Prostate problems also called prostate disease, is a condition where there is an abnormality in the prostate gland. Prostate problems usually affect older men and it occurs when cells are produced and grow out of control. It can cause pain in the lower back and other discomforting symptoms.
Cancer, erectile dysfunction, heart disease, diabetes, and allergies are common problems that affect an alarming number of men. Some of these health issues can be easily remedied if you take preventative care of yourself.
The Prostate
The prostate and seminal vesicles are part of the male reproductive system. The prostate is about the size of a walnut and weighs about one ounce. The seminal vesicles are two much smaller paired glands. These glands are attached to each side of the prostate. Some have said that the seminal vesicles look like rabbit ears attached to the prostate. The prostate is below the bladder and in front of the rectum. The prostate surrounds the urethra. The urethra is a tube that carries urine from the bladder out through the penis. This is why men with an enlarged prostate have difficulty urinating. It can disrupt the flow of urine from the bladder.
The main job of the prostate and seminal vesicles is to make fluid to bathe semen. During ejaculation, sperm is made in the testicles and then moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture of semen and fluid from the prostate and seminal vesicles forms the ejaculate that passes through the urethra and out of the penis.
When prostate cancer occurs, it starts in the prostate gland and occasionally spreads to the seminal vesicles.
Symptoms
In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Prostate cancer can also cause symptoms unrelated to BPH. If you have urinary problems, talk with your healthcare provider about them.
Symptoms of prostate cancer can be:
- Dull pain in the lower pelvic area
- Frequent urinating
- Trouble urinating, pain, burning, or weak urine flow
- Blood in the urine (Hematuria)
- Painful ejaculation
- Pain in the lower back, hips, or upper thighs
- Loss of appetite
- Loss of weight
- Bone pain
Causes
No one knows why or how prostate cancer starts. Autopsy studies show 1 in 3 men over the age of 50 has some cancer cells in the prostate. Eight out of ten “autopsy cancers” found are small, with tumors that are not harmful.
Even though there is no known reason for prostate cancer, there are many risks associated with the disease.
What Are the Risk Factors for Prostate Cancer?
Age
As men age, their risk of getting prostate cancer goes up. It is rarely found in men younger than age 40. Damage to the genetic material (DNA) of prostate cells is more likely for men over the age of 55. Damaged or abnormal prostate cells can begin to grow out of control and form tumors.
Age is a well-known risk factor for prostate cancer. But, smoking and being overweight are more closely linked with dying from prostate cancer.
Ethnicity
African American men have, by far, the highest incidence of the disease. One in six African American men will get prostate cancer. African American men are more likely to get prostate cancer at an earlier age. They are also more like to have aggressive tumors that grow quickly, spread, and cause death. The reason why prostate cancer is more prevalent in African American men is unclear yet it may be due to socioeconomic, environmental, diet, or other factors. Other ethnicities, such as Hispanic and Asian men, are less likely to get prostate cancer.
Family History
Men with a family history of prostate cancer also face a higher risk of also developing the disease. A man is 2 to 3 times more likely to get prostate cancer if his father, brother, or son had it. This risk increases with the number of relatives diagnosed with prostate cancer. The age when a close relative was diagnosed is also an important factor.
Smoking
Studies show prostate cancer risk may double for heavy smokers. Smoking is also linked to a higher risk of dying from prostate cancer. However, within 10 years of quitting, your risk for prostate cancer goes down to that of a non-smoker the same age.
World Area
Prostate cancer numbers and deaths vary around the world but are higher in North America and Northern Europe. Higher rates may be due to better or more screening procedures, heredity, poor diets, lack of exercise habits, and environmental exposures.
Diet
Diet and lifestyle may affect the risk of prostate cancer. It isn’t clear exactly how. Your risk may be higher if you eat more calories, animal fats, and refined sugar, and do not enough fruits and vegetables. A lack of exercise is also linked to poor outcomes. Obesity (or being very overweight) is known to increase a man’s risk of dying from prostate cancer. One way to decrease your risk is to lose weight and keep it off.
