for treatment of patients with localized prostate cancer: radical prostatectomy, radiation therapy, and surveillance (also called watchful waiting).

Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection and prevent damage to the opening of the bladder.

Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered by placing radioactive seeds in the prostate during a surgical procedure.

Surveillance, a third option sometimes referred to as watchful waiting, is recommended by doctors for some patients, particularly those who are older or have other medical conditions that are likely to compromise their health. These patients are followed with regular examinations. If there is evidence of cancer growth, active treatment may be recommended.

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How does a patient decide what is the best treatment option for localized prostate cancer?

Choosing a treatment option involves the patient and his family and doctor. Considerations include the grade and stage of the cancer, the patient's age and health, and the individual choices that each patient makes about the benefits and risks of each treatment option. Because there are several reasonable treatment options for most patients, the decision can be difficult. Patients may hear different opinions and recommendations. They should try to get as much information as possible. There is rarely a need to make a decision without time to understand the pros and cons of various approaches.

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What about hormone therapy?

When a man undergoes hormone therapy, the level of male hormones is decreased. This drop in hormone level can affect all prostate cancer cells, even if they have spread to other parts of the body, keeping them from getting the male hormones they need to grow.

Not every patient diagnosed with prostate cancer needs hormonal therapy. Hormonal therapy is usually used:

Prior to surgery or radiotherapy, to reduce the volume of the prostate gland.

When prostate cancer that has metastasized to other parts of the body. Prostate cancer that has spread can usually be controlled with hormone therapy for a period of time, but most prostate cancers eventually are able to grow with very little or no male hormones. When this happens, hormone therapy is no longer effective.

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What is cyrosurgery?

Cryosurgery (also called cryotherapy) is the use of extreme cold to destroy cancer cells. Cryosurgery is being evaluated in the treatment of a number of cancers, including prostate cancer.

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