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Prostate Cancer - What are the causes?
The exact causes of prostate cancer are unknown. The risk of developing prostate cancer increases as men age. Ultimately,
more than one in six men will develop prostate cancer during their lifetime. Men with a family history of prostate cancer
and African-American men may also be at an increased risk. As men continue to live longer and healthier lives, prostate cancer
will likely become a more common problem in the 21st century.
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What exactly is PSA? PSA stands for Prostate Specific Antigen. It is a chemical produced only by prostate
cells, both normal and cancerous. It can be measured easily in the blood. Your physician must carefully review your PSA results.
Traditionally, it had been thought in the past that a PSA of 4 was normal. We now know that a “normal” PSA depends
on your age and the size of your prostate, amongst other factors. What is a normal PSA for one man, may, in fact, be very
abnormal for another. Generally speaking, as men age and their prostates enlarge, the “normal” level for
PSA increases. Likewise, for men with prostate cancer, as the amount of prostate cancer increases, the PSA level typically
increases. Your physician will typically be alerted when your PSA is above what is expected for your age or if it shows a
significant rise from the previous year. Because not all cancers can be found by an elevated PSA, it is critical that you
also have regular physical exams to feel for abnormal growths of the prostate.
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Prostate Cancer Screening - Don't Delay!
Early detection is the hallmark of successful treatment of prostate cancer. Usually there are no warning signs for prostate
cancer. As the cancer progresses, symptoms can be very non-specific and might include a change in your urinary or bowel habits
or a new onset of bone pain. Regular physical exams and PSA tests will aid in the earlier diagnosis of prostate cancer. PSA
is a simple blood test that can be done in most doctors’ offices or laboratories. The American Cancer Society recommends that
beginning at age 50, all men should have yearly PSA blood tests and physical exams.Men with a close relative who has had prostate
cancer and African-American men should have yearly exams starting at age 40.
Because of regular screening, the majority of men are now diagnosed with prostate cancer at an early, curable stage. In
contrast, 20 years ago, most men were not diagnosed until the cancer had already grown and spread to other parts of the body.
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Diagnosis & Staging
What do you do if your PSA blood test or physical exam is abnormal?
If your primary care physician detects an abnormal PSA or a lump in your prostate during a physical exam, you will be referred
to a Urologist for evaluation and consideration for a biopsy. This is a simple procedure that can be done in a few minutes
in the Urologist’s office. With an ultrasound in the rectum, thin needles can be inserted into the prostate to remove tiny
fragments for evaluation. Typically at least eight biopsies are performed, four from each side of the prostate.
These biopsies are sent to a lab where a physician will determine if cancer is present. If so, they will then determine
how aggressive the cancer is. A scoring system, called the Gleason score, assigns the cancer a number from 2 – 10, with 2
being a less aggressive cancer, and 10 being a more aggressive cancer.
What is early-stage or low-risk prostate cancer?
For truly early-stage disease, you must have a very low risk of cancer being outside of your prostate. This risk can be
estimated following a review of your records. Generally speaking, several important criteria must all be met. These include:
- PSA < 10
- At most, a small nodule felt in the prostate (stage T1-T2A)
- Biopsy showing a Gleason score < 7
The Journal of the American Medical Association recently published a study looking at close to 2,000 men. It showed that
for men with low-risk prostate cancer, a prostate seed implant, external radiation, and surgery offered equivalent cure rates.
These results typically exceed those found with older technologies such as proton beam radiation.
What is intermediate to high-risk prostate cancer?
Although surgery (radical prostatectomy) is an effective treatment option for early stage prostate cancer, it becomes less
effective as the risk of cancer having spread beyond the prostate increases. It is difficult for surgeons to completely remove
the cancer once it has grown beyond the confines of the prostate gland. Several factors can potentially identify patients
who are at a higher risk for having cancer outside the prostate.
These can include any of the following:
- PSA > 10
- A nodule felt to occupy half of the prostate gland or more on physical exam
- A biopsy showing a more aggressive tumor, with a Gleason score > 6
- A biopsy showing cancer invading around the small nerves in the prostate (perineural invasion)
- Multiple positive prostate biopsies
What do you do once diagnosed with prostate cancer?
If the biopsy shows the presence of prostate cancer, the next step is to determine how much cancer is present and to make
sure that it has not spread. Our prostate cancer experts will expertly review your PSA blood tests, physical exam findings,
and biopsy results. Some simple and painless tests such as a CT scan, bone scan, MRI,and possibly a PET scan can help make
sure there is no cancer that has spread outside the prostate.
Using the above information, we can then calculate the likelihood of the cancer being completely confined to the prostate,
having spread beyond the confines of the prostate, or having spread some distance to the lymph glands in the pelvis.
This information, as well as an evaluation of your overall medical condition and well-being, is critical in
determining which treatment options will offer you the best chance for a cure.
Treatment Options
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