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Questions for Men About Prostate Cancer

Q. What is prostate cancer?

A. Prostate cancer is a malignancy that develops from cells of the prostate gland that may eventually spread outside the gland to other parts of the body. It is one of the most common types of cancer among American men. It is usually found in men older than 65. The prostate gland is about the size of a walnut, although it can grow larger, and is behind the base of the penis and under the bladder. The main function of the prostate is to make fluid that carries sperm. Most prostate cancers grow very slowly; some, however, spread quickly to other areas.

Q. What causes prostate cancer?

A. It is not known exactly what causes prostate cancer, though researchers have identified some risk factors. A risk factor is anything that increases your chances of getting a disease. Researchers are making progress toward understanding how these factors cause cells in the prostate gland to become cancerous.

Age is the most important risk factor. It is rare in men younger than 40, and about two out of three cases are found in men older than 65. Prostate cancer is more common in African-American men. Having a father or brother who has had the disease increases your risk.

Evidence exists that development of prostate cancer is linked to increased levels of androgenic hormones in some men. It is thought that high levels of androgens, or male hormones, may contribute to prostrate cancer risk in some men. Additional research is needed to evaluate the practical value of these observations.

Q. Can prostate cancer be prevented?

A. Because the exact cause of prostate cancer is not known, doctors aren't certain how to prevent most cases of the disease. Risk factors such as age, race, and family history are beyond a man's control. One possible risk factor that can be changed is diet. A diet high in animal fat–dairy and red meat–seems to increase the risk for prostate cancer. The American Cancer Society (ACS) recommends a diet low in fat and red meat and consisting of mostly vegetables, fruits, and grains.

Q. Is early detection of prostate cancer possible?

A. Yes. Through yearly blood tests for a substance called prostate-specific antigen (PSA) and digital rectal exams (DRE), most cancers are detected before symptoms appear. Because the prostate lies in front of the rectum, it can be examined by a DRE. If either the PSA or DRE are abnormal, then further testing should be done. Some prostate cancers may be found because of symptoms, such as a slowing, weakening, or interruption of the urinary stream or the need to urinate more often, especially at night. Symptoms of advanced prostate cancer include blood in the urine, swollen lymph nodes in the groin area, impotence (difficulty having an erection), and pain in the pelvis, spine, hips, or ribs caused by spread of cancer to the bones.

Early detection may prove beneficial for some men, but it's not clear if routine screening for all men is helpful. Screening can also have risks, including finding some cancers that would never be bothersome but that end up being treated, which can lead to side effects. The ACS recommends that men 50 and older discuss the risks and benefits of screening with their doctor before deciding whether to be screened. This discussion should start at age 45 if you are African-American or you have a strong family history of prostate cancer. Other expert groups have different recommendations. For example, the U.S. Preventive Services Task Force now recommends against routine prostate cancer screening, because the task force believes the benefit does not outweigh the harm. 

More than 90 percent of all prostate cancers are found when the cancer is confined to the prostate or has only spread to nearby areas. The five-year survival rate for cancer found there is nearly 100 percent. Over the last 30 years, the five-year survival rates for all stages combined have increased dramatically. 

Q. Am I at risk for prostate cancer?

A. Prostate cancer is the most common cancer among men (after skin cancer), so all men are at risk of getting this cancer to some degree. Several factors, such as age, race, nationality, diet, physical activity, and family history, are consistently associated with the risk of developing prostate cancer. African-American men and men who have a family history of prostate cancer in a father or brother are at higher risk.

Q. Should I be tested for prostate cancer?

A. The ACS recommends that most men older than 50 find out if prostate cancer screening is right for them. Because African-American men and men with a father or brother with prostate cancer are at a higher risk than other men, the ACS recommends that these men talk with their health care provider about screening by age 45. The ACS encourages men to learn about this disease and talk with their doctors about whether prostate cancer testing is right for them. Other expert groups have different recommendations. For example, the U.S. Preventive Services Task Force now recommends against routine prostate cancer screening, because the task force believes the benefit does not outweigh the harm. 

Q. What are the different ways to treat prostate cancer?

A. Many different ways exist to treat prostate cancer, including surgery; radiation therapy; hormone therapy; chemotherapy; vaccines; and experimental or clinical trials. Some men–especially those who are older and have early, slow-growing cancers–may not need active treatment because their cancer is unlikely to ever cause problems for them. These men may consider having their doctors watch their cancer closely, which is known as expectant therapy, active surveillance, or watchful waiting. Men need to discuss the most appropriate course of action with their doctor.

Q. Can prostate cancer be cured?

A. Prostate cancer can be cured in many cases if diagnosed early enough. Nearly 100 percent of those with the disease confined to the prostate gland or that has only spread to nearby areas will survive at least five years. Cancer that has spread to other organs is much harder to cure, and the prognosis will depend on response to hormonal therapy, chemotherapy, and/or radiation therapy, as well as the man's overall health.

Q. How many new cases of prostate cancer are diagnosed each year?

A. The ACS estimates that annually about 240,000 new cases of prostate cancer are diagnosed in the U.S. For as yet unknown reasons, African-American men are more likely to have prostate cancer and to die from it than are white or Asian men.

Q. Where can I get more information on prostate cancer?

A. Information about prostate cancer can be found on the ACS website.