Prostate Cancer Basics

According to the National Cancer Institute, prostate cancer is the second most common form of cancer affecting men in the United States.  This translates to about 1 in every 7 men in America.  That means you or someone you know has probably dealt with prostate cancer.  There are more than 2.9 million men living with prostate cancer in America, and more than 60 percent of men diagnosed with prostate cancer each year are over the age of 65.


What is the prostate and what is prostate cancer?

The prostate is a gland in the male reproductive system located deep within the pelvis just below the bladder, surrounding the urethra, and in front of the rectum.  The prostate gland produces fluid which makes up part of the semen. Prostate cancer is a disease in which malignant cancer cells form and multiply in the tissues of the prostate. 

What causes prostate cancer?

The exact cause of prostate cancer is not clear, but research has found that both genetic and environmental factors can play a part.  Men with a father or brother with prostate cancer are two times as likely to get the disease. Men with three relatives diagnosed with prostate cancer are nearly certain to develop prostate cancer.

Similar to other cancers, prostate cancer starts when cells of the prostate gland mutate and become abnormal.  These mutations in the DNA, whether inherited or environmental, cause the cells to continuously divide and grow more rapidly than other cells, eventually overcrowding healthy cells.

What screening methods exist and should I be screened?

The most widely used screening tools we currently have for prostate cancer, are the PSA blood test and the digital rectal exam, or DRE.  In recent years, researchers have actively been trying to develop alternative screening methods, to help increase the accuracy of prostate cancer detection.  Some of these new screening methods include the PHI test, the 4K Score, and the PCA3 test.  The Prostate Health Index (PHI) test is a combination of three forms of the PSA protein. The results are used to provide a probability of cancer. The 4K score is a blood test measuring 4 different prostate related proteins that provides a percent risk score of having an aggressive prostate cancer. Another test is the Prostate Cancer Gene 3 test (PCA3) which is a gene based test carried out on urine. The higher the level, the more likely the chance cancer is present.


What is a Gleason score?

A Gleason score is the most commonly used grading system in the U.S. for prostate cancer.  After a prostate biopsy, if prostate cancer is found it is graded against this scale to determine how similar or different it is than normal prostate tissue.  The lower the grade the more similar the tissue is to normal tissue.  A score is assigned based on the appearance of prostate cells under a microscope.  In assigning a grade to a tumor, a pathologist will assign a primary grade to the pattern of cancer that is most commonly observed and a secondary grade to the second most commonly observed pattern in the specimen.  This is why Gleason scores are always seen as a combination of 2 numbers.  Grades range from 1-5, so scores range from 2-10.


What are the treatment options for prostate cancer?

There is not one best treatment for all prostate cancer patients.  The best treatment option for you depends on your age, risk factor, past medical history and your expectations. Here are some of the most widely available treatments for prostate cancer:

  • Prostatectomy – removes the cancerous gland, surrounding tissue and a few lymph nodes
  • Hormone therapy – eliminates androgens (male hormones) from the body which the prostate cancer cells thrive on
  • Radiation therapy (2 most common types):
    • External beam radiation: involves a machine delivering high-powered energy beams to your cancer
    • Brachytherapy: involves the placement of radioactive seeds into your prostate which deliver a low dose of radiation over a long period of time
  • Cryosurgery or cryoablation – involves freezing the prostate tissue to kill cancer cells
  • Chemotherapy – uses drugs to kill rapidly growing cells, including cancer cells
  • Watchful waiting - is the decision not to treat prostate cancer at the time of diagnosis.  Instead, the prostate cancer is monitored until it shows signs of causing harm