Facts About Prostate Cancer

Understanding Prostate Cancer

Symptoms

Prostate cancer symptoms typically don’t appear early in the disease. In many men, physicians first detect signs of prostate cancer during a routine check-up.

More advanced prostate cancer symptoms may include:

• Weak or interrupted flow of urine
• Urinating often (especially at night)
• Difficulty starting or stopping urination
• Pain or burning during urination
• Difficulty getting or sustaining an erection (impotence)
• Painful ejaculation
• Blood in the urine or semen
• Frequent pain or stiffness in the lower back, hips or upper thighs

Many of these symptoms are also seen with noncancerous diseases. They may be similar to BPH symptoms or prostatitis symptoms. (Prostatitis is infection of the prostate.) If you are experiencing any signs and symptoms of prostate cancer, call your doctor.

Diagnosing

When it is diagnosed early, prostate cancer is curable. Good prostate cancer screening tests, like the prostate-specific antigen (PSA) test, have resulted in early diagnosis in about 80 percent of men with the disease. According to the American Cancer Society, all of these men survive at least five years.

Whether cancer is suspected based on symptoms or a digital rectal exam or PSA test, the actual diagnosis is made with a prostate biopsy, a procedure in which samples of your prostate are removed and examined under a microscope.

A core needle biopsy, the main method for diagnosing prostate cancer, is typically performed in a physician’s office by a urologist.

• Using transrectal ultrasound (TRUS) and a local anesthetic, the physician inserts a needle into your prostate through a probe in your rectum.
• The doctor uses the needle to take about 12 samples of cells.
• The procedure typically takes no more than 5 to 10 minutes, and you should have very little discomfort.

Your biopsy samples will be sent to a lab to be examined by a pathologist. Getting results usually takes a few days.

• If your biopsy reveals that you are cancer-free, you may still need to continue with routine screenings. Talk with your physician about this.
• If cancer cells are present, certain information available from the biopsy, such as the grade and stage of your cancer, helps your physician determine the best treatment options for you and the outlook for your recovery.

Fred Hutch offers an imaging test called prostate-specific membrane antigen (PSMA) positron emission tomography (PET), which is considered the most sensitive measure of prostate cancer detection. This test may be appropriate in certain situations. We also have an imaging test called Axumin® PET. Before the scan, you get an injection of fluciclovine F 18 (Axumin®), a radioactive agent that tends to collect in areas with cancer activity, which then light up on your scan.

Staging: The TNM System

Staging is done as part of the diagnosis process to determine how extensive your cancer is within your prostate and whether it has spread to lymph nodes or other organs.

Prostate cancer is typically staged using the TNM system, which is based on:

• The extent of the primary tumor (T category)
• Whether the cancer has spread to nearby lymph nodes (N category)
• The presence or absence of distant metastasis (M category)
• Your PSA level at the time of diagnosis
• Your Gleason score and the amount of cancer

Using this information, prostate cancer is then grouped into stages I through IV, with stage I being the least advanced and stage IV being the most advanced.

Stage I: Cancer is confined to your prostate. Gleason score is 6 or below. PSA level is less than 10.
Stage II: The tumor is more advanced but does not extend beyond your prostate.
Stage III: The tumor extends beyond your prostate and may be in a seminal vesicle. Cancer has not spread to lymph nodes.
Stage IV: The tumor has spread to another part of your body, such as your bladder, rectum, lymph nodes or bones.

Testing for Prostate Cancer Metastasis

After your biopsy, additional tests or imaging may be performed to check for cancer spread, though these are not required in all men with newly diagnosed prostate cancer.

Many centers, including Fred Hutch, are testing other means of finding cancer spread using new types of positron emission tomography (PET) scans. We offer prostate-specific membrane antigen (PSMA) PET, which is considered the most sensitive measure of prostate cancer detection. We also have an imaging test called Axumin® PET. Sometimes lymph nodes around the prostate may be checked for metastasis in order to design treatment appropriately.

At Fred Hutch and UW Medicine, a long-term effort has identified cells in the bone marrow that originated from prostate cancer, even in the absence of other evidence of spread. With these and other studies being offered to men with advanced prostate cancer, we hope to find ways to identify men at the highest risk of relapse so this knowledge can inform our treatment recommendations.

What Causes Prostate Cancer?

While the exact cause of prostate cancer is unknown, generally speaking it results from mutations in cell DNA. 

• DNA is the chemical that makes up your genes, which control when your cells grow, divide into new cells and die. 
• DNA mutations that turn on oncogenes (which help cells grow and divide) or that turn off tumor-suppressor genes (which slow cell division or make cells die when they should) can cause prostate cells to grow abnormally and lead to cancer.

How Common Is Prostate Cancer?

Each year about 160,000 men are diagnosed with prostate cancer in the U.S. and about 27,000 die of the disease. Prostate cancer is the third leading cause of cancer death, behind lung cancer and colon cancer, in men in the United States.

The incidence of prostate cancer has nearly doubled over the past 20 years. One possible reason is that, due to a decline in deaths from heart disease, more men are living longer, reaching ages at which the risk of prostate cancer is highest.

Resources

There are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.

Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community. 

Cancer Research Organizations

Our list of online resources provides accurate health information from reliable and reputable sources, like the National Cancer Institute (NCI), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).

Cancer Support Organizations

Our list includes local and national organizations that are dedicated to improving the quality of life for patients and family members through providing emotional support, education and community.