- 1 in 6 men will be diagnosed with prostate cancer in their lifetime – a new case is diagnosed every 2.1 minutes.A man dies from prostate cancer every 18 minutes.
- In 2012, 242,000 new cases of the disease will be diagnosed and 28,000 men will die of prostate cancer.
- Prostate cancer is the most frequently diagnosed cancer in men after skin cancer.
- A man is 35% more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
- The incidence rates are nearly double for African American men.
- If detected and treated early, prostate cancer has a 95 percent success rate.
- While there are cases of prostate cancer showing up in younger men, it is recommended that men begin an annual screening at age 50 and at age 40 if there is a family history.
WHAT IS PROSTATE CANCER?
The normal prostate is a small, squishy gland about the size of a walnut. It sits under the bladder and in front of the rectum. The urethra—the narrow tube that runs the length of the penis and carries both urine and semen out of the body—runs directly through the prostate. The rectum, or lower end of the bowel, sits just behind the prostate and the bladder.
Sitting just above the prostate are the seminal vesicles—two little glands that secrete about 60% of the substances that make up semen. Running alongside and attached to the sides of the prostate are the nerves that control erectile function.
The prostate is not essential for life, but it’s important for reproduction. The prostate typically grows during adolescence under the control of the male hormone testosterone and its byproduct DHT, or dihydrotestosterone. Prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumors. The term “cancer” refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably. Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process. Unlike normal cells, instead of dying, as they should, cancer cells outlive normal cells and continue to form new, abnormal cells.
Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect.
WHAT IS METASTATIC PROSTATE CANCER?
Metastatic cancer is cancer that has spread from the place where it first started to another place in the body. If untreated and allowed to grow, the cells from these tumors can spread in a process called metastasis. In this process, prostate cancer cells are transported through the lymphatic system and the bloodstream to other parts of the body, where they lodge and grow secondary tumors. The most common sites of cancer metastasis are the lungs, bones and liver. Once the cancer has spread beyond the prostate, cure rates drop dramatically.
In most cases, prostate cancer is a relatively slow-growing cancer, which means that it typically takes a number of years for the disease to become large enough to be detectable, and even longer to spread beyond the prostate. This is good news. However, a small percentage of patients experience more rapidly growing, aggressive forms of prostate cancer. Unfortunately, it is difficult to know for sure which prostate cancers will grow slowly and which will grow aggressively – complicating treatment decisions.
The spread of cancer outside the prostate can be detected by the presence of prostate cancer cells in areas surrounding the prostate such as the seminal vesicle (glands near the bladder), lymph nodes in the groin area, the rectum and bones. When prostate cancer spreads to another site, such as bone, the new tumor is still considered to be prostate cancer, not bone cancer.
HOW CURABLE IS PROSTATE CANCER?
As with all cancers, "cure" rates for prostate cancer describe the percentage of patients likely remaining disease-free for a specific time. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free.
Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high—nearly 100% of men diagnosed and treated at this stage will be disease-free after five years. By contrast, in the 1970s, only 67% of men diagnosed with local or regional prostate cancer were disease-free after five years. However, being diagnosed with prostate cancer can still be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the life of the man diagnosed, but also the lives of his family members in significant ways for many years to come. Prostate cancer can be slow to grow following initial therapy, and it has been estimated that about 20-30% of men will relapse after the five-year mark and begin to show signs of disease recurrence.
Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. In fact, about 97% of all prostate cancers are diagnosed in men 50 and older.
The roles of race and family history are important as well. African American men are 60% more likely to develop prostate cancer compared with Caucasian men and are nearly 2.5 times as likely to die from the disease.
Genetic studies suggest that strong familial predisposition may be responsible for 5%-10% of prostate cancers.
Men with a first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed at a young age, with the highest risk seen in men whose family members were diagnosed before age 60.
Although genetics might play a role in deciding why one man might be at higher risk than another, social and environmental factors, particularly diet and lifestyle are likely to have an effect as well.
In recent years, research has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease.
When weighing risk factors for prostate cancer, it’s also important to recognize that there are non-risk factors, or factors that have not been linked to an increase in risk.
The purpose of screening is to detect prostate cancer at its earliest stages, before any symptoms have developed.
Typically, prostate cancer that’s detected by screening is in the very early-stages and can be treated most effectively. Physicians can screen for prostate cancer quickly and easily in their office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE).
The PSA Blood Test
PSA is a protein produced by the prostate and released in very small amounts into the bloodstream. When there’s a problem with the prostate—like the development and growth of prostate cancer—more and more PSA is released. It eventually reaches a level where it can be easily detected in the blood. During a PSA test, a small amount of blood is drawn from the arm, and the level of PSA is measured.
The Digital Rectal Exam
During a DRE, the physician inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture. Often, the DRE can be used by urologists to help distinguish between prostate cancer and non-cancerous conditions.
The question of screening is a personal and complex one. It’s important for every man to talk with his doctor about whether prostate cancer screening is right for him.
There is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects.
Ultimately, decisions about screening should be individualized based on a man’s level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer. When to start screening is generally based on individual risk, with age 40 being a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate cancer at a young age). For otherwise healthy men at high risk (positive family history or African American men), starting at age 40-45 is reasonable.
It’s important for men to create a proactive prostate health plan based on your lifestyle and family history, as well as to discuss these tests with your doctor to make the screening decisions that are best for you.