There are a number of signs and symptoms of prostate cancer, many having to do with urine flow. This is due to the fact that the prostate surrounds the urethra, the tube that carries urine from the bladder to the penis. The prostate gland is about the size of a small walnut, and is located just below the bladder and in front of the rectum. A cancerous prostate can become enlarged, and a tumor may exert pressure on the bladder or the urethra. The primary urinary symptoms include an inability to urinate, incontinence, frequent nighttime urination, a weak urine stream, starting and stopping while urinating, pain or burning during urination or ejaculation, and blood in the urine or semen. These symptoms are not from the cancer itself, but are related to the blockage caused by the cancerous growth within the prostate gland. Still, urinary symptoms are the initial symptom in less than 5% of all prostate cancer cases.

Advanced prostate cancer (ie, cancer that has spread from the gland to adjacent areas of the body), often causes symptoms in the back, pelvis, hips and legs. Persistent pain in the pelvic area, lower back or upper thighs should be evaluated, as well as chronic bone pain. Prostate cancer can cause bone fractures, too. Other symptoms of prostate cancer in the advanced stages include weight loss, loss of appetite and nausea and vomiting.

It is crucial to note that any of the above symptoms could be caused by other diseases or infections. Benign prostate hyperplasia (BPH), for instance, is a condition wherein the prostate gland becomes enlarged. The symptoms of BPH closely mimic those of prostate cancer, particularly the difficulties in urination, although this condition is not life-threatening. Prostatitis is an infection or swelling of the prostate gland, which is often painful. There are several types of prostatitis and it is sometimes (but not always) caused by bacteria. Some symptoms of prostatitis which are similar to prostate cancer are: difficulty in passing urine, burning when urinating, urine flow that is weaker than normal, waking many times during the night to urinate, lower back pain, and pain during or after ejaculation.

Because prostate cancer can be life threatening and its symptoms mimic those of other diseases and conditions, The American Cancer Society recommends that men undergo yearly screening tests (ie, PSA and DRE) for prostate cancer beginning at age 50. African-American men and those who have a family history of the disease (ie, a brother or father with prostate cancer) should beginning screening earlier. When prostate cancer is detected in its early stages, it is easier to treat and the patient’s prognosis is much improved.

The growth of the prostate gland begins before birth, continuing until a man reaches adulthood. Male hormones called androgens cause this growth, and if the body does not produce enough of them the prostate gland will not grow to its full size. In older men, however, the part of the prostate gland surrounding the urethra may keep growing, surpassing normal size. This can cause benign prostatic hyperplasia (or BPH) which often results in problems passing urine. It must be treated, but it is not cancer.

Prostate Cancer is often asymptomatic as well as slow growing. Autopsy studies have demonstrated that many older men who died from other causes also had Prostate Cancer that never exhibited symptoms or caused any problems. These studies also found that roughly 7 to 9 out of 10 men had prostate cancer by age 80, although neither the men nor their doctors were aware of it.

Prostate Cancer rarely produces noticeable symptoms in its early stages. Some early signs and symptoms for the disease are urinary problems, including starting and stopping while urinating, a weaker stream of urine, and trouble urinating. Signs of more severe disease include blood in the urine or semen, discomfort in the pelvic area and swelling in the legs. When Prostate Cancer becomes advanced, it can spread to the bones and cause persistent bone pain, fractures and compression of the spine.

There are several risk factors that affect a man’s likelihood of developing Prostate Cancer. The most common are diet, family history, high testosterone levels, ethnicity, and age. Of these, the strongest risk factor is age. A man’s chances of having Prostate Cancer rise dramatically after 50, and nearly 2 of 3 Prostate Cancers are diagnosed in men over 65.

Obesity and a high fat diet may increase the risk of Prostate Cancer. It is theorized that fat increases the body’s production of the hormone testosterone, which may induce the development of Prostate Cancer cells.

High testosterone levels have been linked to an increased risk of Prostate Cancer. Because testosterone induces growth of the prostate gland, men who undergo any type of testosterone therapy are more likely to develop this type of cancer.