Can Prostate Cancer Be Prevented?
Doing things that are “heart healthy”, will also keep your prostate healthy. Eating right, exercising, watching your weight and not smoking can be good for your health and help you avoid prostate cancer.
Some healthcare providers believe drugs like finasteride (Proscar ®) and dutasteride (Avodart ®) can prevent prostate cancer. Others believe they only slow the development of prostate cancer. Studies do show that men taking these drugs were less likely to be diagnosed with prostate cancer. Still, it is not clear if these drugs are effective so you should talk to your doctor about the possible side effects.
Diagnosis
Screening
“Screening” means testing for a disease even if you have no symptoms. The prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) are two tests that are used to screen for prostate cancer. Both are used to detect cancer early. However, these tests are not perfect. Abnormal results with either test may be due to benign prostatic enlargement (BPH) or infection, rather than cancer.
The two main types of screenings are:
PSA Blood Test
The prostate-specific antigen (PSA) blood test is one way to screen for prostate cancer. This blood test measures the level of PSA in the blood. PSA is a protein made only by the prostate and prostate cancers. The test can be done in a lab, hospital, or healthcare provider’s office.
Very little PSA is found in the blood of a man with a healthy prostate. A low PSA is a sign of prostate health. A rapid rise in PSA may be a sign that something is wrong. Prostate cancer is the most serious cause of a high PSA result. Another reason for a high PSA can be benign (non-cancer) enlargement of the prostate. Prostatitis, inflammation of the prostate, can also cause high PSA results.
A rise in the PSA level does not tell us the type of cancer cells present. The rise tells us that cancer may be present.
Talk with your healthcare provider about whether the PSA test is useful for you. If you decide to get tested, be sure to talk about changes in your PSA level with your provider.
DRE
The digital rectal examination (DRE) helps your doctor find prostate problems. For this exam, the healthcare provider puts a lubricated gloved finger into the rectum. The man either bends over or lies curled on his side on a table. During this test, the doctor feels for an abnormal shape or thickness of the prostate. DRE is safe and easy to do. But the DRE by itself cannot detect early cancer. It should be done with a PSA test.
Who Should Get Screened?
Screening is recommended if you are a man:
- Between 55–69 years old
- African–American
- Have a family history of prostate cancer
What are the benefits and risks of screening?
The PSA test and DRE are very important tools. They help to find prostate cancer early before it spreads. When found early, it can be treated early which helps stop or slow the spread of cancer. This is likely to help some men live longer.
A risk of a PSA test is that it may miss detecting cancer (a “false negative”). Or, the test may be a “false positive,” suggesting something is wrong when you are actually healthy. A false positive result may lead to a biopsy that isn’t needed. The test might also detect very slow-growing cancer that will never cause problems if left untreated.
What is a Biopsy?
A biopsy is a type of minor surgery. For a prostate biopsy, tiny pieces of tissue are removed from the prostate and looked at under a microscope. The pathologist is the doctor who will look carefully at the tissue samples to look for cancer cells. This is the only way to know for sure if you have prostate cancer.
The decision to have a biopsy is based on PSA and DRE results. Your doctor will also consider your family history of prostate cancer, ethnicity, biopsy history, and other health factors.
Prostate biopsy is usually done using an ultrasound probe to look at the prostate and guide the biopsy. You may be given an enema and antibiotics to prevent infection. For the test, you will lie on your side as the probe goes into the rectum. First, your provider takes a picture of the prostate using ultrasound. Your healthcare provider will note the prostate gland’s size, shape, and any abnormalities. He/she will also look for shadows, which might signal cancer. Not all prostate cancers can be seen, and not all shadows are cancer. The prostate gland is then numbed (anesthetized) with a needle passed through the probe. Then, the provider removes very small pieces of your prostate using a biopsy device. The amount of tissue removed depends on the size of the gland, PSA results, and past biopsies.
