What is prostate cancer? Prostate cancer arises within the prostate gland, part of the male reproductive system that makes the major component of seminal fluid. (Healthy semen consists of 5% sperm from the testicles and 95% seminal fluid from the prostate gland.) The walnut-sized prostate gland lies below the bladder and surrounds the urethra. Most prostate cancers grow slowly and often cause no symptoms in the early stages. When symptoms develop, they are similar to the symptoms of BPH (benign prostatic hyperplasia). This includes urgent need to urinate, frequent urination, difficulty starting urination, weak urine stream, and erection problems. What are the different types of prostate cancer? While there are different types of prostate cancer, more than 99% are adenocarcinomas. This type of cancer affects the cells that make prostatic fluid, which is part of semen. Prostatic adenocarcinoma can be either slow-growing or fast-growing. Most grow and spread very slowly. Other types of prostate cancer are very rare. Who gets prostate cancer? In the United States, prostate cancer is the most common cancer in men after skin cancer. This year, doctors will diagnose an estimated 175,000 American men with prostate cancer. This represents nearly 10% of all new cancer diagnoses. However, the rate of new prostate cancer cases has been falling by about 5% per year over the last decade. The falling incidence rate is likely due to changes in routine screening recommendations. Today, men older than 70 with an average risk usually do not require screening. The cancer is most often so slow-growing that screening in this population can lead to unnecessary treatment. Here are some additional prostate cancer facts, statistics and trends: About 1 in 9 men will get prostate cancer at some point during his lifetime. The average age at diagnosis is 66. About 60% of cases occur in men 65 years or older. Nearly 33% of cases affect men between 55 and 64 years of age. It rarely occurs in men younger than 45. Prostate cancer is more common in African American men. The risk is about 60% higher for this ethnic group compared to Caucasian men. In about 20% of cases, men with prostate cancer have a family history of it. In about 5% of cases, men with prostate cancer have hereditary prostate cancer associated with a gene mutation. Can you die from prostate cancer? More than 31,000 American men will die of prostate cancer this year. This makes it the sixth leading cancer-related cause of death in the United States. However, death rates from prostate cancer are falling by nearly 2.5% per year. Prostate cancer is different from most other types of cancer. Unlike other cancers, prostate cancer tends to grow and spread very slowly. Most men with prostate cancer will end up dying from another cause. In fact, there are nearly 3 million men living with prostate cancer today. However, some forms of the disease can be aggressive and spread rapidly. Thanks to effective screening, about 90% of prostate cancers are confined to the prostate gland or have only spread locally at diagnosis. The likelihood of dying from prostate cancer is very low at these early stages. The 5-year relative survival rate for local or regional prostate cancer is nearly 100%. A 5-year relative survival rate looks at people with the same type and stage of cancer five years after the original diagnosis. It compares them to the overall population of the same age and sex. This comparison shows how much a disease can shorten life. For men with local or regional disease, prostate cancer has little to no effect on life expectancy. The risk of dying is higher in African American men and in men with more advanced stages. When prostate cancer has spread to distant body sites, the 5-year relative survival rate falls to 30%. It’s important to know survival rates are only statistics and can’t determine how long a person will live or tell you how long you will live. Prognosis depends on many factors, including the patient’s age and overall health. Cancer treatments are also continually improving, which oftentimes improves patient prognosis as well. How does prostate cancer affect quality of life? The vast majority of men with prostate cancer have low-risk disease. However, this doesn’t mean it has no effect on them emotionally or mentally. For men with prostate cancer, concerns about quality of life are nearly as important as longevity. The four main areas of concern that affect quality of life for these men are: Sexual function: Erectile dysfunction (ED) is a major concern with prostate cancer. All men will notice some degree of ED after surgery (if surgery is part of the treatment plan). It can take up to two years to regain erectile function with nerve-sparing surgery. But ED can also result from radiation therapy, medications, and even the cancer itself. Urinary and bowel function: