What is prostate cancer?

 

Prostate cancer is cancer that begins in tissues of the prostate gland. Located just below the bladder and in front of the rectum, the prostate is the male sex gland responsible for the production of semen.

 

 Fortunately, prostate cancer is one of the most treatable malignancies if caught early. Routine screening has improved the diagnosis of prostate cancer in recent years. In addition, new and innovative technology helps to minimize the side effects of prostate cancer treatment, including incontinence and erectile dysfunction.

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Types of prostate cancer

 

The prostate is a walnut-sized organ that surrounds the urethra; it produces a fluid that becomes part of semen. More than 99 percent of prostate cancers develop in the gland cells. This type of prostate cancer is called adenocarcinoma.

 

More rarely, prostate cancer originates in other tissues of the prostate, which is called a sarcoma.

It's very important to point out the need for men over 50 to be seen by a urologist as there are other noncancerous causes for an irregular prostate such as benign prostatic hyperplasis (BPH) or prostatitis.

Prostate Exam

In most cases, prostate cancer symptoms are not apparent in the early stages of the disease. The symptoms of prostate cancer may be different for each man and any one of these symptoms may be caused by other conditions. As a result, routine screenings in the form of  a prostate specific androgen (PSA) blood test and a digital rectal exam (DRE) are important. If either exam provides a reason for continued concern, other follow up procedures may be recommended. But don't feel like you must make these decisions alone. Be a part of a team. Here's how to start.

DRE

The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer, beginning at age 50. Men with one or more risk factors for prostate cancer should consult with their physician about whether to start routine screening earlier.

 

Prostate problems are fairly common in men of all ages, and they are especially common in older men. Prostate problems can range from simple inflammation to metastatic cancer. It is important to have a basic understanding of the possible problems that can develop in the prostate.

Signs and Symptoms of Prostate Problems

  • Frequent urination, especially at night.

  • Difficulty starting or stopping urination.

  • Weak or interrupted urination stream.

  • Painful or burning sensation during urination or ejaculation.

  • Blood in urine or semen.

Advanced cancer can also cause deep pain in the lower back, hips or upper thighs.

​​​Any prostate problem can also result in an increased prostate specific antigen (PSA) level in the blood. The more dangerous prostate problems, such as cancer, typically result in higher levels of PSA than noncancerous causes. However, the PSA test alone cannot distinguish between noncancerous (benign) and cancerous (malignant) prostate problems.

 

Noncancerous Prostate Problems

Noncancerous prostate problems are far more common than prostate cancer and are usually not life-threatening. They are not completely without danger, however, and should be taken seriously.

The most common noncancerous prostate problems are:

  • benign prostatic hyperplasia (BPH)

  • acute prostatitis

  • chronic prostatitis

Prostate Cancer

Prostate cancer is the most dangerous prostate problem, but it can cause the same symptoms as any other prostate problem at first. Oftentimes, prostate cancer is diagnosed before any symptoms are noticed.

 

Distinguishing Between Benign and Malignant Prostate Problems

It's important to remember that all prostate problems can have the same signs and symptoms.

 

These signs and symptoms cannot be used to distinguish between the various prostate problems. Additionally, the PSA test cannot be used to definitively distinguish between malignant and benign prostate problems, as a great deal of overlap exists in PSA levels between the various conditions.

 

The only definitive way to differentiate between benign and malignant prostate problems is to seek a prostate biopsy.

Gleason Score

The pathologist looking at the biopsy sample will assign one Gleason grade to the most predominant pattern in your biopsy and a second Gleason grade to the second most predominant pattern. For example: 3 + 4. The two grades will then be added together to determine your Gleason score (between 2 and 10.

The lower your Gleason Score, the more likely it is that your doctor will recommend Active Surveillance. However, your doctor will take your Gleason Score as well as many other factors into consideration when suggesting a treatment plan.

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