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Prostate: Tests for prostate, prostate cancer, enlarged prostate and prostate cancer symptoms

The prostate (PROS-tate) is a gland found only in men, so only men get prostate cancer. The prostate is about the size of a walnut. It is just below the bladder and in front of the rectum. The tube that carries urine (the urethra) runs through the prostate.

Prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be about 230,900 new cases of prostate cancer in the United States in the year 2004. About 29,900 men will die of this disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. While 1 man in 6 will get prostate cancer during his lifetime, only 1 man in 32 will die of this disease. The death rate for prostate cancer is going down. And the disease is being found earlier as well.

African-American men are more likely to have prostate cancer and to die of it than are white or Asian men. The reasons for this are still not known.

Common Prostate Symptoms
Prostate cancer is the most common cancer in men. Because it is usually diagnosed before symptoms appear, screening and early detection are critical to finding the disease at an early stage when it can be potentially cured, and there are more treatment options.

Men with this cancer may have one or more of these symptoms, but none of the symptoms below are specific for cancer, and most men with prostate cancer have none of them. However, when present they may point to other health problem that can - and often should - be treated. Their presence should prompt men to seek medical evaluation, including a digital rectal exam (DRE) of the prostate and serum PSA, from a urologist or other physician.

Painful or burning urination
Inability to urinate or difficulty in starting to urinate
Frequent or urgent need to urinate
Trouble emptying the bladder completely
Blood in the urine or semen
Continual pain in the lower back, pelvis, or thighs

It is not known at present what exactly what causes prostate cancer, but we do know that certain risk factors are linked to the disease. A risk factor is anything that increases a person's chance of getting a disease. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. But having a risk factor, or even several, doesn’t mean that you will get the disease.

While all men are at risk for prostate cancer, the factors listed below can increase the chances of a man having the disease.

Age	The chance of getting prostate cancer goes up as a man gets older.
Race	For unknown reasons, prostate cancer is more common among African-American men than among white men. And African-American men are twice as likely to die of the disease.
Nationality	Prostate cancer is most common in North America and northwestern Europe. It is less common in Asia, Africa, Central America, and South America.
Diet	Men who eat a lot of red meat or have a lot of high-fat dairy products in their diet seem to have a greater chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors are not sure which of these factors causes the risk to go up.
Exercise	Getting enough exercise and keeping a healthy weight may help reduce prostate cancer risk.
Family history	Men with close family members (father or brother) who have had prostate cancer are more likely to get it themselves, especially if their relatives were young when they got the disease.

Some people get cancer because of changes to a chemical called DNA that controls how cells behave. DNA is inherited from our parents. A small percent (about 5% to 10%) of prostate cancers are linked to such changes. Please refer to the process of Oxidative Stress to gain further information on how these DNA changes may be prompted. It is also thought that prostate cancer may be linked to higher levels of certain hormones. High levels of male hormones (androgens) may play a part in prostate cancer risk in some men. Also, some researchers have noted that men with high levels of the hormone called IGF-1 are more likely to get prostate cancer. But others have not found such a link. More research is needed in this area.

Can Prostate Cancer Be Prevented

Some cases of prostate cancer might be prevented. One risk factor that can be changed is diet. You may be able to lower your risk of prostate cancer by eating less fat and more vegetables, fruits, and grains. The American Cancer Society suggests a diet low in red meats (especially those high in fat) and high in vegetables, fruits, and grains. Eat 5 or more servings of fruits and vegetables each day. These guidelines provide an overall healthful approach to eating that may help lower your risk for some other types of cancer. Tomatoes, grapefruit, and watermelon are rich in a substance (lycopenes) that helps prevent damage to DNA and may help lower prostate cancer risk.

While some studies suggest that taking 50 milligrams of vitamin E daily can lower the risk of prostate cancer, other studies have found no benefit. But this vitamin is not expensive and doesn’t cause any major side effects. So taking reasonable doses is not harmful. On the other hand, vitamin A supplements may actually increase prostate cancer risk. It’s always a good idea to check with your doctor about taking vitamins or supplements.

There is another study going on to find out if the drug finasteride, which prevents the prostate from using male hormones, can reduce prostate cancer risk. Because prostate cancer forms slowly, it will be several years before we know the answer.

How is Prostate Cancer Detected

Prostate cancer can often be found early by testing the amount of PSA (prostate-specific antigen) in your blood. Another way prostate cancer is found early is when the doctor performs a rectal exam. Because the prostate gland lies just in front of the rectum, the doctor can feel if there are any bumps or hard places in the prostate. These often indicate a cancer. If you have had routine yearly exams and either one of these test results becomes abnormal, your cancer has probably been found at an early stage.

Since about 1990 it has become more common for men to have tests to find prostate cancer early. The prostate cancer death rate has dropped, too. But we do not yet know if this drop is the direct result of the tests. Studies are going on to try to find the answer to this question.

Until the answer is known, you should talk to your doctor about whether or not you want to be tested. Things to take into account are your age and your health. If you are young and you get prostate cancer, it will probably shorten your life if it is not caught early. But if you are older or in poor health, then prostate cancer may never become a major problem, because it often grows so slowly.

The PSA blood test measures a protein (prostate-specific antigen) made by prostate cells. PSA results are reported as ng/ml, which stands for nanograms per milliliter. Results under 4ng/ml are usually considered normal. If your level is above 4 but less than 10, you have about a 25% chance of having prostate cancer. If it goes above 10, your chances are higher. But factors other than cancer can also cause the PSA level to go up. And your PSA level will also go up slowly as you get older. Men with a high PSA will need further tests to find out if they actually have cancer.

The PSA test is also useful after prostate cancer has been found. It can help predict survival (prognosis) before treatment. And it can be used along with other results to help decide the need for further treatment. And it can be used to help decide if treatment is working or not. A very high PSA level might mean that the cancer has most likely spread beyond the prostate. Some forms of treatment are not as useful for cancer that has spread to the lymph nodes or other organs.

DRE (Digital Rectal Exam)

To do the DRE the doctor inserts a gloved, lubricated finger into the rectum to feel for any irregular or abnormally firm area that might be cancer. The prostate gland is next to the rectum, and most cancers begin in the part of the gland that can be reached by a rectal exam. While it is uncomfortable, the exam isn’t painful and takes only a short time.

DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, ACS guidelines recommend that both the DRE and the PSA be used for finding prostate cancer early. The DRE is also used once a man is known to have prostate cancer. It can help predict whether the cancer has spread beyond his prostate gland. It is also used to find cancer that has come back after treatment.

Treatment and Therapies for Prostate Cancer

There is a great deal of information available on the various ways to treat prostate cancer. With so many treatment options and therapies available that we feel the best place to start is with the American Cancer Society web site.