African-American men are at a greater risk for Prostate Cancer, although the reasons have not yet been determined.

Family history has a bearing on one’s risk for developing Prostate Cancer. A man who has a brother or father with the disease has a greater risk than the average man.

The two most common tests used to detect Prostate Cancer are the PSA blood test and the digital rectal examination (DRE). The PSA test checks levels of prostate-specific antigen (PSA) in the blood. PSA is a protein produced by the prostate, and it is normally found in small amounts. When Prostate Cancer develops, the prostate begins to release greater amounts of PSA into the blood. A PSA amount of under 4 ng/mL is generally considered “normal,” 4-10 ng/mL is generally considered “intermediate,” and anything over 10 ng/mL is generally considered “high.”

During the DRE, the physician inserts a gloved, lubricated finger into the rectum, and feels the prostate gland, checking for any abnormalities in shape, size and texture. Generally, malignant tissue is hard and often irregularly shaped. Although the DRE is an effective diagnostic tool, sometimes other methods are necessary. This is due to the fact that of all patients with Prostate Cancer, roughly one-third will have a normal DRE.

An elevated PSA level is the single most accurate predictor of prostate cancer, and this test detects cancer roughly 5 to 10 years earlier than the DRE. Clinical studies have shown many benefits of PSA testing, including the fact that most cancers detected with the PSA test are curable, and serial PSA testing of a population results in the virtual elimination of advanced prostate cancer at the time of diagnosis. The PSA blood test determines the level of an antigen normally produced by prostate cells in a patient’s blood. This antigen is not found in large amounts anywhere else in the body, although small amounts normally leak into the bloodstream and can be seen with a blood test. Greater levels of PSA are associated with enlargement or inflammation of the prostate or prostate cancer. Mild to moderate increases in PSA, however, do not necessarily mean cancer. They could point to other problems such as benign prostate hyperplasia (ie, enlargement of the gland) or prostatitis (ie, infection or swelling of the prostate), neither of which are life threatening. There is no current evidence linking these conditions to prostate cancer, although a man could have either or both and develop prostate cancer as well.

An abnormal PSA level is 4.0 ng/ml or higher, although a higher level of PSA does not necessarily mean cancer. A number of factors can affect PSA results, including prostate size, infection, and the age of the patient. Recent ejaculation has also been found to affect results, which is why men should abstain from sex for two days before taking the PSA test. Even DREs and biopsies of the prostate may influence PSA levels, though the increase in PSA resulting from a DRE is not thought to be significant.

Recent improvements in the use of the PSA test have resulted in greater accuracy in detecting prostate cancer. One is to assess PSA in relation to prostate size (ie, PSA density). PSA density considers the size of a man’s prostate when determining his PSA level. PSA density is determined by dividing the PSA value by prostate size (as observed on transrectal ultrasound). This measurement helps physicians decipher BPH from prostate cancer. A high PSA density indicates a greater chance of cancer, because an elevated PSA level is less likely from prostate enlargement.

The DRE is a brief but effective screening tool for prostate cancer. To perform a DRE, the patient either kneels on the examination table, lies on his side, or bends over the table. The physician then inserts a gloved, lubricated finger into the rectum and palpates the prostate gland. Although most of the prostate cannot be felt, the back wall of the gland will give the doctor a good idea of the prostate’s overall health. During this procedure the doctor looks for any abnormalities such as lumps, hard nodules or firmness.

It is important to note that neither of these screening tools is 100% effective. The most reliable way to detect prostate cancer in its early stages is to have both of these tests performed yearly.

The four most common treatments for prostate cancer include radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting.

A radical prostatectomy is complete removal of the prostate gland and the adjacent lymph nodes. This surgery is performed when the cancer is confined solely to the gland itself. Because this surgery can affect the muscles and nerves that control urination and sexual function, some postoperative side effects are possible. There are two approaches used to perform a radical prostatectomy: 1) Perineal (an incision is made between the anus and scrotum), and 2) Retropubic (the gland is removed through an incision in the lower abdomen that runs from just beneath the navel to an inch above the base of the penis). The retropubic approach is the most common because the same incision can be used to remove the pelvic lymph nodes. In addition the procedure allows clear and unobstructed access to the prostate, making it easier for the physician to save nerves that control erections and bladder function.

