The prostate is an organ found in males that produces the fluid that nourishes semen. The prostate is typically the size of a walnut and surrounds the urethra, which removes urine through the penis. As men age, the prostate can become cancerous. Almost all prostate cancers are adenocarcinomas, which develop in the gland cells.
Men with prostate cancer usually have no noticeable symptoms, and the first sign of the disease is found during a routine screening exam. The following symptoms overlap with the benign (non-cancerous) enlarged prostate, but may indicate the presence of prostate cancer:
- Frequent urge to urinate
- Difficulty starting or holding back urination
- Weak or interrupted flow of urine
- Painful urination and ejaculation
- Blood in the urine or semen
- Difficulty having an erection
- Decreased fluid ejaculated
- Pressure or pain in the rectum
- Pain or stiffness in the lower back, hips, pelvis, or thighs
Inherited and acquired gene mutations can cause prostate cancer. Acquired gene mutations might also contribute to prostate cancer risk in some men. Male hormones such as testosterone promote prostate cell growth. When too much testosterone causes cells to grow and divide too quickly, mutations can occur.
Not everything happens because of gene mutations, majority of patients get prostate cancer due to environmental exposures, hormonal changes, inflammation. There are also research findings that indicate association between prostate cancer and breast cancer.
Almost all prostate cancers are adenocarcinomas, which develop in the gland cells. Symptoms of adenocarcinoma of the prostate include blood in the semen, frequent urge to urinate, and painful urination and ejaculation.
After skin cancer, prostate cancer is the most common form of cancer among men in the United States.
All men should be screened for prostate cancer. Certain risk factors can influence the timing and frequency of screening. These include age, race, and family history. About two-thirds of prostate cancers affect men over the age of 65. African-American men over the age of 65 are particularly affected.
In its early stages, prostate cancer has no obvious symptoms. With advanced prostate cancer, you may experience problems with urination, although this can also be a sign of an enlarged prostate, benign prostatic hyperplasia, or prostatitis.
We know that African-American men are at higher risk for prostate cancer than Caucasian men. In addition, if a close relative such as a father or brother has had prostate cancer, your risk is higher than average. Acquired gene mutations may also contribute to prostate cancer risk in some men. Male hormones such as testosterone promote prostate cell growth. When too much testosterone causes cells to grow and divide too quickly, mutations can occur and can result in cancer.
The current (2020) lifetime risk of prostate cancer for men living in the United States is approximately 1 in 9 men. The incidence though is highly dependent on a number of factors. There are many well known risk factors for prostate cancer. Amongst these are age, ethnicity and genetic factors, and these can impact upon the significance of findings from blood tests (like PSA) and imaging (like MRI). However, while each factor on its own is useful, in combination they are more powerful, and provide more accurate estimates of each individual’s risk.
Personalizing care is a focus of Dr. Tewari’s research group.
Dr. Tewari’s team has developed multiple risk tools to help personalize risk assessment for prostate cancer.
This work has been published in peer-reviewed medical journals:
- Artificial intelligence and neural networks in urology
- Development of a model to predict prostate cancer at the apex (PCAP model) in patients undergoing robot-assisted radical prostatectomy
- Novel nomogram for the prediction of seminal vesicle invasion including multiparametric magnetic resonance imaging
The Gleason grading system
To estimate your prostate cancer’s aggressiveness—its potential to grow and spread to other parts of the body—we use a method called the Gleason grading system. A pathologist looks at tissue samples from your biopsy under a microscope to describe how the tumor cells look compared to normal cells and to identify their distinct patterns.
- The pathologist assigns a score of 1-5 to the most predominant cell pattern and a score of 1-5 to the next most predominant cell pattern and adds these scores together. The sum of the two scores is the “ grade” of your cancer. The higher the grade, the more aggressive the cancer.
- A grade of 6 or less describes cancer cells that look similar to normal cells and may be less likely to spread or may grow more slowly.
Factors to consider
Treatment for prostate cancer is chosen after a thorough evaluation of various factors related to your current situation. You should discuss the benefits and risks of each treatment with your doctor.
For some patients, only one treatment may be recommended because of the specific type of cancer and the particular risk factors. For other patients, two or more treatment options may be viable.
Here are some factors you must think about when considering treatment options:
- Your age and other medical problems you may have
- Side effects that may occur with each type of treatment
- Whether the prostate cancer is localized or how much the cancer has spread
- Your Gleason grade, which tells how aggressive the cancer is
- Your prostate-specific antigen (PSA) test result
To determine which treatment option may be best, you should ask the following questions:
- Which choices offer the best chance of curing your cancer or controlling its spread?
- How likely is it that you will experience side effects, and how they will affect your life?
Outcomes and implications
Less than 10 percent of men experience complications after prostatectomy, and these are usually treatable or short-term. The two most common post-surgery problems are urinary incontinence and erectile dysfunction(ED). Less than 5 percent of men younger than age 50, and less than 15 percent of men age 70 or older, are incontinent after radical prostatectomy.
Most men are able to have sex after prostatectomy while using ED medicines (such as Viagra®
or Cialis ®), an external pump, or injectable medications. The younger the man, the higher the chance of maintaining potency after prostatectomy. A period of penile rehabilitation is often necessary.
Sparing the nerves that can cause urinary incontinence or erectile dysfunction is the hallmark of a skilled surgeon. A patient who has a radical prostatectomy by a surgeon at an advanced prostate cancer center has a better chance of maintaining sexual and urinary function.