Questions for Men About Prostate Cancer

Q. What is prostate cancer?

A. Prostate cancer is a malignancy that develops from cells of the prostate gland that may eventually spread outside the gland to other parts of the body. It is one of the most common types of cancer among American men. It is usually found in men over the age of 65. The prostate gland is about the size of a walnut and is behind the base of the penis and under the bladder. The main function of the prostate is to make fluid that   carries sperm. Most prostate cancers grow very slowly; some, however, spread quickly to other areas.

Q. What causes prostate cancer?

A. It is not known exactly what causes prostate cancer, though researchers have identified some risk factors (a risk factor is anything that increases your chances of getting a disease) and are making progress toward understanding how these factors cause cells in the prostate gland to become cancerous.

Age is the most important risk factor; it is rare in men under the age of 40, more than 75 percent of cases are found in men over the age of 65.   Prostate cancer is more common in African American men.  Having a father or brother who has had the disease increases your risk.

Evidence exists that development of prostate cancer is linked to increased levels of androgenic hormones in some men. It is thought that high levels of androgens (male hormones) may contribute to prostrate cancer risk in some men. Further research is needed to evaluate the practical value of these observations.

Q. Can prostate cancer be prevented?

A. Because the exact cause of prostate cancer is not known, we are not certain how to prevent most cases of the disease. Risk factors such as age, race and family history are beyond a man's control. One possible risk factor that can be changed is diet. A diet high in animal fat (dairy and meat) seems to increase the risk of prostate cancer. The American Cancer Society recommends a diet low in fat and consisting of mostly vegetables, fruit and grains.

Q. Is early detection of prostate cancer possible?

A. Yes. Through an annual blood test for a substance called prostate-specific antigen test (PSA) and digital rectal exam (DRE), most cancers are detected when they are asymptomatic. Because the prostate lies in front of  the rectum, it can be examined by a digital rectal exam. If either the PSA or DRE are abnormal, then further testing should be done. Some prostate cancers may be found because of symptoms, such as slowing, weakening or interruption of the urinary stream or the need to urinate more often, especially at night. Symptoms of advanced prostate cancer include hematuria (blood in the urine), swollen lymph nodes in the groin area, impotence (difficulty having an erection) and pain in the pelvis, spine, hips or ribs.

Early detection may prove beneficial for some. The American Cancer Society recommends DRE and PSA screening annually for men aged 50 to 79 years and age 45 if African-American or there is a strong family history of prostate cancer. About 86 percent of all prostate cancers are found in local stage (the cancer is confined to the prostate). The five-year survival rate for cancer found in the local or stage is 91 to 97 percent  and 85 to 92 percent at 10 years.  For regional disease (the cancer has spread from the prostate to nearby areas but not to other organs), the survival is 74 percent at 5 years and 68 percent at 10 years.

Over the past 20 years, the survival rates for all stages combined have increased from 67 percent to 93 percent. According to the most recent data, 68 percent of men diagnosed with prostate cancer survive 10 years and 52 percent survive 15 years.

Q. Am I at risk for prostate cancer?

A. Several factors, such as age, race, nationality, diet, physical activity and family history are consistently associated with an increased risk of developing prostate cancer.

African American men and men who have a family history of prostate cancer in a first degree relative (father, brother) are at higher risk.

Q. Should I be tested for prostate cancer?

A.The American Cancer Society (ACS) recommends that most men over 50 years find out if prostate cancer screening is right for them.  Because African-American men, and men with a father or brother who had prostate cancer are are at higher risk than other American men, the ACS recommends African American men talk to their health care provider about screening by age 45; men with a strong family history of prostate cancer should talk to their provider by age 40. The ACS   encourages men to learn about this disease and ask their doctors if prostate cancer testing is right for them, which test they should have, and at what age testing should begin.

Q. What are the different ways to treat prostate cancer?

A. Many different ways exist to treat prostate cancer including surgery, radiation therapy, hormone therapy, chemotherapy, expectant therapy (watching-and-waiting or deferred therapy) and experimental/clinical trials. Men need to discuss the most appropriate course of action for themselves with their physicians.

Q. Can prostate cancer be cured?

A. Prostate cancer can be cured in many cases if diagnosed early enough.  About 91 to 97 percent of those with disease confined to the prostate gland will survive at least five years and 74 percent will survive at least 10 years.  For those with regional disease, the survival is less and depends on the stage and aggressiveness (measured by an index suggested by Dr. Gleason and hence named for him).  For metastatic disease (that has spread to other organs), the prognosis will depend on response to hormonal therapy, chemotherapy and/or radiation therapy, as well as the person's overall health.

Q. How many new cases of prostate cancer are diagnosed each year?

A. The American Cancer Society estimates that annually more than 215,000 new cases of prostate cancer are diagnosed in the United States. For as yet unknown reasons, African-American men are more likely to have prostate cancer and to die from it than are white or Asian men.

Q. Where can I get more information on prostate cancer?

A. Information about prostate cancer can be found on the American Cancer Society Web site.