There are two types of radiation used to treat prostate cancer. External beam radiation therapy (EBRT) is delivered by a machine that emits high-powered x-rays to kill the cancer cells. This therapy is time consuming with treatments usually administered 5 days a week for 7 to 8 weeks. No anesthesia is necessary, and the side effects from EBRT are less than with brachytherapy, the second delivery method. With brachytherapy radioactive pellets are injected directly into the prostate gland. This procedure requires anesthesia and takes about one to two hours. Higher doses of radiation can be delivered via brachytherapy and there is more discomfort following the treatment; however, most patients return home the same day. For about one year the pellets then release radiation that attacks the cancer cells. Both forms of radiation therapy leave the prostate gland and lymph nodes intact, therefore some uncertainty goes along with this treatment regarding long-term prognosis, because the cancer could return several years after radiation therapy.

Hormone therapy involves lowering the levels of androgens (ie, the male sex hormones), which are known to stimulate the growth of cancer cells. Androgens are produced primarily in the testicles. For this type of therapy, drugs (eg, leuprolide, goserelin) that block hormone production are given via monthly injections, or the testicles are surgically removed. Hormone treatments are generally given to patients with aggressive cancer that has spread outside the prostate gland. Prostate cancer usually responds to hormone therapy for a few years, but after that time most cancers redevelop because they learn to thrive without the hormone. Intermittent hormone therapy programs have been devised to combat this tendency. In these programs the hormonal drugs are discontinued after the PSA level drops and remains steady. When the PSA level rises, the patient resumes taking the drugs. The side effects of hormone therapy include breast enlargement, hot flashes, weight gain and reduced sex drive. Some hormone therapy medications can cause fatigue, nausea, diarrhea and liver damage.

Watchful waiting is most often used with patients who have a small, slow-growing and asymptomatic cancer. Regular follow-up tests including blood tests, rectal examinations and biopsies are performed to monitor the cancer’s progress. Watchful waiting is also appropriate for men who are elderly, in poor health, or both. Many such men can live a normal life-span without the cancer spreading or causing problems. Younger men can also choose watchful waiting, as long as they stay up-to-date with recommended tests to monitor their cancer. They must also be willing to accept the risk that the cancer could grow and become incurable without treatment.

Several risk factors have been linked to prostate cancer, and may change one’s risk of getting it. These risk factors are nationality, genes, diet, age, family history, and race/ethnicity. Other risk factors that are thought to affect one’s risk of getting prostate cancer but are still under study include exercise, obesity, vasectomy, infection and inflammation of the prostate.

Nationality has a bearing on the incidence of prostate cancer with North America having the highest rate of the disease, followed by Australia, northwestern Europe and the Caribbean islands. Lower rates are reported for Africa, Asia, Central America and South America, which may be partially due to lower screening in some of these countries. Lifestyle differences such as diet may be responsible, as well. The lower rate of prostate cancer observed in Asian men may be due to diet, which consists of more vegetables and less red meat than in the United States. However, men of Asian descent living in the United States have a lower risk of prostate cancer than white Americans but a higher risk than Asians living in Asia. The reasons for different rates of prostate cancer in different countries are still unclear.

Several inherited genes seem to raise the risk of prostate cancer, but they most likely account for just a small number of cases. Recent studies have linked some gene variations to prostate cancer but further studies are necessary to confirm these results and determine if testing for the variants will help predict the risk of prostate cancer. Inherited mutations of the BRCA1 or BRCA2 genes have been linked to the incidence of breast and ovarian cancers in some families and may increase prostate cancer risk as well, but this genetic link also accounts for only a small number of prostate cancer cases.

One major risk factor for prostate cancer is age. It is rare for a man to contract prostate cancer before the age of 40, but his chances of contracting the disease rise dramatically after age 50. Nearly 2 out of 3 prostate cancers are diagnosed in men over 65 years of age.