Urinary incontinence is very common after prostate removal surgery. Radiation therapy can cause changes in bowel function. These problems usually resolve within a few weeks or months of treatment. But in the meantime, they can cause significant distress and embarrassment. Anxiety: This is common for most cancer patients at one time or another. For men with prostate cancer, it is often linked with treatment side effects. However, some men only need watchful waiting to manage their disease. While this option can be a good choice for many men, it causes distress in some. They experience high levels of anxiety by ‘doing nothing’ to treat their disease. Active treatment may help relieve anxiety in these men. Relationships: All three of the other concerns can end up affecting relationships and intimacy. Research suggests more than half of men with ED due to prostate cancer or its treatment experience depression. The combination of depression and ED often leads to relationship problems. This can become a spiral of frustration, as one problem feeds the other. Relationship problems can worsen depression, further straining relationships. Fortunately, there are solutions for the main areas affecting quality of life in prostate cancer. What causes prostate cancer? Cancer occurs when cells keep dividing and growing out of control when they should normally die like other cells. Experts don’t know exactly why this happens, but they understand how it happens. It has to do with the genes that control cell growth. Oncogenes are genes that help cells grow. Tumor suppressor genes make cells die when it is time. Changes—or mutations—in either of these types of genes can lead to cancer. In some cases, the mutations are inherited. Other times, people acquire them during their lifetime. Acquired mutations can be the result of random mistakes during cell replication. Environmental factors can also contribute to acquired mutations. In prostate cancer, a very small number of cases are due to inherited gene mutations, such as BRCA1 and BRCA2. Most prostate cancers are the result of acquired mutations. Factors that may increase the risk of acquiring gene mutations leading to prostate cancer include: Exposure to certain chemicals, including Agent Orange Obesity Smoking How are you diagnosed with prostate cancer? Screening finds most prostate cancers before symptoms develop. There are two types of screening tools—DRE (digital rectal exam) and PSA (prostate-specific antigen) blood test. However, neither of these tests are specific for prostate cancer. They can both be abnormal for other reasons, such as BPH. So, a biopsy is how prostate cancer is diagnosed. A biopsy takes a sample of cells for examination under a microscope. It is the only way to know for sure whether cancer is present or not. Typically, doctors use a transrectal ultrasound (TRUS) to perform the biopsy. TRUS allows them to precisely locate the area to biopsy. It involves inserting a thin ultrasound transducer into the rectum. From the images the transducer produces, doctors use a needle to painlessly remove a slender core of tissue from the prostate. What are common treatments for prostate cancer? Prostate cancer treatment depends on the stage and aggressiveness of the cancer. Options include: Watchful waiting—or active surveillance—to monitor small, slow-growing tumors confined to the prostate Surgery to remove the prostate Radiation therapy, whether conventional external beam, implanted radioactive seeds, or proton therapy, as an alternative to surgery, when cancer is confined to the prostate Hormone therapy to shrink the tumor before radiation therapy or when cancer has spread Chemotherapy in combination with hormone therapy when cancer has spread Cryotherapy to freeze cancer cells when cancer returns after radiation therapy Cancer vaccine for advanced prostate cancer when hormone therapy and chemotherapy no longer work Additional prostate cancer facts Screening is an important part of prostate cancer management. All men need to be informed about their choices for prostate cancer screening, including the risks of unnecessary procedures. Several organizations offer screening recommendations. According to the American Cancer Society: At age 50, men with an average risk should discuss with their doctors whether screening is right for them. At age 45, men with a higher-than-normal risk should ask about screening. This includes African American men and men with one first-degree relative who developed prostate cancer before age 65. At age 40, men with a very high risk should talk with their doctors about screening. Men with more than one first-degree relative who had prostate cancer before age 65 are at high risk for prostate cancer. September is prostate cancer awareness month. To learn more, visit the Prostate Cancer Foundation or the American Cancer Society.