For U.S. Healthcare Professionals Only
Caregivers of patients may not know the location and function of the prostate gland.
They may ask about the symptoms of prostate cancer and how it is diagnosed. They
may have little understanding of how prostate cancer is graded and staged and how
that information impacts the outlook for survival. They may wonder how prevalent
prostate cancer is and who else in the family is at risk. You may find the following
set of questions and simple replies useful when speaking with caregivers.
What is prostate cancer?
The prostate is a gland found only in men. It is a small gland located just underneath
the bladder and is wrapped around the tube that carries urine from the bladder (the
urethra). The prostate makes fluid for semen. Prostate cancer occurs when prostate
cells become abnormal and grow in an uncontrolled fashion. Prostate cancer cells
do not die after a set amount of time, as other cells do, but instead keep dividing
and forming new abnormal cells. Metastasis means that the cancer cells have invaded
other parts of the body.1
What are the symptoms of prostate cancer?
Early prostate cancer is rarely symptomatic. Symptoms that may be associated with
prostate cancer may include1:
- Frequent need to urinate, especially at night
- Difficulty urinating or holding back urine
- Weak or interrupted flow of urine
- Pain and burning during urination
- Difficulty in achieving an erection
- Painful ejaculation
- Blood in the urine or semen
- Frequent pain or stiffness in the low back, hips, or upper thighs
These symptoms are often associated with other benign prostate conditions.1
How is prostate cancer diagnosed?
Simple screening tests for prostate cancer are the digital rectal examination (DRE)
and a blood test for prostate-specific antigen (PSA). During a DRE, the doctor puts
a lubricated, gloved finger into the rectum; the prostate can be felt through the
front wall of the rectum. The doctor checks for hard or lumpy areas or increased
gland size.2 PSA is a substance made by prostate cells. PSA levels in
the blood may rise for a number of reasons including prostate cancer, benign prostatic
hypertrophy, and prostate infection.1
If either of these screening tests is positive, the doctor may perform other, more
specific, tests. These tests include a transrectal ultrasound (TRUS) and a biopsy.
During a TRUS, a small probe placed in the rectum bounces sound waves against the
prostate; the returning echoes are picked up by the probe and used to create an
image of the prostate. A biopsy is a procedure to remove a very small amount of
the prostate so that it can be examined under a microscope. Usually the doctor will
use a TRUS for guidance, numb the area, and quickly insert a very fine needle into
the prostate and then remove some tissue. The needle will contain a small cylinder
of tissue that can be sent to the laboratory for examination. The doctor usually
takes multiple samples, a minimum of 6 to 13, to make sure that the area of cancer
is not missed.2
What does the grade and stage of prostate cancer mean?
The grading system for prostate cancer labels the cancer cells
by how abnormal they look under a microscope and how likely they are to grow and
spread. Grading is used to predict how aggressive the cancer is. Prostate cancer
cells are graded according to the Gleason system. This system uses numbers from
1 to 5, based on how much the arrangement of the cells in the tissue looks like
normal prostate tissue. A grade is assigned to each of the two largest areas of
cancer in the tissue samples. The two grades are added together to create the Gleason
Score. Gleason Scores of 2 to 4 are considered low, 5 to 7 are intermediate, and
8 to 10 are high.1
The staging of prostate cancer involves performing tests to discover
whether the cancer has spread outside of the original site. Staging is used to decide
how advanced the cancer may be. The results of a DRE, PSA level, the TRUS, the biopsy,
and the Gleason score are used to decide if staging tests are needed. Tests that
may be used to stage prostate cancer include some radiological tests, including
CT scan, MRI, bone scan, and ProstaScint®4* scan (capromab pendetide).2
Surgical tests include lymph node biopsy and laparoscopy.1
The stage of a cancer is described by the extent of the original tumor
(T category), whether the tumor has spread to nodes (N category), and whether or
not there are distant metastases (M category). The TNM categories and the Gleason
grading score are used to decide the stage grouping.1,2
How common is prostate cancer?
Prostate cancer is the second most common cancer in men in the United States (US).
One in six men will be diagnosed with prostate cancer during their lifetime, but
only one man in 32 will die of it. Prostate cancer is the second leading cause of
cancer death (not all death) in men in the US. Nevertheless, in men diagnosed with
early prostate cancer, nearly 100% survive at least 5 years, 91% survive at least
10 years, and 76% survive at least 15 years. For men whose prostate cancer has already
spread through the body when it is found, the 5-year survival rate is 34%.2
Who else in our family is at risk?
Prostate cancer appears to run in families; having a father or brother with this
disease doubles the probability that a man will develop it himself. The risk is
higher for men with several affected relatives, especially if those relatives were
young at the time of diagnosis.2
A number of other factors influence risk for prostate cancer as well. The chance
of having prostate cancer increases quickly after a man is 50 years old. Prostate
cancer occurs 70% more often in African American men than in Caucasian men. Diet
may influence the likelihood of having prostate cancer. A diet composed of a lot
of red meat or high-fat dairy products may increase the risk of prostate cancer.2