Source: Cancer Resource Room

What is Prostate Cancer?
Cancer is a disease caused by a group of abnormal cells (a tumor) that grow and multiply without stopping. Prostate cancer is a tumor (or mass) that starts from abnormal cells in the prostate gland. These cells can travel through the blood and lymph to other parts of the body and form tumors called metastases. The cancer is named after the organ in which the cancer started to grow. So a cancer that starts in the prostate gland is prostate cancer even if it spreads from the prostate to another part of the body.

What is my prostate? What does it do?
The prostate gland is part of the male reproductive organs. It is a small, round organ (about the size of a golf ball) located behind the pubic bone and in front of the rectum. It wraps around the narrow, bottom part of the bladder called the “neck.” The urethra passes through the middle of the prostate. It is the tube that carries both urine from the bladder and sperm from the testicles out of the body through the penis. The prostate makes a fluid that is added to sperm in the urethra during ejaculation.

How is prostate cancer diagnosed?
Prostate cancer is quite common. It develops in almost 30% of men. About 200,000 new cases are diagnosed each year in the US. For most men prostate cancer can be controlled and cured. The best chance for a cure in prostate cancer is with early detection. Early detection means finding a cancer while it is still a small area of abnormal, cancerous cells that have not yet spread beyond the prostate.

Symptoms of prostate cancer—What does the patient feel or notice?
The problem with finding prostate cancer early is that it does not have any symptoms. Symptoms from prostate cancer usually occur after the disease has spread. The symptoms that can come from prostate cancer include:

• Dull pain in the pelvis, just above or behind the pubic bone
• Problems with urination (peeing)—urgency, pain, difficulty starting urination, weak flow, dribbling, frequent urination, feeling the bladder is not empty after urinating
• Blood in the urine
• Painful ejaculation
• Low back pain, especially at night
• Bone pain
• Loss of appetite and weight

Early Detection of Prostate Cancer
Finding or diagnosing prostate cancer early is possible because of two tests, 1) the DRE or Digital Rectal Exam, and 2) PSA or Prostate-Specific Antigen. These tests can help identify prostate cancer before any symptoms develop from the disease.

• DRE is an examination done by a doctor to feel the outside of the prostate for any bumps on its surface. The doctor puts on a rubber glove, lubricates one finger, and inserts that finger through the anus into the rectum. Because the prostate is just in front of the rectum, its back part can be felt. Prostate cancer forms a lump or mass in the prostate gland that can be felt as a bump. The DRE is also used to feel for masses in the rectum or pushing on the rectum from the sacrum or coccyx (end of the spine—the “tail bone”). The DRE is done to test the stool for microscopic amounts of blood that may come from a cancer in the colon. This exam has been used for many years and most men are familiar with it.
• PSA is a blood test. The prostate makes a protein that is used in producing semen. This protein is not made by any other organ. When anything causes the prostate cells to be overactive, extra PSA leaks into the blood flowing through the prostate. The PSA can be measured in a blood sample and compared to the normal amount. The normal level of PSA is 4 ng/ml or less. (4 nanograms per milliliter is a very small amount!) Many different conditions can cause the PSA to be above normal, not just prostate cancer. Other causes are infection (prostatitis) or other inflammation. Enlargement of the prostate (Benign Prostatic Hypertrophy or BPH) that occurs naturally with aging can make the PSA level go up. Even having had a DRE will increase the PSA in the blood. So the PSA blood test is sensitive (it can be measured in very small amounts) but it is not specific (it comes from the prostate but not always from a cancer there).
  One more test can help in the early diagnosis of prostate cancer. That is the TransRectal Ultrasound (TRU). An ultrasound probe is put into the rectum through the anus. The probe produces high-frequency sound waves that are used to make a “picture” of the prostate gland. The sound waves will reflect differently from abnormal areas in the prostate and these spots will be seen in the picture. The TRU can show suspicious spots in the gland that cannot be felt by the doctor.
  If the PSA level is higher than normal or if the doctor feels a bump (sometimes called a nodule) on the prostate by DRE, or sees an abnormal spot in the ultrasound picture, then a biopsy of the prostate needs to be done.

