What is prostate cancer?
Prostate cancer starts in the prostate gland. The prostate is part of the male reproductive system. It is the size of a large walnut and is located just below the bladder at the base of the penis. The prostate surrounds the urethra – the tube that carries urine from the bladder out through the penis. The main function of the prostate gland is to produce the seminal fluid.
Prostate cancers start in the glandular tissue of the prostate and are called adenocarcinomas. Prostate cancer is often slow-growing and can be managed successfully. Prostate cancer is the most common cancer in Canadian men.
What causes prostate cancer?
There is no single cause of prostate cancer, but some factors appear to increase the risk of developing it:
age – particularly after 65 (uncommon in men under 50)
family history of prostate cancer
diet high in fat
African ancestry
The effects of diet (especially a high fat diet), obesity, inactivity and working with cadmium are being studied. Some men develop prostate cancer without any of these risk factors.
Some men develop prostate cancer without any of these risk factors.
Signs and symptoms of prostate cancer
Prostate cancer in its early stages is a slow-growing cancer and may not cause any signs or symptoms. It may be found when you’ve had a PSA test or digital rectal examination. Symptoms appear once the tumour enlarges the prostate gland or spreads to other organs.
Signs and symptoms for prostate cancer are:
need to urinate often, especially at night
intense need to urinate (urgency)
difficulty in starting or stopping the urine flow
inability to urinate
weak, decreased or interrupted urine stream
a sense of incompletely emptying the bladder
burning or pain during urination
blood in the urine or semen
painful ejaculation
If you have any of these symptoms, it’s important that you have them checked by your doctor. Most enlargements of the prostate are not cancer.
How is prostate cancer diagnosed?
Your doctor may have suspected prostate cancer after talking with you about your health and completing a physical examination.
You may have had a DRE (digital rectal examination) and a blood test for a substance called PSA (prostate specific antigen) to look for signs of cancer. If your PSA result is higher than expected for your age, a more detailed analysis may help determine if it’s prostate cancer, or another prostate problem.
A number of special tests are usually necessary to confirm a prostate cancer diagnosis. They include:
Biopsy
Cells or tissues are removed from the body and checked under a microscope. If the cells are cancerous, they may be studied further to see how fast they are growing.
There are many ways to do a biopsy. A prostate biopsy is often taken during an ultrasound. Several samples of prostate tissue are removed through the rectum. This is uncomfortable but not painful, and is done with a local anesthetic. The tissue is checked for signs of cancer and to estimate its grade. The grade of a tumour tells you how active or aggressive the tumour is. In prostate cancer the grade is usually described as a Gleason score from 2 to 10. The lower the score the better.
Imaging studies
X-rays, ultrasound, CT scans (computerized axial tomography), MRIs (magnetic resonance imaging) and bone scans allow tissues, organs and bones to be examined in more detail. They may be uncomfortable but are usually painless. An ultrasound is typically the only imaging study needed to diagnose prostate cancer.
Staging for prostate cancer
Once a definite diagnosis of cancer has been made, it is important to know the stage of your cancer. The stage helps determine which treatment will work best for you. The stage of a cancer depends on its size and the extent to which it has spread to other parts of the body. Complete staging may only be possible after surgery or additional tests and it may be necessary to remove some lymph nodes near the cancer.
Sometimes the stage of a cancer is described as a number – Stage 0, 1, 2, 3 or 4. The higher numbers are used for cancers that have spread. Sometimes the stage is described using the “TNM system” which is a combination of letters and numbers that are a bit like a postal code (for example, T2N1M0). The T, N and M stand for Tumour, Nodes and Metastases. The number following the “T” indicates the size of the tumour, and the numbers following the “N” and the “M” indicate the extent to which lymph nodes or other parts of the body are involved. Sometimes other staging systems are used. Ask your doctor to tell you the stage of your cancer and to explain what the numbers and letters mean in your case.
What treatment will you have for prostate cancer?
Once your doctors know the type, grade and stage of your cancer, they will decide which treatment will work best for your type of cancer, and any other health issues you may have. You will be encouraged to help make the final treatment choices.
Because prostate cancer is often slow-growing, you may be offered a program of careful, regular follow-up with PSA testing and clinical examinations. This is called watchful waiting.
If active treatment is recommended, your treatment may include:
surgery
radiation therapy
hormone therapy
Learn more about treatments for prostate cancer
During treatment
Learn more about ways to manage and control your pain and discomfort, side effects and stress when you are having cancer treatments.
Clinical trials
Clinical trials are scientific studies to test new ways of preventing, treating or managing cancer. Ask your doctor if there is a clinical trial suitable for you as a treatment option.
Complementary and alternative therapies
Some people choose to use complementary or alternative therapies together with or instead of their conventional treatments or medicine. Tell your doctor if you are using these therapies as they might affect tests or treatments.
Support
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Services
Get more information on practical help, such as transportation to treatment, peer support and services in your community.