Prostate Cancer

The prostate gland is an organ that is located at the base or outlet of the urinary bladder.  The urethra is the passage through which urine drains from the bladder to leave the penis.  The main function of the prostate gland is to produce some of the substances that are found in normal semen.  In a young man, the normal prostate gland is the size of a walnut (<30g).

What is prostate cancer?

Prostate cancer is a cancerous tumor that consists of cells from the prostate gland.  Generally, the tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs.  

Symptoms

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms.

The symptoms listed below can occur with prostate cancer, usually at a late stage. These symptoms can also be caused by other prostate problems:

• Delayed or slowed start of urinary stream
• Dribbling or leakage of urine, most often after urinating
• Slow urinary stream
• Straining when urinating, or not being able to empty out all of the urine
• Blood in the urine or semen
• Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)

Signs and tests

A biopsy is needed to tell if you have prostate cancer. A sample of tissue is removed from the prostate and sent to a lab.

Your doctor may recommend a prostate biopsy if:

• You have high PSA level
• A rectal exam shows a large prostate or a hard, uneven surface

The results are reported using what is called a Gleason grade and a Gleason score.

The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 - 5. You may have different grades of cancer in one biopsy sample. The two main grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer is to have spread past the prostate:

• Scores 2 - 5: Low-grade prostate cancer
• Scores 6 - 7: Intermediate- (or in the middle-) grade cancer. Most prostate cancers fall into this group.
• Scores 8 - 10: High-grade cancer

The following tests may be done to determine whether the cancer has spread:

• CT scan
• Bone scan

The PSA blood test will also be used to monitor your cancer after treatment. Often, PSA levels will begin to rise before there are any symptoms. An abnormal digital rectal exam may be the only sign of prostate cancer (even if the PSA is normal).