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The cause of prostate cancer is unknown. It is known, however, that the growth of cancer cells in the prostate, like that of normal prostate cells, is stimulated by male hormones, especially testosterone.
Compared with other types of cancer, prostate cancer is relatively slow growing. In fact, many men with prostate cancer will not die from it but with it. As a man gets older, his risk of developing prostate cancer increases. More than 75% of cases are diagnosed in men older than age 65.1When a cancerous tumor is small and located only within the prostate, the cancer often is not detected. It may not cause symptoms and may be too small for a doctor to feel during a routine prostate examination. A doctor performs this examination, which is called a digital rectal examination (DRE), by inserting a finger into the rectum to feel the size and shape of the prostate.
A man may live for many years without ever having the cancer discovered. As the cancer grows, however, the prostate may eventually squeeze the urethra, which it surrounds (see illustration on the page entitled What is the Prostate?). Then, symptoms such as difficulty in urinating may develop. This is usually the first symptom of prostate cancer. (It is important to note, however, that difficulty in urinating can be caused by other, noncancerous conditions of the prostate and does not always mean that prostate cancer is present.)With or without symptoms, a growing cancer also can begin to attack cells close to the prostate. At the same time, cells can break off from the cancer and spread to other parts of the body. Sites where prostate cancer tends to spread are the lymph nodes, the lungs, and various bones, especially the bones of the hip and lower back.
Like the main prostate tumor, tumors that have spread to other areas of the body can expand and squeeze other body parts. When prostate cancer spreads, the most common symptom is bone pain. The American Cancer Society (ACS) has developed guidelines to help doctors detect prostate cancer during its early stages. ACS has recently revised these guidelines to reflect new scientific literature. The new guidelines recognize that prostate cancer screening, including a digital rectal examination (DRE) and a yearly test to measure prostate-specific antigen (PSA) in the blood, should be offered to the general male population 50 years of age and older. In addition, males with two or more first-degree relatives affected by the disease, or those of African-American descent, should consider starting prostate cancer screenings at an earlier age. Although there is still some disagreement concerning this issue and until more scientific evidence exists, 45 years of age may be an appropriate time for men with higher risk to begin screening. There are some instances in which prostate cancer screening may not be recommended.3 Because prostate cancer can be a slow-growing cancer, a man with a less than 10-year life expectancy would most likely die of some other illness, and, therefore, is not very likely to benefit from prostate cancer screening and treatment. For this reason, the new ACS guidelines include a statement for patients explaining the risks and benefits of prostate cancer screening. These guidelines can be found on the Internet at: www.cancer.org/media/story/1jun12.html or by calling the American Cancer Society at 1-800-ACS-2345.You and your physician can discuss ACS guidelines together and determine if screening is right for you, and, if so, when you should begin.
PSA is a substance produced by both normal and cancerous prostate cells. When prostate cancer grows or when other prostate diseases are present, the amount of PSA in the blood often increases. New ACS guidelines advise men with high PSA results to have a biopsy. This will help determine if cancer is actually present. A PSA test is generally said to be in the normal range when it is reported to be between 0 and 4 nanograms per milliliter, sometimes abbreviated as ng/mL on the lab report. If the results are in the high range (reported to be greater than 10 ng/mL), then your physician may suggest a biopsy.
Sometimes, PSA results are in the "borderline high" range. This occurs when the results are measured to be between 4 and 10 ng/mL. PSA test results in this range can be confusing and do not always mean that cancer is present. Certain other conditions, such as benign prostatic hyperplasia (also called BPH – a type of noncancerous prostate enlargement) and prostatitis (inflammation of the prostate), may cause an abnormal PSA result. If your PSA test results are borderline high, but your DRE results are normal, then your doctor may decide to recommend a transrectal ultrasound (TRUS). This is a test that may help to find abnormal areas that may require a biopsy. On the other hand, if the results of the TRUS are normal, you may be able to wait and repeat the PSA test a few months later and have a biopsy then if needed. New ACS guidelines suggest a biopsy for any man with abnormal DRE results, even if the PSA is normal.
Because borderline PSA tests can be confusing, your physician may advise you to consider having one or more of the newer PSA tests. These are described below:Percent free-PSA ratio is a blood test that measures how much PSA circulates by itself (unbound) in the blood and how much is bound together with other blood proteins. If PSA results are borderline and percent free-PSA ratio is low (25% or less), then prostate cancer is more likely to be present. If this is the case, a biopsy may be needed. If the results of the percent free-PSA ratio are normal, even with a borderline PSA, you may be able to avoid a biopsy.
Another way of looking at PSA involves age-specific PSA reference ranges. Higher PSA levels are normally seen in older men more often than in younger men, even without cancer. An age-specific PSA reference range compares the results of men in the same age group. If a man's PSA levels are high compared to his own age group, then there is a higher chance that prostate cancer could be present. In older men with borderline PSA results, this comparison can be more confusing than useful. As a result, age-specific PSA reference ranges are not routinely done.If you have had your PSA measured and also have had a TRUS, then PSA density (PSAD) can be determined. To determine what the PSAD is, your physician will divide the PSA number result by the size, or volume, of the prostate (from the TRUS results). The chance that prostate cancer is present is greater with a high PSAD.
Finally, a PSA velocity will show how quickly the PSA level rises over a period of time. Two or more PSA tests will be required, often over several months of time. Although PSA velocity may be useful in helping your doctor better interpret borderline PSA results, it is not really used to diagnose prostate cancer. Instead, it is used more as a tool to keep track of how your PSA levels compare over a period of time. PSA often rises as part of the natural aging process; an increase in the PSA from time to time does not necessarily indicate that prostate cancer is present. On the other hand, if PSA increases too quickly (as determined by your physician), prostate cancer is a possibility.
Transrectal ultrasound of the prostate.
References
American Cancer Society Cancer Facts and Figures 1999: Selected Cancers.
Available at: http://www.cancer.org/statistics/cff99/selectedcancers.html.
Accessed on: February 10, 1999.
American Cancer Society.
American Cancer Society Updates Prostate Cancer Screening Guidelines.
Available at: http://www.cancer.org/media/story/1jun12.html.
Accessed on: September 24, 1998 and on November 20, 1998.
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