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The prostate is a small, walnut-shaped organ that surrounds the urethra and produces seminal fluid. Prostate cancer is the most common cancer among men -- particularly older men.  Some types of prostate cancer grow slowly and stay confined to the immediate area for long periods of time. Others are aggressive, invasive and develop rapidly.  This is a cancer that strikes at the very heart of manhood because of its ramifications on sexual function as well as the uneasiness associated with preventative examinations. Early detection is vital.  Prostate cancer discovered in its early stages is quite frequently cured.

Causes

Like many cancers, the root causes are elusive. It is known that mutations to the DNA can start the process, programming some prostate cells to grow and divide in a very rapid manner. These cancer cells continue living far past their normal lifespan, forming a tumor that can extend into nearby tissues and organs. When cancer cells break off of the main body of the tumor, they can migrate to other distant sites, or metastasize.

Age is the single biggest risk factor, and it increases over time. Men with a family history (father or brother) of prostate cancer are also at heightened risk.

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Symptoms

In its early stages, prostate cancer may not produce any significant signs or symptoms at all.  That's why regular checkups are so important. In its more advanced stages, symptoms might include:

  • Difficult urination
  • Reduced urine flow and force
  • Blood in the urine
  • Blood in the semen
  • Swollen legs
  • Pelvic discomfort
  • Painful bones

You should always seek medical advice whenever encountering worrisome symptoms you can't explain.  The medical community is not in complete agreement on recommendations for prostate screening, but if you're 50 or over, you should discuss the issue with your doctor.

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Prevention & Reducing Risks

As always, the risk of developing any type of cancer is reduced by living a healthy life style.  Many carcinogens are present in our everyday lives, so reducing exposure to them may potentially lower your overall cancer risk.

Don't smoke

Smoking is the single most implicated risk factor involving cancers of all kinds.  If you smoke, speak with your doctor about plans to quit. A number of very effective medications and strategies are available to greatly increase your chances of successfully quitting.

Eat plenty of fruits and vegetables

Colorful fruits and vegetables are high in antioxidants and fiber, and low in fat.  All three factors help your immune system fight cancer and lower your overall risk.  

Healthy weight and blood pressure

Combining a proper, nutritional diet and a regular program of exercise is the best strategy for managing weight and reducing high blood pressure. Obesity places a tremendous load on the vascular system and predisposes patients to a variety of health risks, including cancer.  When diet and exercise fail to correct high blood pressure, your doctor may recommend a specialized medication to help bring it down.

Avoid chemical exposure

If you work in a profession that requires working with chemical compounds, be sure to follow all recommended safety precautions to avoid direct exposure. Even household chemicals carry some degree of risk that should be minimized wherever possible.

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Diagnosis & Evaluation

Early detection is the single best defense of any type of cancer, including that of the prostate. Routine screening most often catches prostate cancer early, even in patients with no symptoms. If you or any family members have a history of prostate cancer, you are at a higher risk than the general population.  The medical community is somewhat divided over the benefits of early screening, so this is a conversation you need to have with your doctor.

Digital rectal exam (DRE)

Your doctor inserts a gloved, lubricated finger to your rectum to check for prostate enlargement or suspicious lumps.  (most PCA diagnosed in nowadays are done just by elevation of PSA with normal DRE

Prostate-specific antigen (PSA) test

PSA is a compound produced by the prostate gland.  A low level of this substance is a natural and healthy thing.  If PSA levels are elevated, it could be an indication of prostate infection, inflammation, enlargement or possible cancer.  PSA levels are checked by a simple blood test. 

Additional diagnostic testing may be performed if suspicions are raised by an abnormal DRE or PSA test.  

Biopsy

This procedure uses a very thin needle, inserted into the prostate, to collect a small sample of tissue. A local anesthetic is administered to minimize discomfort.  Laboratory analysis will determine if any cancer is present in the sample.

Gleason Grading

If cancer is confirmed, your doctor will want to determine the aggressiveness of the cancer. This is a step called grading, and it will help determine the appropriate course of treatment. Tissue samples are examined microscopically and compared with normal prostate cells.  The greater the difference in cell biology, the greater the cancer's aggressiveness. The standard scale of evaluation is the Gleason score, which ranges from 2 to 10. Higher values indicate a more aggressive form of cancer.

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Staging

It's very important to also determine how far the cancer has spread.  This is a step called staging, and it describes the severity of migration. If your doctor suspects that the cancer has spread beyond your prostate, other tests may be prescribed:

  • Bone scan
  • Ultrasound
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)

The results of these tests will provide a very clear picture of the cancer's progress within your body. 

  • Stage I 

Very early cancer that's microscopic in nature, and cannot be physically felt by your doctor during an exam. 

  • Stage II 

The cancer can be felt (palpable), but is still confined to your prostate.

  • Stage III

The cancer has spread beyond the prostate to nearby tissues like the seminal vesicles.

  • Stage IV 

The cancer has migrated to distant sites such as the lymph nodes, bones, lungs or other organs.

Pathologic Staging

  • Stage I

pT1 - Tumor that is not felt during a digital rectal exam (DRE).  Cancer cells are found in a prostate biopsy or prostatectomy specimen 

  • Stage II   

pT2 - Tumor is confined to the prostate.  Findings are based on a nodule felt by a doctor during a DRE and/or based on the pathology results after a radical retro pubic prostatectomy (confined within the prostate)

pT2a - Tumor affects one-half of one lobe or less.  The cancer is in only the right or left side of the prostate, but not both sides, and is in only half (or less) of that side.

pT2b - Tumor affects only one side of the prostate. The cancer is in more that half of that side

pT2c - Tumor affects both left and right side of the prostate

  • Stage III 

pT3 - Tumor has spread beyond the outer rim (capsule) that surrounds the prostate.  The cancer has reached the connective tissue next to the prostate and/or the seminal vesicles but does not involve any other organs 

pT3a - Tumor is growing outside the prostate.  It has not spread to the seminal vesicles

 pTb - Tumor is growing outside the prostate and has spread to the seminal vesicles 

  • Stage IV

pT4 - Cancer has spread to tissues next to the prostate, such as the bladder neck or its external sphincter (muscles that help control urination), the rectum, the muscles in the pelvis or the wall of the pelvis

 

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