Source: Cancer Resource Room
What is Prostate Cancer?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.
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?
How is prostate cancer
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
- 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
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
- 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
- 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
- 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.
& 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
To find information on the Prostate Support Group, education
workshops, and wellness services offered this month, please
view the HOPES
Read the most recent SUPPORT
publication, a resource written by
patients and families for patients and families >>>