Prostate Cancer

One in six American men will be diagnosed with prostate cancer in their lifetime. Nationally, that means more than 200,000 men will be diagnosed with the disease this year. When prostate cancer is diagnosed early, new advanced therapies allow patients a more rapid return to normal activity and a better quality of life after treatment. 

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The prostate is a gland about the size and shape of a walnut. It surrounds the upper part of the urethra in men, the tube that carries urine from the bladder. The prostate is part of the male reproductive system and produces most of the semen in which sperm travel.

As a man ages, his prostate changes. Inside a changing prostate, groups of cells may form tumors or other growths:

  • Noncancerous growths. As a man ages, the prostate may grow larger. This condition is called benign prostatic hyperplasia (BPH). Extra prostate tissue often squeezes the urethra, causing symptoms such as difficulty urinating. But BPH does NOT lead to cancer.
  • Atypical cells (prostatic intraepithelial neoplasia, or PIN). Some cells don’t appear normal, but they are not cancer. These cells may indicate that cancer is present or is likely to form.
  • Cancer. Abnormal cells form a tumor—a lump of cells that grow uncontrolled. Cancer may or may not produce symptoms. Some tumors can be felt during a physical exam; others can’t. Prostate cancer can often be cured or controlled, especially if it is found and treated early. Screening tests help detect prostate cancer before it causes any symptoms.
  • Cancer spread. Prostate cancer may spread to nearby organs. In some cases, the cancer spreads to bones or organs in distant parts of the body. This spread is called metastasis.

Risk factors for prostate cancer include the following:

  • Age. As you grow older, your risk of developing prostate cancer increases.
  • Family history. If your father or brother has had prostate cancer, your risk of developing it is higher.
  • Race. African-American men are more likely than other men to develop prostate cancer. They are also more likely to die of prostate cancer than other men with this disease.

Screening and Diagnosis of Prostate Cancer

Screening for prostate cancer can help to check if you have cancer. Your healthcare provider may recommend regular screening starting at age 50—or earlier if you are at higher risk.

Prostate cancer may not cause symptoms at first. Urinary problems are not often a sign of cancer, but of another condition. To find out if you have prostate cancer, your doctor must examine you and order tests. The following tests help confirm a diagnosis of cancer and also provide information about a cancerous tumor:

  • Prostate specific antigen (PSA) testing: PSA is a chemical made by prostate tissue. The PSA level (amount of PSA in the blood) is tested to evaluate a man’s risk for prostate cancer. In general, a high or rising PSA level may mean an increased cancer risk. PSA testing is also used to evaluate the success of cancer treatments.
  • Core needle biopsy: This test involves taking tissue samples from the prostate to obtain more information about cancer cells. During the test, a small probe is inserted into the rectum as the patient lies on his side. An image of the prostate is displayed on a video monitor. With this image as a guide, the doctor uses a thin needle to remove tiny tissue samples from the prostate. The patient is given medications so he does not feel pain during the test.

Surgery for Prostate Cancer

Radical (total) prostatectomy is surgery to remove the entire prostate. Your doctor may decide to do a prostatectomy if diagnostic tests show that the cancer is confined to the prostate.

The surgery may be done through several small incisions in the abdomen, a technique called laparoscopy. In many cases, a technique called robotic-assisted laparoscopy is used. The robotic system provides a 3-dimensional view of the inside the body and also assists the surgeon’s hand movements.

In some cases, your surgeon may decide to perform the surgery through a larger incision in the abdomen. This is called the retropubic approach. Alternatively, your doctor may perform the surgery through an incision behind the scrotum. This is called the perineal approach.

The surgeon may remove and check the lymph nodes near the prostate to see if the cancer has spread. If the cancer has spread, the surgeon may decide not to remove the prostate. If the cancer has not spread, the surgeon will remove the prostate, the seminal vesicles, and a portion of urethra. Nerve-sparing techniques may be used to help preserve erectile function (the ability to achieve and maintain an erection).

Your surgeon will give you detailed instructions on preparing for surgery. After surgery, you will be told how to care for yourself at home as you recover. Be sure to ask any questions you have about the procedure and recovery.