Prostate cancer occurs more frequently in African-American men than in men of other races. In addition the cancer is more likely to be diagnosed at an advanced stage. The number of African Americans who die from prostate cancer is more than twice that of white men. Non-Hispanic whites have a higher incidence of prostate cancer than Asian-American or Hispanic-Latino men. Further study is necessary as the reasons for these racial and ethnic disparities are unclear.

Family history has a bearing on one’s risk of developing prostate cancer. Men who have a first degree relative (ie, brother or father) with prostate cancer have a greater risk of developing the disease. If a man has several affected relatives he has an even higher risk of developing prostate cancer.

Diet and exercise are thought to be linked to prostate cancer. A diet of high-fat dairy products and red meat seems to increase the risk of getting prostate cancer. However, men who have this type of diet also eat fewer vegetables and fruit, and scientists are unsure which of these factors is responsible for the increased risk. Studies on exercise have demonstrated no significant link between exercise and reduced risk of prostate cancer; however, some studies have shown that the risk of advanced prostate cancer may be lowered by high levels of physical activity, particularly in older men.

Other possible risk factors for prostate cancer include inflammation of the prostate, vasectomy and infection, but studies performed thus far have been inconclusive.

The development of the prostate begins before birth and continues through to adulthood. Male hormones, known as androgens, cause this development. If not enough male hormone is produced, the prostate gland will not grow to normal size. At the other end of the spectrum, too much male hormone can cause the prostate to become enlarged, causing discomfort and urination problems.

The prostate is located near the bladder and rectum, and the urethra (ie, the tube that carries urine from the bladder to the penis) runs through the prostate. One of the prostate’s functions is to produce some of the substances (eg, minerals and sugar) found in semen, the fluid that nourishes and protects the sperm. Another function is to control urination by pressing on part of the urethra.

The prostate gland is relatively small in younger men, although it grows during normal aging. This enlargement is called benign prostatatic hyperplasia or BPH. BPH is not associated with prostate cancer but may cause similar symptoms, such as impingement of the bladder outlet or the urethra and problems with urination. Other symptoms resulting from BPH are frequent urination, particularly at night, and slowing of the urinary stream.

Another condition that affects the prostate is prostatitis, which is a painful swelling or infection of the prostate gland. Symptoms of prostatitis include excessive urinating during the night, pain or discomfort in the lower back, pain or discomfort during or after ejaculation, pain in the tip of the penis, and a burning sensation during urination. This condition can be caused by bacteria, but sometimes the cause is unknown.

The symptoms common to BPH, prostatitis and even a bladder infection may be similar to those for prostate cancer. Prostate cancer is one of the leading causes of death in American men, which is why men 50 and over (40 and over for those with risk factors) should be sure to include prostate cancer screening tests in their yearly physical examinations. The two most common screening tools are the digital rectal examination (DRE) and the prostate-specific antigen (PSA) blood test.

The DRE takes a minute or less. During the DRE, the patient either kneels on the examination table, bends over the table, or lies on his side. The doctor inserts a gloved, lubricated finger into the rectum and palpates the prostate gland, looking for any abnormalities such as lumps, hard nodules or firmness.

The PSA blood test shows the levels of an antigen that is normally produced by prostate cells. Elevated PSA levels are associated with enlargement or inflammation of the prostate or prostate cancer; however, mild-to-moderate increases in PSA do not always mean cancer. Sometimes a raised PSA level is caused by problems such as BPH or prostatitis (ie, infection or swelling of the prostate). Neither of these conditions is life threatening, nor is there any evidence (up to now) linking these conditions to prostate cancer; however, it is possible for a man to have prostatitis or BPH and develop prostate cancer as well.

The prostate gland is a small but mighty organ and because the health of the prostate is so crucial to a man’s overall sense of well being and quality of life, every man 40 and over should meet with their physician to tailor a prostate care and cancer screening program that is right for them.

