What is prostate cancer?
Prostate cancer is a cancer of the prostate gland; a small walnut shaped gland in men. It lies in front of the rectum and surrounds the upper portion of the urethra, the tube that carries urine from the bladder to the outside of the body.
The function of the prostate gland is to secrete a fluid that makes up part of the semen. Prostate cancer is the most common non-skin cancer in men and is the third-leading cause of cancer deaths among men in the United States. Most prostatic cancers originate in the outer shell or peripheral zone of the gland. As they grow, they distort the normal tissue and produce a hard lump or "nodule". The diagnosis of prostate cancer is rare before age 40 but increases dramatically thereafter. In the United States, it is estimated that one in 55 men between the ages of 40 and 59 will be diagnosed with prostate cancer. This incidence climbs almost to one in six for men between the ages of 60 and 79. Blacks are in the highest risk groups, as are men with a family history of prostate cancer, and men with a high intake of fat in their diets.
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What are the symptoms?
In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they may include dull pain in the lower pelvic area; frequent urination; problems with urination such as the inability, pain, burning, weakened urine flow; blood in the urine or semen; painful ejaculation; general pain in the lower back, hips or upper thighs; loss of appetite and/or weight; and persistent bone pain.
Prostate cancer is different than most cancers in that in an appreciable percentage of men, particularly older men with a shorter life expectancy, the cancer may be "silent," meaning it will not cause symptoms or progress beyond the prostate gland during their lifetime. Sometimes this cancer can be small, slow growing and present limited risk to the patient. Clinically important prostate cancers can be defined as those that threaten the well-being or lifespan of a man.
How is prostate cancer diagnosed?
Digital Rectal Examination (DRE) - The Digital Rectal Examination has been the primary method for detecting prostate cancer for many years. A physician places a finger within the rectum to detect a lump or nodule on the prostate gland. Most men should undergo a yearly digital examination once they have reached 40. Other common rectal studies such as barium enemas and colonoscopies do not always directly examine the prostate gland and therefore should not be considered a substitute for this examination.
Prostatic Specific Antigen (PSA) - The Prostatic Specific Antigen test greatly expands the ability to help diagnose prostate cancer in its infancy and detect small tumors. PSA material is a protein produced by all types of prostatic tissue, especially cancer or malignant tissue, which is then secreted into the bloodstream. By testing the blood for abnormal levels of prostatic specific antigen, cancer may be detected in the prostate. It is recommended that men 50 years of age or older have a PSA test yearly, along with a digital rectal examination.
Ultrasound Study (ECHO) - During an ultrasound (ECHO) study, a small probe is placed in the rectum, directly behind the prostate gland, and sound waves are utilized to produce an actual picture of the prostate on a television monitor. These pictures are studied, searching for areas which appear suspicious for cancer; any such areas can be immediately biopsied without the need for anesthesia using a very small needle guided through the probe. While prostate ultrasound has proven to be quite simple, accurate and safe, it is more involved than simple digital examinations or PSA determinations; therefore, this study is usually restricted to men whose prostate glands feel abnormal on rectal examinations or whose PSA levels are abnormal.