Prostate Cancer

Other than skin cancer, prostate cancer is the most common cancer in American men.

For 2023, The American Cancer Society estimates:

Types of Prostate Cancer We Treat

There are multiple types of prostate cancer that vary both in how prevalent they are, where they are located, and how aggressive the cancer behaves. Identifying and understanding the specific type of prostate cancer a specific patient is suffering from is crucial to effective treatment.

• Adenocarcinomas: This most common form of prostate cancer develops from the gland cells.
• Small cell carcinomas: Rare and aggressive tumors that often present at advanced stages or as metastatic diseases.
• Neuroendocrine tumors (other than small cell carcinomas): Rare and aggressive/highly malignant variant of prostate adenocarcinomas.
• Transitional cell carcinomas: Rare and develops in the urethra or in the prostate ducts.
• Sarcomas: Rare and aggressive, with higher risk of local recurrence.

Risk Factors

It is estimated that 1 in 8 men will be diagnosed with prostate cancer during their lifetime. Studies show prostate cancer is more likely to develop in older men, with an average age of men at diagnosis of 66. Prostate cancer is rare in men under the age of 40, but the chance of occurrence increases more after the age of 50.

Studies show prostate cancer is more likely to develop in older men and in non-Hispanic black men, and is geographically most common in North America, northwestern Europe, Australia, and on the Caribbean islands.

Genetics and Family History

Prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. But statistically, most prostate cancer cases occur in men without a family history of it.

Even so, having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. The risk is actually higher for men who have a brother with the disease than for those who have a father with a history of prostate cancer. Risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.

Several inherited gene changes (mutations) seem to raise prostate cancer risk, but they probably account for only a small percentage of cases overall. For example:

• Inherited mutations of the BRCA1 or BRCA2 genes, which are linked to an increased risk of breast and ovarian cancers in some families, can also increase prostate cancer risk in men (especially mutations in BRCA2).
• Men with Lynch syndrome (also known as hereditary non-polyposis colorectal cancer, or HNPCC), a condition caused by inherited gene changes, have an increased risk for a number of cancers, including prostate cancer.

Having a risk factor – or even multiple factors – does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors. But understanding your risk factor – especially age-related risk – is an important step in early detection and prevention.

Screening

Prostate cancer screening can help detect cancer early on, when treatment is most effective. If a screening test result is abnormal, the patient will likely need a prostate biopsy to know for sure if they have cancer.

Prostate-specific Antigen (PSA) Blood Test

The most common test for prostate cancer is the Prostate-specific antigen (PSA) blood test. PSA is a protein produced by both cancerous and non-cancerous prostate tissue. A small amount of PSA normally enters the bloodstream in healthy males, but prostate cancer cells usually make more PSA than do non-cancerous cells, causing PSA levels in your blood to rise. Besides the PSA number itself, your doctor will consider a number of other factors to evaluate your PSA scores, including:

• Your age
• The size of your prostate gland
• How quickly your PSA levels are changing
• Whether you’re taking medications that affect PSA measurements

PSA levels in blood are measured in units called nanograms per milliliter (ng/mL). The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesn’t have prostate cancer.

• Most men without prostate cancer have PSA levels under 4 ng/mL of blood. On the other hand, the PSA level often goes above 4 when prostate cancer develops. Still, a level below 4 is not a guarantee that a man doesn’t have cancer – in fact, about 15% of men with a PSA below 4 will indicate the presence of prostate cancer if a biopsy is done.
• If your PSA level is high, you might need further tests to look for prostate cancer. PSA testing is sometimes combined with a digital rectal exam (DRE) to feel the prostate for abnormalities.

Digital Rectal Exam (DRE)

For a digital rectal exam (DRE), the doctor inserts a gloved, lubricated finger into the rectum to feel for any abnormalities in texture, size, or shape of the prostate gland. While this exam can be uncomfortable, it typically isn’t painful and only takes a short time. If your doctor finds an abnormality, further tests like an ultrasound, MRI, or a prostate biopsy may be needed.

DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels, so may be included as a part of a regular prostate cancer screening.

Prostate Biopsy

A prostate biopsy is a procedure that removes samples of questionable tissue from the prostate, using a needle to collect a number of tissue samples from your prostate gland. The procedure is performed by a urologist.

A prostate biopsy may be recommended if results from PSA or DRE suggest that you may have prostate cancer. Tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it’s likely to progress and to determine your best treatment options.

Every newly diagnosed prostate cancer case at Phoebe Cancer Center is presented a weekly multi-disciplinary tumor conference prior to the initiation of a customized treatment plan.