What is a biopsy and how is it done?
A biopsy is a sample of tissue, or group of cells, that is examined under a microscope by a pathologist. The pathologist is a doctor who uses cells and tissues to diagnose diseases, including cancer. A prostate biopsy is done by putting the transrectal ultrasound (TRU) probe into the rectum and using the picture of the prostate to guide a biopsy needle into the prostate tissue. If abnormal areas can be seen in the ultrasound picture, those spots will be sampled. But if no abnormal spots are seen, then six or more samples will be taken from different areas of the prostate. The pathologist will look at all the samples of prostate tissue to determine whether or not any cancerous cells are there. If cancer is found, the pathologist can also estimate how aggressive the cancer is.

Other tests

• Urine test—a sample of urine is tested for things that show how well the kidneys are working. It is tested for infection, blood, proteins, and sugars. It does not test for prostate cancer, but it tests for other causes of symptoms in the urinary system.
• CT scan— series of Xrays is put together on a computer to show cross-sections of part of the body. A CT scan of the abdomen and pelvis can show enlarged lymph nodes and abnormal areas in organs, muscles, and bones. Any of these could be caused by cancer that has spread from the prostate to other places in the body.
• MRI—uses magnetic and radio waves translated by a computer to show cross-sections of part of the body. It is similar to a CT scan but is more detailed and does not use Xrays.
• Bone scan—uses a radioactive substance to make a picture of the entire skeleton. Anything that interferes with normal bone tissue (arthritis, infection, injury, cancer) shows a dark spot on the scan. If a bone scan shows a spot, regular Xrays, and a CT or MRI scan can be done of the area to show what caused the abnormality.
• Chest Xray—to show the health of the lungs and heart, and to see whether or not cancer has spread to the lungs or ribs from the prostate.
• Lymph node biopsy—lymph nodes near the prostate are removed. They are looked at under a microscope for cancer cells that may have spread from the prostate.
  The PSA level in the blood, a lump felt by digital rectal exam, and a biopsy of the prostate are used to make a diagnosis of prostate cancer. All the other tests are done to find out if the cancer has spread beyond the prostate. The information helps in choosing the right treatments for each person.

How is prostate cancer graded and staged?
The grade of prostate cancer is a measure of how abnormal the cancer cells look compared to a normal prostate. When a pathologist looks at the biopsy tissue with a microscope, he/she is comparing that tissue to normal. The more abnormal in size, shape, and arrangement, the higher the grade of the cancer. Higher grade cancers are often more aggressive in their ability to replace normal tissue and to spread beyond the prostate. The grade of a prostate cancer is important information in deciding how to treat a person’s disease.
Stage means how far the cancer has spread within the prostate gland, to nearby tissues, or to lymph nodes and other organs. Several different ways to determine and describe the stage of prostate cancer have been used. Many are detailed and confusing. The following is a simplified and useful way to understand the stage of prostate cancer.

• Stage I—early cancer in a microscopic spot within the prostate. It cannot be felt as a bump on the prostate by DRE.
• Stage II—the area of cancer can be felt but it has not spread beyond the prostate
• Stage III—the cancer has spread just to nearby tissues (for example, the seminal vesicles or lymph nodes)
• Stage IV—the cancer has spread to distant lymph nodes, bones, brain, lungs, or other organs
  The combination of stage and grade are used by cancer doctors to design the best treatment plan for each patient.

Support & Education Programs

We know that being diagnosed with cancer can be stressful for you and your family. We offer a variety of cancer support services to help patients and families gain the support and information they will need to meet the challenges ahead.

To find information on the Prostate Support Group, education workshops, and wellness services offered this month, please view the HOPES calendar.

Read the most recent SUPPORT publication, a resource written by patients and families for patients and families >>>