All cancers are named for the part of the body where they originate. Prostate cancer starts in the prostate, a gland found only in men that's critical for reproduction. Prostate cancer begins when cells in this gland grow abnormally. The cancer uses male sex hormones called androgens as fuel for growth. Hormone therapy can block androgen action and treat prostate cancer.
Cancerous cells grow slowly and can take years to become large enough to detect. They may take even longer to spread to other parts of the body. However, some cases of prostate cancer may be more aggressive and need urgent treatment.
Who is at risk for prostate cancer?
Although all men are at risk for prostate cancer, some groups have a greater risk than others. Risk increases significantly after age 50. About 6 in 10 cases of prostate cancer are found in men over age 65.
African American men have a higher risk of prostate cancer than men of other races. They also tend to be younger when diagnosed and more likely to die from the disease. Asian and Hispanic/Latino men have a lower risk of prostate cancer than non-Hispanic white men. It's unclear why these disparities exist, but the difference in outcomes is narrowing.
As with many diseases, family history also plays a role in the development of prostate cancer. It can run in some families, suggesting that a genetic component may increase risk. Men who have a father or brother with prostate cancer have double the risk of developing the disease. However, most cases of prostate cancer are found in men who don't have a family history.
What are the early symptoms of prostate cancer?
Since prostate cancer grows slowly, most men don’t realize something is wrong in the early stages. However, there are five warning signs that you shouldn't ignore:
- Pain or burning during urination or ejaculation
- Frequent urination, especially at night
- Trouble getting an erection (erectile dysfunction)
- Blood in the urine or semen
- Difficulty starting or stopping urination
Other early symptoms of prostate cancer can include weak urine flow and discomfort or pain while sitting.
Note that not all men who have been diagnosed with prostate cancer will have these symptoms. Similarly, these symptoms don’t necessarily mean you have prostate cancer. They may be related to less serious conditions, such as benign prostatic hyperplasia (BPH). This is a common condition in which a man's prostate is enlarged, sometimes twice or three times its original size. However, BPH doesn't mean you're at increased risk of prostate cancer.
Prostatitis also has symptoms that are similar to prostate cancer symptoms. Prostatitis is a painful condition in which the prostate is inflamed and swollen. It’s the most common cause of urinary tract infections in men, but it isn't cancer. It's almost always treatable with antibiotics.
What are the signs of advanced prostate cancer?
Prostate cancer that has spread to other parts of the body is known as advanced or metastatic prostate cancer. Advanced prostate cancer typically spreads to the bladder, rectum and bones. It may also spread to the liver, lungs, lymph nodes or other body tissues.
The signs of advanced prostate cancer depend on where the cancer has spread. These signs can include swelling or weakness in the legs, back or hip pain, trouble breathing or a cough that doesn't go away. Cancer that has spread to the bowels may also cause a loss of bowel control, stomach pain or constipation.
When should men be screened for prostate cancer?
Although there's no one-size-fits-all approach to screening, there are recommendations that can help. If you have certain risk factors, such as age or race, you may want to talk to your doctor about screening sooner than men without risk factors.
The U.S. Preventive Services Task Force issued the following prostate cancer screening recommendations in 2018:
- Men ages 55 to 69 should make individual decisions about when to be screened using a prostate-specific antigen (PSA) test.
- Men should talk to their doctor about the benefits and risks of screening, tests and treatment.
- Men who are 70 or older should not be screened.
The recommendations apply to men who:
- Have an average risk
- Have an increased risk
- Do not have symptoms
- Have never been diagnosed with prostate cancer
What should you do if you think you have prostate cancer?
Talk to your doctor if you have early symptoms of prostate cancer, especially if they come on suddenly. Your doctor will use the PSA blood test or a digital rectal exam to determine if there are any issues with your prostate. Depending on the results, your doctor may order a biopsy.
If you do have prostate cancer, the biopsy can help identify the stage so your doctor can develop a treatment plan for you. Early diagnosis is best and increases the odds of effective treatment, so don't hesitate to discuss your concerns with your doctor.
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