Education

The prostate is a gland found in males that is part of the genitourinary system (that also includes the bladder, kidney and testis). It is located in the pelvis, just below and behind the bladder, and just in front of the rectum. The prostate is located at the “neck” of the bladder, where it funnels down and becomes the urethra, which runs through the prostate. The prostate is a single gland, but it does have a right and left side, or lobe. The prostate tissue is surrounded by a thin rhine, or capsule.

The purpose of the prostate is to aid in making the seminal fluids which, during ejaculation, are used to move the sperm out of the body. Two glands, called seminal vesicles, also contribute to the ejaculate. The seminal vesicles are also attached to the prostate from above, and lie behind the bladder.

As men get older, the prostate can enlarge. This is a benign occurrence, often called BPH, or benign prostatic hypertrophy. Since the urethra runs through the prostate, BPH can sometimes cause the prostate tissue to bulge into the urethra, causing some urinary symptoms such as a weak stream or nighttime frequency.

For reasons not entirely known, something in the normal cells of the prostate goes awry, and the normal activity of a prostate cell changes. It loses its ability to know when to stop growing, and becomes malignant, a prostate cancer cell. Prostate cancer cells grow at first within the confines of the prostate itself. Sometimes the cells are in only one particular area of the prostate, and sometimes they may be in several locations (“zones”), or lobes. Prostate cancer can grow locally and pierce the capsule of the prostate toward the neighboring per-prostatic area or into the seminal vesicles. Eventually spread further away from the prostate gland itself (metastasis) can occur, typically to the lymph nodes in the pelvis, or to the bones.

Information for this section was graciously provided by the physicians and staff of Advanced Radiation Centers of New York. For further information on prostate cancer, please visit the ARC website.

There is not yet one “magic pill” that can prevent prostate cancer. One study looked at the use of a drug called finesteride which was given to men to see if it prevented them from developing prostate cancer. The results of this study did show that the men who took this drug versus placebo had a lower risk of developing prostate cancer, however, those that did develop cancer and that were taking finesteride were found to have a more aggressive form of prostate cancer. The results of this study are somewhat controversial however, and further research is needed before this drug or others can be recommended in the prevention of prostate cancer.

Another study called the SELECT trial randomized men to take Vitamin E and/or Selenium, to see if this supplements might decrease the incidence of cancer. The results of this trial ended early and were reported in December, 2008 – showing that neither Zinc or Selenium were able to reduce the incidence of getting prostate cancer. Click here to read the report by the NCI.

So apart from outright preventing prostate cancer, what can be done then? Clearly, the most important thing that you can do to increase the chance of cure is to ensure early detection of the disease.

Although much speculation about diet has been made, including the benefits of Lycopene found in tomatoes and Saw Palmetto, a natural herb, there is conflicting data on even these two substances.

Information for this section was graciously provided by the physicians and staff of Advanced Radiation Centers of New York. For further information on prostate cancer, please visit the ARC website.

There is no one or clear reason why someone gets prostate cancer. There are also very few risk factors for getting it. The one that is most widely known is a family history, or genetic predisposition. However, most men who are diagnosed with prostate cancer have no family history at all. In addition, African American men have a higher risk over Caucasian American men in developing prostate cancer, and African American men of Caribbean descent have an even higher risk, while various other nationalities and races have lower risks.

Information for this section was graciously provided by the physicians and staff of Advanced Radiation Centers of New York. For further information on prostate cancer, please visit the ARC website.

In the past, most men with prostate cancer were diagnosed after presenting with new urinary symptoms, including blood in the urine, or a significant change in how they were able to urinate (frequency, weak stream, etc.). This is not a common presentation however, since most men will have some of these symptoms as a normal part of aging.

A more common sign of cancer is the finding of a nodule or abnormality during a routine DRE, or digital rectal examination. Most men will have a DRE during their annual physical exam. If asymmetry, firmness or nodularity is detected, a referral to a Urologist for investigation will likely be made.

However, in the last decade, most men with prostate cancer have a perfectly normal DRE and no urinary symptoms at all, but instead present with an abnormal blood test called the PSA, or prostate specific antigen. PSA is a protein that is made only by normal or cancerous prostate cells. All men have a detectable amount of PSA in their bloodstream, which is there because it can “leak” into the blood from the prostate at low levels. Prostate cancer cells also may make this PSA, and cause more of it to leak into the bloodstream where it can be detected during a routine blood test. If the PSA level is high (many labs have the “normal range” between 0 and 4.0 ng/ml), or if the PSA level has risen significantly over a short time period, a man might be referred to a Urologist for further investigation. It should be noted that an elevated PSA does not mean that prostate cancer is present, as other benign conditions can cause an elevation in PSA, such as a prostate infection (prostatitis), or the normal enlargement of the prostate with age (due to BPH or benign prostatic hypertrophy), etc.

Information for this section was graciously provided by the physicians and staff of Advanced Radiation Centers of New York. For further information on prostate cancer, please visit the ARC website.

In general, prostate cancer is treated with either surgery or radiation. All patients with a new diagnosis of prostate cancer should have a thorough consultation with both a Urologist and a Radiation Oncologist to discuss both surgical and radiation options.

It is important to understand that prostate cancer is not just “one disease”, but has many variations and subtypes based on the extent of the disease (or stage), pathologic findings on biopsy (such as the Gleason score), PSA level, etc. Just like no snowflake is alike, no two cases of prostate cancer are alike, and treatment decisions must be individualized for each and every case.

The Urologist and Radiation Oncologist will discuss the risks and benefits to using surgery or radiation, taking into consideration both individual disease parameters, as well as your age and general medical health.

In general, early stage prostate cancer can be cured with equal effectiveness using either surgery or radiation therapy (provided that the radiation therapy uses state-of-the-art technologies, as older technologies may be less effective). For this reason, there is not necessarily a “right” or “wrong” decision, and patients, along with their physicians and families, need to weigh the risks and benefits of every treatment and can choose one that they feel most comfortable with.

More advanced or aggressive prostate cancers (such as a Gleason score of 7 or higher, or a PSA of 10 or higher) may be better treated with radiation, since it can encompass a larger area than surgery can. Sometimes hormone therapy is used in conjunction with radiation in these cases to enhance the effect of the radiation.

There are other “experimental” treatments which remain experimental, and should not be considered until 10 year data becomes available (since there is not enough data to prove that in the long run they will be as effective as radiation or surgery which have decades of proven data). To learn more about experimental or other treatment radiation technologies, click here.

Information for this section was graciously provided by the physicians and staff of Advanced Radiation Centers of New York. For more information, view Web MD‘s prostate cancer treatment resources.

*IMF does not endorse any course of treatment for men with prostate cancer or other medical conditions. Treatment decisions should be made by a patient in collaboration with his health care providers.