If cancer cells are found, the pathologist will assign a “Gleason Score” which helps to determine the severity/risk of the disease.
After a biopsy, you may have blood in your ejaculate, urine, and stool. This should go away fairly quickly. If not, or you get a fever, contact your doctor or book an online appointment with us at https://questiondoctors.com/online-diagnosis/
How is Prostate Cancer Graded and Staged?
Grading (with the Gleason Score) and staging define the progress of cancer and whether it has spread:
Grading
When prostate cancer cells are found in tissue from the core biopsies, the pathologist “grades” it. The grade is a measure of how quickly the cells are likely to grow and spread (how aggressive it is).
The most common grading system is called the Gleason grading system. With this system, each tissue piece is given a grade between three (3) and five (5). In the past, we assigned scores of one (1) and two (2). A grade of less than three (3) means the tissue is close to normal. A grade of three (3) suggests a slow-growing tumor. A high grade of five (5) indicates a highly aggressive, high-risk form of prostate cancer.
The Gleason system then develops a “score” by combing the two most common grades found in biopsy samples. For example, a score of grades 3 + 3 = 6 suggests slow-growing cancer. The highest score of grades 5 + 5 = 10 means that cancer is present and extremely aggressive.
The Gleason score will help your doctor understand if the cancer is as a low-, intermediate- or high-risk disease. Generally, Gleason scores of 6 are treated as low-risk cancers. Gleason scores of around 7 are treated as intermediate/mid-level cancers. Gleason scores of 8 and above are treated as high-risk cancers.
If you are diagnosed with prostate cancer, ask about your Gleason score and how it impacts your treatment decisions.
Staging
The tumor stage is also measured. Staging describes where the cancer is within the prostate, how extensive it is, and if it has spread to other parts of the body. One can have low-stage cancer that is very high risk. Staging the cancer is done by DRE and special imaging studies.
The system used for tumor staging is the TNM system. TNM stands for Tumor, Nodes, and Metastasis. The “T” stage is found by DRE and other imaging tests such as an ultrasound, CT scan, MRI, or bone scan. The imaging tests show if and where cancer has spread, for example: to lymph nodes or bone.
These staging imaging tests are generally done for men with a Gleason grade of 7 or higher and a PSA higher than 10. Sometimes follow-up images are needed to evaluate changes seen on the bone scan.
Imaging Tests
Not all men need imaging tests. Your doctor may recommend imaging exams based on results from other tests.
Prostate cancer may spread from the prostate into other tissues. It may spread to the nearby seminal vesicles, the bladder, or further to the lymph nodes and the bones. Rarely, it spreads to the lungs and or other organs.
Your healthcare provider may recommend a pelvic CT scan, an MRI scan, or a bone scan to check if your cancer has spread.
What Are the Survival Rates For Prostate Cancer?
Many men with prostate cancer will not die from it; they will die from other causes. For men who are diagnosed, it is better if it is caught early.
Survival rates for men with prostate cancer have increased over the years, thanks to better screening and treatment options. Today, 99% of men with prostate cancer will live for at least 5 years after diagnosis. Many men having treatment are cured. Most prostate cancer is slow-growing and takes many years to progress. One out of three men will survive after five years, even if the cancer has spread to other parts of the body.
Treatment
Some cancers grow so slowly that treatment may not be needed at all. Others grow fast and are life-threatening so treatment is usually necessary. Deciding what treatment you should get can be complex. Talk with your healthcare team about your options. Your treatment plan will depend on:
- The stage and grade of cancer (Gleason score and TNM stage)
- Your risk category (whether the cancer is low, intermediate, or high risk)
- Your age and health
- Your preferences with respect to side effects, long-term effects, and treatment goals
Results from other diagnostic tests will help your provider understand if cancer can spread or recur (return) after treatment.
Before you decide what to do, you should consider how immediate and long-term side effects from treatment will affect your life, and what you’re willing to tolerate. Also, you should consider that you may try different things over time.
