Prostate cancer is the most common malignancy
diagnosed in men. On an annual basis globally,
approximately 1.1 million men are diagnosed with
prostate cancer and more than 300,000 will die of
prostate cancer each year.
The prostate is a walnut sized gland that is part
of the male reproductive system. It is located
beneath the urinary bladder and in front of the
rectum. The prostate makes some of the fluid that
nourishes and protects sperm cells in the semen.
Just behind the prostate are the seminal vesicles,
which make most of the fluid for the semen.
The urethra is a tube that carries urine and
semen out of the body through the penis, running
through the prostate. The activity and growth of
the prostate is stimulated by male hormone
Prostate cancer is to men what breast cancer or
cervical cancer is to women. Prostate cancer has
the potential to grow and spread quickly, but for
most men, it is a relatively slow growing disease.
It is important for patients to discuss with their
doctors the various aspects of their particular
type of prostate cancer to understand how
aggressive it is and how best to treat it.
Many men with prostate cancer have no
symptoms related to their cancer. For those that
do have symptoms, they could include any of the
Urinary problems – weak urine stream, difficulty
initiating urination, stopping and starting during
urination; urinating frequently, especially at night,
pain or burning with urination. These symptoms
are also often associated with noncancerous
enlargement of the prostate, called benign
prostatic hypertrophy (BPH).
Blood – in the urine and semen.
Pain – in the hips, pelvis, spine or upper legs.
Also pain or discomfort during ejaculation.
Men with certain risk factors are more likely to
develop prostate cancer. Perhaps the most
significant of these risk factors is age.
Old age particularly 65 and over is the main risk
factor for prostate cancer. The older a man gets,
the more likely he will develop prostate cancer.
The disease is rare in men under 45 years of age.
Family History – one’s risk of prostate cancer is
higher if you have a father, brother or son with
Race – prostate cancer is more common among
black men and less common among Asians and
Certain Prostate Changes – men with cells called
high grade prostatic intraepithelial neoplasia (PIN)
may be at increased risk for prostate cancer.
Certain Genome Changes – research suggests
that the risk for prostate cancer many be linked to
specific changes on particular chromosomes.
Having a risk factor does not mean that one will
develop prostate cancer. Most men with any of
the above risk factors will still never develop the
Screening and diagnosis
Diagnosis of prostate cancer should be part of a
routine annual examination by a primary care
doctor. The prostate cancer tests for early
detection and screening are the Digital Rectal
Exam, DRE, combined with a blood test to
measure the Prostate Specific Antigen, PSA level,
in the bloodstream. Abnormal DRE, elevated PSA
or confirmation of more advanced Prostate
Cancer will require additional testing.
A prostate gland biopsy is a test to remove small
samples of prostate tissue to be examined under
a microscope. Needle biopsies of the prostate are
usually done under TRUS guidance.
Prostate Specific Antigen – PSA
This is an enzyme found in the blood produced
exclusively by prostate cells. Normal levels of
PSA in the blood are small amounts between
0-2.5 ng/ml. Higher than normal levels, greater
than 2.5 ng/ml, can be caused by cancer or
benign, non-cancerous conditions such as
enlarged prostate, prostate inflammation,
infection, or trauma. All elevated readings of PSA
should be checked.
Occasionally, a Digital Rectal Exam, DRE, does
not reveal any abnormalities, but the PSA is
elevated. Sometimes the opposite is true, and
PSA is normal, but the DRE is abnormal. For this
reason, the Prostate Specific Antigen PSA blood
test together with the DRE is best for early