Prostate Cancer

Overview

Prostate cancer starts from cells in the prostate gland. This gland is a part of the male reproductive system which also includes the penis, seminal vesicles, vas deferens, and testicles. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder). It produces fluid that makes up a part of semen.

As a man ages, the prostate often increases in size, either due to benign growth, prostate cancer, or both. This can cause the urethra to narrow, decreasing urine flow and making it harder to empty the bladder.

Prostate Cancer Symptoms

Prostate cancer may cause a variety of symptoms, or no symptoms at all (if found after elevated PSA screening exam).

If you have any of the following symptoms, be sure to see your doctor right away:

  • Difficulty starting urination
  • Weak or interrupted flow of urine.
  • Frequent urination, especially at night.
  • Difficulty emptying the bladder completely.
  • Pain or burning during urination.
  • Blood in the urine or semen.
  • Pain in the back, hips, or pelvis that doesn’t go away.
  • Painful ejaculation.

Keep in mind that these symptoms may be caused by conditions other than prostate cancer.

Prostate Cancer Risk Factors

All men with a prostate gland are at risk for developing prostate cancer. The most common non-cutaneous cancer in men, prostate cancer, will be diagnosed in 13% of American men during their lifetime, and about 2-3% of American men will die from prostate cancer (approximately 34,000 per year).

The most important risk factor is age. The older a man is, the greater the chance he will be diagnosed with prostate cancer. Additionally men with a family history of prostate cancer, as well as African American men are at an increased risk of developing the disease.

Family History (Genetic Risk Factors)

For some men, genetic factors may put them at higher risk of prostate cancer. You may have an increased risk of getting a type of prostate cancer caused by genetic changes that are inherited if:

  • You have more than one first-degree relative (father, son or brother) who had prostate cancer, including relatives in three generations on your mother’s or father’s side of the family
  • You were diagnosed with prostate cancer when you were 55 years old or younger.
  • You were diagnosed with prostate cancer and other members of your family have been diagnosed with breast, ovarian, or pancreatic cancer.

Prostate Cancer Screening

In 2018, the U.S. Preventive Services Task Force (USPSTF) made the following recommendations about prostate cancer screening:

  • Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test (see below).
  • Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
  • Men who are 70 years old and older should not be screened for prostate cancer routinely.

This recommendation applies to men who:

  • Are at average risk for prostate cancer.
  • Are at increased risk for prostate cancer.
  • Do not have symptoms of prostate cancer.
  • Have never been diagnosed with prostate cancer

PSA Testing

Prostate specific antigen (PSA) is released by the prostate and can be measured in the blood. It can be elevated by prostate cancer or other non-cancer related causes including:

  • Certain medical procedures.
  • Certain medications.
  • An enlarged prostate.
  • A prostate infection.

Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results. If the PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer.

Prostate Cancer Treatment

Treatment recommendations for localized prostate cancer are made after considering the risk group of a patient’s prostate cancer in the context of the patient’s personal values and overall health status. The prostate cancer risk group is determined by the patient’s PSA, their biopsy result, and the extent of disease on examination. The risk group ranges from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups. Radical surgery and definitive radiotherapy are two NCCN guideline supported treatments for localized prostate cancer, and patients should be counseled by a urologist and radiation oncologist before deciding on their treatment.

Radiation Therapy at CCC

Douglas County patients with prostate cancer who are candidates for radiation therapy have access to state-of-the-art treatment at the Community Cancer Center. Radiation treatment is delivered using external beam radiotherapy with x-rays which are neither seen nor felt. Patients are treated daily, typically for 5 and a half weeks. The treatment itself is typically less than 5 minutes, while a patient can expect to be in the clinic about 45 minutes per day. Daily image guided intensity modulated radiotherapy is used to safely reduce the treatment margins which allows complete cancer target coverage while reducing the dose received by the nearby healthy tissues.