If you have time before you start treatment, consider your range of options. Get a second opinion from different prostate cancer experts. You may need to see another urologist, oncologist, or radiation oncologist. Consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects (like incontinence) is lower. Also, it helps to talk with other survivors and learn from their experiences.
In addition, try and get or stay healthy. Eating a well-balanced diet, maintaining a healthy weight, exercising and not smoking are all important factors when fighting prostate cancer.
Moreover, don’t ignore your emotions. Think about how you’re coping with this diagnosis. Many men who have prostate cancer feel worried, stressed, and angry. You and those that care about you may need to consider professional counseling.
Treatment choices for prostate cancer include:
Surveillance
- Active Surveillance
- Watchful Waiting
Localized Therapy
- Surgery
- Radiation Therapy
- Cryotherapy
- Focal Therapy
Systemic Therapy
- Hormonal Therapy
- Chemotherapy
- Immunotherapy
What to Expect After the Prostate is Removed
After the prostate has been removed, the urinary tract and the bladder are reconstructed. A catheter is passed through the urethra into the bladder to drain the urine while the new connections heal. One or two suction drains may be left in the pelvic cavity after surgery. They are brought through the lower belly to drain fluid from the wound. They help lower the risk of infection. The drains are usually removed before you are discharged from the hospital.
After surgery, your surgeon will review the final pathology report. Together you will make plans for the next steps.
What Are the Benefits, Risks, and Side Effects of Surgery?
The main benefit of radical prostatectomy is the prostate with cancer is removed. This is true as long as cancer hasn’t spread outside the prostate. Surgery also helps the healthcare provider know if you need more treatment.
The goal of surgery is to get a PSA value of less than 0.1 ng/mL for 10 years. Surgery is often a good choice if prostate cancer has not spread beyond the prostate.
Surgery always comes with risks. Some complications from surgery can happen early and some later. Bleeding or infection can happen with any major operation, so you will be monitored to prevent or manage these problems.
Not everyone has the same side effects for the same amount of time. With surgery (and with radiation therapy), there are two main side effects to consider: erectile dysfunction (ED) and urinary incontinence (a loss of urine control). For some men, surgery can relieve pre-existing urinary obstruction. Most men with these side effects find ways to manage them over time.
Erectile Dysfunction and Sexual Desire
All men have some form of erectile dysfunction after prostate surgery. Erectile dysfunction is the inability of a man to have an erection long enough for satisfying sexual activity. Nerves involved in the erection process surround the prostate gland, and they can be affected by surgery. They can also be affected by radiation treatment. These nerve bundles help control blood flow to the penis. The length of time ED lasts after treatment depends on many things, including how firm your erections are before treatment. Sometimes, it may take one year or longer to recover erectile function. In the meantime, your doctor may have ED treatment options for you. If it’s possible, nerve-sparing surgery may help prevent long-term damage. Older men have a higher chance of permanent ED after this surgery.
After Treatment
Each year, more men are surviving prostate cancer and winning back their lives. Prostate cancer can be a manageable disease if caught early and treated appropriately.
Once you have finished treatment, it is time to manage your side effects. It is time to create a long-term schedule with your doctor for future tests. It’s also time to go on with your life.
Talk to your healthcare provider about the side effects or problems you have after treatment. You and your healthcare provider can decide your best next steps.
If you haven’t yet started treatment, consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects, like incontinence, is lower.
What are the Emotional Effects Following Treatment?
After treatment, you may feel very emotional. You may also worry about cancer returning. Many men still feel anxious and unsure, or upset about treatment side effects.
Whatever you’re feeling, it’s important to tell your healthcare provider about it. Work together. Build a plan with your provider or a counselor to deal with your emotional health and general well-being.
What Are The Physical Effects Following Treatment?
Erectile dysfunction and urinary incontinence are the side effects reported most often by men following prostate cancer treatment.