Prostate cancers that are found when they are small and before they have spread outside the gland usually respond well to treatment, and they are generally easier to remove or eradicate. The two diagnostic procedures that provide the most effective screening are the digital rectal examination (DRE) and the prostate-specific antigen (PSA) tests. If a physician performs these tests and sees questionable results from either one, further tests such as transrectal ultrasound and a biopsy of the prostate will be ordered to confirm the diagnosis.

The process of diagnosing prostate cancer includes grading and staging of the disease. Cancer grading is a system used to assess the aggressiveness of the cancer cells. Grading aids in predicting long-term results, how a patient will respond to treatment, and survival. The most common scale used to grade prostate cancer is the Gleason scale. This system has three parts: 1) the cancer cells are analyzed, 2) the two most common cancer cell patterns are each given a score from 1 to 10, and 3) those two numbers are combined to give a total score (ie, 3 + 5 = 8). There are 3 levels of scoring. A Gleason score of 4 or less is designated as “low grade.” These cancers are slow growing, the cells are most like normal prostate cells, and it is the least aggressive. A Gleason score between 4 and 7 is designated as “intermediate grade.” This cancer is the most common of the three, falling somewhere between the low- and high-grade cancers. This cancer can act like either a high- or low-grade cancer, depending on tumor volume and PSA levels. A Gleason score between 8 and 10 is designated as “high-grade.” This cancer has the highest rate of abnormal prostate cells, and is extremely aggressive. This grade grows quickly and spreads into the surrounding lymph nodes and bones. It can be very difficult to treat, and has a high recurrence rate.

The last step in diagnosing prostate cancer is staging. Cancer staging describes the size and location of the cancer. A system called TNM is used to grade prostate cancer. The “T” refers to a description of the tumor, and different numbers are used to explain the tumor size. For example, a Stage T1 designation means that the tumor is confined to the prostate and can only be observed microscopically (ie, undetectable by a DRE or ultrasound).

The “N” stands for nodes, and a number is added to show whether it has spread to the lymph nodes. For example, a Stage N0 designation means that the cancer cells have spread, but not to the lymph nodes.

The “M” stands for metastatic, and a number is added to represent the extent cancer has spread throughout the body. For example, a Stage M0 designation means that cancer cells have spread, but only regionally, and haven’t grown outside the pelvic area. Letters are added to the TNM system to provide a more elaborate description of the cancer.

Prostate cancer is a malignancy found in the prostate gland. If untreated, it can spread to adjacent organs, lymph nodes and bones.

The statistics regarding prostate cancer are sobering. Prostate cancer is the most common cancer in American men, second only to skin cancer. The American Cancer Society estimates that in the United States, roughly 192,280 new cases of the disease will be diagnosed and approximately 27,360 men will die of the disease by the close of 2009. Translated, this means that 1 man in 6 will be told he has prostate cancer during his lifetime. In addition, prostate cancer is behind only lung cancer in the number of cancer deaths in American men. Nearly 1 man in 35 will die from the disease. About 10% of cancer-related deaths are linked to prostate cancer.

There are two methods commonly used to monitor prostate health and diagnose prostate cancer: 1) the digital rectal examination or DRE and 2) the prostate-specific antigen (PSA) blood test. These two methods combined are extremely effective in diagnosing prostate cancer before it metastasizes.

The DRE takes less than a minute and is uncomfortable, but brief. During this examination the doctor inserts a gloved, lubricated finger into the rectum and palpates the prostate, feeling for any abnormalities.

The PSA test is a blood test that measures the levels of an antigen in the blood. High levels of the antigen indicate an enlargement or inflammation of the prostate. If PSA test results signal a problem, the physician will order further diagnostic procedures, such as a transrectal ultrasound or a biopsy.

The DRE and PSA tests should be included in a man’s yearly physical examination if he is 50 years of age or older. If there is a history of prostate cancer in a man’s family, these tests should be initiated at the age of 40.

The risk factors for prostate cancer are race/ethnicity, age, family history, genes, and diet. Other factors that are linked but have not been scientifically proven are obesity, vasectomy, inflammation of the prostate and infection. Studies on these possible factors have inconclusive.

