Prostate cancer

Prostate cancer is a group of cancerous cells (a malignant tumor) that begins most often in the outer part of the prostate. It is the second most common type of cancer in men in the United States. Skin cancer is the most common. Of all the men who are diagnosed with cancer each year, more than one-fourth have prostate cancer.

The prostate

The prostate is a gland in a man's reproductive system. It makes and stores seminal fluid, a milky fluid that nourishes sperm. This fluid is released to form part of semen.

The prostate is about the size of a walnut. It is located below the urinary bladder and in front of the rectum. It surrounds the upper part of the urethra, the tube that empties urine from the bladder. If the prostate grows too large, the flow of urine can be slowed or stopped.

To work properly, the prostate needs male hormones (androgens). Male hormones are responsible for male sex characteristics. The main male hormone is testosterone, which is made mainly by the testicles. Some male hormones are produced in small amounts by the adrenal glands.

Prostate cancer: who's at risk

The causes of prostate cancer are not well understood. Doctors cannot explain why one man gets prostate cancer and another does not.

Researchers are studying factors that may increase the risk of this disease. Studies have found that the following risk factors are associated with prostate cancer:

* Age. In the United States, prostate cancer is found mainly in men over age 55. The average age of patients at the time of diagnosis is 70.
* Family history of prostate cancer. A man's risk for developing prostate cancer is higher if his father or brother has had the disease.
* Race. This disease is much more common in African American men than in white men. It is less common in Asian and American Indian men.
* Diet and dietary factors. Some evidence suggests that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies are in progress to learn whether men can reduce their risk of prostate cancer by taking certain dietary supplements.

Although a few studies suggested that having a vasectomy might increase a man's risk for prostate cancer, most studies do not support this finding. Scientists have studied whether benign prostatic hyperplasia, obesity, lack of exercise, smoking, radiation exposure, or a sexually transmitted virus might increase the risk for prostate cancer. At this time, there is little evidence that these factors contribute to an increased risk.

Recognizing symptoms

Early prostate cancer often does not cause symptoms. But prostate cancer can cause any of these problems:

* A need to urinate frequently, especially at night;
* Difficulty starting urination or holding back urine;
* Inability to urinate;
* Weak or interrupted flow of urine;
* Painful or burning urination;
* Difficulty in having an erection;
* Painful ejaculation;
* Blood in urine or semen; or
* Frequent pain or stiffness in the lower back, hips, or upper thighs.

Treatment for prostate cancer

Getting a second opinion

Decisions about prostate cancer treatment involve many factors. Before making a decision, a man may want to get a second opinion by asking another doctor to review the diagnosis and treatment options. A short delay will not reduce the chance that treatment will be successful. Some health insurance companies require a second opinion; many others will cover a second opinion if the patient requests it. There are a number of ways to find a doctor who can give a second opinion:

* The patient's doctor may be able to recommend a specialist or team of specialists to consult. Doctors who treat prostate cancer are urologists, radiation oncologists, and medical oncologists. Patients may find it helpful to talk to a specialist in each of these areas. Different types of specialists may have different thoughts about how best to manage prostate cancer.
* In the USA, the Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
* People can get the names of doctors from their local medical society, a nearby hospital, or a medical school.
* The Official Directory of the American Board of Medical Specialties (ABMS) lists doctors' names along with their specialty and their educational background. This resource, produced by the ABMS, is available in most public libraries. The ABMS also has an online service that lists many board-certified physicians