Erectile Dysfunction (ED) Issues After Prostate Cancer Treatment
After prostate cancer, many men experience erectile dysfunction (ED). An erection happens when sexual arousal causes nerves near the prostate to send signals. The signals cause the blood vessels in the penis to fill with blood. The blood in the vessels makes the penis erect. ED happens when this process doesn’t work well (or is damaged from surgery or radiation) and a man cannot keep an erection long enough for sexual satisfaction. Your doctor can help you understand the causes of ED and therapies that could help you recover.
What Causes ED After Prostate Cancer Treatment?
Nerves involved in the erection process surround the prostate gland. Surgery may damage the nerve bundles that control blood flow to the penis, causing ED. Or, these nerves may be removed with cancer. Radiation therapy also can damage the erectile nerves causing ED. In addition, the amount of blood flowing to the penis can decrease after treatment.
While most surgeons try to perform a nerve-sparing procedure, it is not always possible.
The chance of ED after treatment depends on many things:
- Age
- Health
- Sexual function before treatment
- Stage of the cancer
- Whether the nerves that control erection were damaged after surgery or radiation.
How Long Can ED Last?
If the treatment causes ED, there is still a chance for erectile function to come back over time (unless both nerves were destroyed). It may take up to 24 months or longer before you are able to have a full erection, but it is possible. Some men recover sooner. The average time for erections that allow intercourse is between 4 and 24 months. Men under age 60 have a better chance of regaining erections than older men. Even with nerve-sparing surgery, erections do not return right away or to full pre-surgery function. But, they may recover enough for sex. There are medicines and devices to treat ED.
Even with no erection, or a weak erection, men can orgasm.
Are There Treatments for ED After Prostate Cancer Treatment?
There are several treatments that can help ED. They include pills, vacuum pumps, urethral suppositories, penile injections and penile implants. Individual treatments don’t work for every patient. They have their own set of side effects. A healthcare provider can talk with you about the pros and cons of each method. They can help you decide which individual or combination of treatments is right for you.
Urinary Incontinence After Prostate Cancer Treatment
Urinary incontinence can sometimes result from prostate cancer treatment. Urinary incontinence is urine leakage without your control. Men may have many types of incontinence after prostate surgery.
- Stress incontinence – Coughing, laughing, sneezing, or exercising can strain the pelvic floor muscles, causing urine to leak. This is the most common type of urinary incontinence.
- Urge incontinence – You feel a sudden, urgent need to go to the bathroom, even when the bladder is not full. This happens because the bladder is overly sensitive. Urge incontinence is also called overactive bladder.
- Urinary frequency – You go to the bathroom very often. You may feel the need to go every 30 to 60 minutes.
- Mixed incontinence – You have symptoms of more than 1 type of urinary incontinence.
- Because incontinence may affect your physical and emotional recovery, it is of great value to understand how to manage this problem.
How Long Will Incontinence Last?
It is common to have incontinence for a time after prostate surgery. If you have stress incontinence, you may need to wear pads for a few weeks or months. In most cases, urinary control will return. Still, incontinence may last as long as 6 to 12 months. It’s rare for it to last more than a year.
Are there Treatments for Incontinence After Prostate Cancer Treatment?
Treatment for incontinence depends on the type and severity of the problem. Ask your doctor about treatment choices, risks and benefits, and what you should expect.
- Physical therapy can help you regain bladder control. Your doctor can write you a prescription for it. Most health plans will cover it.
- Kegel exercises build up the pelvic floor muscles, training them to keep urine in the bladder. If you’re going to have prostate cancer surgery, your doctor may suggest that you start doing these exercises before your surgery.
- Biofeedback may be used with Kegel exercises to help you judge how well the pelvic floor muscles are working and let you know whether you are doing the exercises the right way.
- Neuromuscular electrical stimulation uses a device that sends electrical impulses to nerves, which causes muscles to contract. It may be used with Kegel exercises to help train the pelvic floor muscles to contract properly.