The symptoms of prostate cancer include frequent, painful or difficult urination, blood or pus in the urine or semen, painful ejaculation, and pain in the pelvic area, lower back or upper thighs.

Treatment for prostate cancer is similar to other forms of cancer and involves surgery, radiation or drugs alone or in combination. The treatment given matches the severity of the cancer. Prostate cancer that is confined solely to the gland is often surgically removed in an operation called a “radical prostatectomy.” Some radiation can follow to be sure that the cancer cells have been eliminated from the surround area. Another option is called “watchful waiting.” This is primarily used if the patient is elderly and his cancer has been deemed to be slow-growing. In this case the patient is more likely to die from something other than the prostate cancer.

Prostate cancer is slow growing and responds well to treatment when diagnosed in its early stages. Over the past several years, the 5-year survival rate for the disease has increased from 67% to 99%. For these reasons, men should pay attention to their prostate and speak with their physician about prostate care and health.

Bone metastases and the pain they cause are common complications of advanced prostate cancer.

Treatment for bone metastases varies according to each patient’s overall health and cancer prognosis and usually involves some type of radiation therapy or administration of the bone-targeting agents called bisphosphonates. Before instituting a specific regimen, however, most physicians will want to discuss lifestyle habits and diet with the patient. Treatment for bone metastases and prostate cancer is sometimes exhausting and painful, but these aspects of therapy can be lessened if the patient maintains healthy eating and exercise habits. In particular, patients must be sure to maintain adequate levels of calcium and vitamin D, as these are crucial to the general health of the bones.

Radiation therapy and bisphosphonates are two ways to treat bone metastases and the accompanying pain. Radiation therapy is delivered via an x-ray machine (ie, External beam radiation therapy or EBRT) and by the injection of radiopharmaceuticals (ie, radioactive drugs). EBRT uses powerful x-rays to destroy the cancer cells found in bone. This type of treatment is developed and planned by a radiation oncologist, who determines exactly what areas of the bone need to be targeted. Precise and careful delivery of the x-rays will minimize damage to the surrounding bone and muscle tissue.

Strontium (ie, Metastron) and samarium (ie, Quadramet) are the two drugs used to treat bone metastases. In this type of radiation therapy, one of the drugs is injected into a vein, where it travels directly to the site of the bone metastasis and settles there, releasing radiation to kill the cancer cells. Studies have shown that strontium can be effective in relieving pain particularly when administered after doxorubicin (ie, Adriamycin), a drug commonly used in chemotherapy.

Radiopharmaceuticals and EBRT are called “directed palliative treatments” because they can target and alleviate pain in a specific area of the body.

Metastases are caused by an imbalance in bone cell activity. In a normal, healthy person, bone cells are constantly created and destroyed. Cells that form new bone cells are called osteoblasts and an increase in their activity eventually results in an overgrowth of bone tissue. Cells that destroy bone cells are called osteoclasts and an increase in their activity eventually results in brittle, porous bone tissue. In a man with prostate cancer who has bone metastases, these processes have basically run amuck and occur too quickly, causing skeletal instability and fractures. Bisphosphonates are drugs that are designed to normalize and re-coordinate the process of bone growth and destruction.

Some common bisphosphonates are alendronate (Fosamax), Zoledronic acid (Zometa), pamidronate (Aredia), and risedronate (Actonel). Zoledronic acid and pamidronate are administered via injection into a vein. Zoledronic acid has been shown to relieve pain as well as delay the onset of complications, and is usually administered once every 3 weeks as a 15-minute infusion. Some men have reported flu-like symptoms after the first few treatments of zoledronic acid, including generalized aches and pain, fatigue, nausea and vomiting; however, these side effects usually subside in a few days. In addition, this drug can cause kidney problems therefore physicians should draw blood prior to each treatment to insure proper kidney function. Pamidronate has demonstrated only limited benefit and is less frequently used.

Alendronate and risedronate are taken as a pill and often used to slow bone loss in men who are undergoing hormone therapy for prostate cancer.

Because bone metastases are so common in men with prostate cancer, researchers are continuing the search for new drugs and therapies to treat the pain and complications associated with these metastases.