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Definition

Prostate cancer means that cancer cells form in the tissues of the prostate. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize) throughout the body. By the time symptoms appear, the cancer may be more advanced.

Symptoms

Prostate cancer can sit quietly for years. That means most men with the disease have no obvious symptoms. When symptoms finally appear, they may be a lot like the symptoms of BPH. Some Prostate cancer symptoms could include :

  • Trouble passing urine
  • Frequent urge to pass urine, especially at night
  • Weak or interrupted urine stream
  • Pain or burning when passing urine
  • Blood in the urine or semen
  • Painful ejaculation
  • Nagging pain in the back, hips, or pelvis

Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be another symptom.

Risk factors

There are some risk factors linked to prostate cancer. A risk factor is something that can raise your chances of having a problem or disease. Having one or more risk factors doesn't mean that you will get prostate cancer. It just means that your risk of disease is greater.

  • Age: Being 50 or older increases risk of prostate cancer.
  • Family history: Prostate cancer risk is 2 to 3 times higher for men whose fathers or brothers have had the disease. For example, risk is about 10 times higher for a man who has 3 immediate family members with prostate cancer. The younger a man is when he has prostate cancer, the greater the risk for his male family members. Prostate cancer risk also appears to be slightly higher for men whose mothers or sisters have had breast cancer.
  • Diet: The risk of prostate cancer seems to be higher for men eating high-fat diets with few fruits and vegetables.

Investigations

Prostate Biopsy

If your symptoms or test results suggest cancer, your doctor will refer you to a specialist (a urologist) for a prostate biopsy. A biopsy is usually done in the doctor's office.

For a biopsy, small tissue samples are taken directly from the prostate. Your doctor will take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that may have cancer cells. Like other cancers, doctors can only diagnose prostate cancer by looking at tissue under a microscope.

If a biopsy is positive

A positive biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is aggressive and may spread.

Treatment options depend on the stage (or extent) of the cancer (stages range from 1 to 4), Gleason score, PSA level, and your age and general health.

PSA

A test that can help your doctor decide if you need a repeat biopsy is called free PSA. This test is used for men who have higher PSA values. The test looks at a form of PSA in the blood. Free PSA is linked to BPH but not cancer.

Free PSA is figured as a percentage of the total PSA:

  • If both total PSA and free PSA are higher than normal, this suggests BPH rather than cancer.
  • If regular PSA is high but free PSA is not, cancer is more likely. More testing should be done.

Free PSA may help tell what kind of prostate problem you have. It can be a guide for you and your doctor to choose the right treatment. You and your doctor should talk about your personal risk and free PSA results. Then you can decide together whether to have follow-up biopsies and, if so, how often.

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