- Timed voiding, is a way to reduce the urinary frequency with planned bathroom visits. It’s used to help your bladder spread out so that it can hold more urine. Your nurse or doctor can help you make a plan for timed voiding.
- Avoiding bladder irritants during the healing period. These foods and drinks can bother the bladder:
- Caffeine in coffee, tea, and sodas
- Acidic drinks such as juices
- Alcohol
- Artificial sweeteners
- Spicy foods
- Medication can calm bladder irritability and help reduce urine leaks.
- Surgery is mainly offered if your bladder has tried to heal on its own, but healing is not complete after at least a year. Your doctor will talk with you about these choices if other treatments haven’t helped with your urinary problems.
- Products such as pads can help reduce pain from urine leakage. These products do not treat incontinence but do help keep up a higher quality of life.
What if Prostate Cancer Returns?
Prostate cancer may return. Durable (or long-term) remission depends on the specifics of your cancer. If you’d like to learn more about how to manage advanced prostate cancer, book an online consultation with us.
How does prostate cancer compare with other cancers?
- Prostate cancer is the most common non-skin cancer in men in the U.S., and the 4th most common tumor diagnosed worldwide.
- A man is more likely to develop prostate cancer than he is to develop colon, kidney, melanoma, and stomach cancers combined.
How curable is prostate cancer?
As with all cancers, “cure” rates for prostate cancer describe the percentage of patients likely remaining disease-free for a specific time. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free.
Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high—nearly 100% of men diagnosed at this stage will be disease-free after five years. By contrast, in the 1970s, only 67% of men diagnosed with local or regional prostate cancer were disease-free after five years.
What are the symptoms of prostate cancer? If there are no symptoms, how is prostate cancer detected?
What are the symptoms of prostate cancer?
If the cancer is caught at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms such as frequent, hesitant, or burning urination, difficulty in having an erection, or pain or stiffness in the lower back, hips or upper thighs.
Because these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms. You can read more about prostate cancer symptoms.
If there are no symptoms, how is prostate cancer detected?
Screening for prostate cancer can be performed in a physician’s office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE).
How is prostate cancer treated?
There are a wide variety of treatment options available for men with prostate cancer, including surgery, radiation therapy, hormone therapy, and chemotherapy, any or all of which might be used at different times depending on the stage of the disease and the need for treatment.
Consultation with all three types of prostate cancer specialists—a urologist, a radiation oncologist, and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes. For men with advanced disease or an increased risk due to family history or lifestyle, precision treatments based on genetic screening may be recommended.
More information regarding treatments for prostate cancer can be found on our website.
What can I do to help prevent prostate cancer?
- Eat fewer calories and exercise more so that you maintain a healthy weight.
- Try to keep the amount of fat you get from red meat and dairy products to a minimum.
- Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,200 mg per day.
- Eat more fish – evidence from several studies suggest that fish can help protect against prostate cancer because they have “good fat,” particularly omega-3 fatty acids. Avoid trans fatty acids (for example, in margarine).
- Incorporate cooked tomatoes (prepared with olive oil), which may be beneficial, and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy-based foods and green tea are also potential dietary components that may be helpful.
- Avoid smoking for many reasons. Drink alcohol in moderation, if at all.
- Seek medical treatment for stress, high blood pressure, diabetes, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer.
- Avoid over-supplementation with megavitamins. While a multivitamin is not likely to be harmful, you probably don’t need it if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils. Ask your doctor about herbal supplements as some may harm you or interfere with treatment.
- Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
- For men 45 or older (40 or older for Black men or those with a family history of prostate cancer), discuss the risks and benefits of screening with a PSA test and, if indicated, a rectal examination, with your doctor.
It’s an uncomfortable but necessary discussion that most men don’t want to have: prostate problems. But with nearly everyone affected by a variety of health issues, it’s important to start talking about how you can manage any number of symptoms such as frequent urination and other common ailments. Use this information to arm yourself with the best possible tools to seek care if your prostate problems are beginning to interfere with your day-to-day life. You can also book a consultation with us for more information.
