Important Facts About Prostate Cancer

The Condition, Its Causes and Effects

Prostate cancer is a major health concern among men age 50 and older. Since 1980, the incidence of prostate cancer has risen steadily to become the second most common cause of cancer-related deaths among men, exceeded only by lung cancer¹. This increase in prostate cancer cases has led to heightened awareness of the disease and improved diagnostic and treatment methods.

The prostate is a gland of the male reproductive system.
This walnut-sized organ, located below the bladder and behind the base of the penis, produces fluid that carries sperm during ejaculation. The urethra that carries urine to the outside of the body runs through the gland.
Prostate cancer refers to a malignant tumor that most often begins in the outer tissue of the prostate. As the tumor grows, it may spread to the inner tissue of the prostate.
Prostate cancer is the most common internal cancer in American men and outnumbers breast cancer in the number of new cases diagnosed each year though² it receives much less media attention. One out of every six American men will develop prostate cancer at some time in life³.
In 2003, approximately 220,900 new cases of prostate cancer will be diagnosed and an estimated 28,900 men are expected to die of this disease, according to the American Cancer Society⁴. In all, prostate cancer accounts for about 10% of male cancer-related deaths⁵.
Risk factors for prostate cancer include men age 50 and over, a family history of two or more first-degree relatives with the disease and African-American men. For reasons not fully understood, African-American men have the greatest incidence of prostate cancer in the world and a mortality rate more than double that of Caucasian men⁶.

Diagnosis, Grading and Treatment

If diagnosed early, prostate cancer is treatable and most often cured. To ensure early detection, men age 45 years and over should receive an annual prostate exam, including a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. Those with known risk factors should begin this routine at age 40⁷. Because there are no symptoms of early-stage prostate cancer, an exam is necessary to make the diagnosis. Men with advanced prostate cancer may experience symptoms such as a weak or interrupted urine flow, increased frequency or difficulty in urinating, pain or burning during urination, blood in the urine, or dull, persistent pain in the back, hips or pelvis.
A prostate-specific antigen (PSA) test and digital rectal exam (DRE) are commonly used to detect prostate cancer. PSA is a protein produced by prostate cells that resides in the blood. For men in their forties, the PSA should not be higher than 2.5; for men in their fifties it should not be higher than 3.5, and thereafter it should not be higher than 4.0⁸. However, because conditions such as benign prostatic hyperplasia (an enlarged prostate) can contribute to elevated PSA levels, additional tests are necessary. During a DRE, a doctor inserts a gloved, lubricated finger into the patient's rectum to feel for any irregular or abnormally firm area that might be cancerous. If either a DRE or PSA is abnormal, an ultrasound and biopsy are the next steps for diagnosis.
85% of all prostate cancers are found in the local and regional stages (local means it is still confined to the prostate; regional means it has spread from the prostate to nearby areas, but not to distant sites such as other organs). The 5-year disease-specific survival rate for all of these men is nearly 100%⁹.
Of the roughly 6% of men whose prostate cancers have already spread to distant parts of the body at time of diagnosis, 34% will survive at least five years¹⁰.
To determine the growth rate of prostate cancer, a grading system called the Gleason System is used after viewing the cancerous tissue under a microscope. Scores of two through four are considered low, five and six intermediate, and scores of seven to ten are considered high. The higher the score, the more likely the cancer will grow and spread rapidly.
If a prostate biopsy finds cancer, a process called staging is used to determine how far the cancer has spread. The selection of tests for prostate cancer staging is based on a patient's PSA and DRE results and Gleason score. Staging is a standardized method by which cancer care teams describe the extent of a tumor's stage. There are four categories, ranging from T1 (least severe) to T4 (most severe) used to describe the spread of a tumor. The stage is very important to determine the most appropriate treatment option. Stage T1 refers to a cancer tumor that is neither felt during a digital rectal exam nor through imaging tests, but cancer cells are found in a biopsy specimen. Stage T2 means that a doctor can feel the prostate cancer and that it remains within the prostate gland, while T3 refers to cancer that has spread to connective tissue next to the prostate and/or seminal vesicles, but not any other organs. Stage T4 means it has spread beyond the prostate.
Many treatment options are available for prostate cancer, ranging from radiation therapy to prostate removal (radical prostatectomy) to cryotherapy (minimally invasive freezing to kill the cancer). New data supporting cryotherapy indicates that this therapy is highly effective in treating prostate cancer.

American Cancer Society, "Cancer Facts & Figures." Pages 10, 16. www.cancer.org, 2003.
American Cancer Society, "Cancer Facts & Figures," Page 10. www.cancer.org, 2003.
American Cancer Society, "Cancer Facts & Figures," Page 14. www.cancer.org, 2003.
American Cancer Society, "Cancer Facts & Figures." Page 4, www.cancer.org, 2003.
American Cancer Society, "Cancer Facts & Figures." Page 10, www.cancer.org, 2003.
American Cancer Society, "Cancer Facts & Figures." Page 10, www.cancer.org, 2003.
Us Too Prostate Cancer Education and Support, "Screening Recommendations." www.ustoo.org, September 2003.
Us Too Prostate Cancer Education and Support, "Screening Recommendations." www.ustoo.org. September 2003.
American Cancer Society, "What Are the Key Statistics About Prostate Cancer?" www.cancer.org, 2003.
American Cancer Society, "What Are the Key Statistics About Prostate Cancer?" www.cancer.org, 2003.

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