About 
Prostate Cancer

The prostate is a walnut-sized gland located between the bladder and penis, in front of the rectum. The urethra, the tube that carries urine from the bladder and out of the body through the penis, passes through the center of the prostate. The microscopic nerves that control erection are attached to both sides of the prostate as they extend to the penis.  The prostate is surrounded with many small and sensitive nerves and blood vessels that can be damaged as a result of prostate cancer and its treatment. In some ways, it functions as a control center for the male reproductive and urinary systems where urine and semen must pass through the prostate to leave the body. Its importance is less related to what it does than to the problems that it creates when something goes wrong.

Prostate cancer is the uncontrolled growth of cells within the gland. There are several types of cells within the prostate, but most prostate cancers occur within the glandular cells of the organ and are known as adenocarcinoma. Find more educational resources at CancerQuest.

The term “primary tumor” refers to the original tumor within the prostate; secondary tumors are caused when the original cancer spreads to other locations in the body, also known as metastasis. Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate. Early stage prostate cancer produces few or no symptoms and can be difficult to detect.

Prostate cancer is the leading site of new cancer diagnoses and the second leading cause of cancer deaths in men.

Early prostate cancer has no symptoms. Regular testing, beginning as early as age 35 for some men, is the best way to detect prostate cancer in its early stages, when men have the greatest opportunities for successful treatment and maintaining a higher quality of life than waiting for symptoms to become noticeable.

In recent years, Georgia has seen modest improvements in prostate cancer mortality rates while simultaneously recording an increase in the number of new cases reported. GPCC believes these are related: the more men who get tested and identify prostate cancer in its earliest stages, the more men who have the opportunity to successfully recover.  Men who receive early detection and treatment, if appropriate, have higher cure rates (no cancer after 5 years). Later detection typically means a cure is not medically possible. Instead, the disease is managed by you and your doctor with some combination of hormone therapy, chemotherapy, radiation.

Early prostate cancer has no warning signs. Your risk for prostate cancer may vary based on age, race, family history, genetic changes, and your geography. Take an <online risk assessment> and speak with your doctor about when screening is right for you. Some men may begin screening as early as age 35.

Signs and symptoms of advanced prostate cancer may include

  • frequent urination especially at night
  • pain or burning during urination
  • difficulty starting to urinate or being unable to hold back urine
  • weak or interrupted urine flow
  • blood in urine or semen
  • difficulty having an erection or painful ejaculation
  • pain or stiffness in the lower back, hips, or upper thighs.

Prostate cancer treatments are designed to kill cancerous cells, but sometimes, malignant cells remain in the prostate. Recurrent prostate cancer occurs when the cancer has returned after treatment. The malignancy may recur in the prostate area or in other areas of the body.Cancer that returns to the prostate is called a local recurrence. If the disease develops in another part of the body, it is called metastatic prostate cancer, regional recurrence or distant recurrence. Cancer cells may travel away from the original prostate tumor to other parts of the body through the blood or lymphatic system. If the cancer metastasizes or spreads outside the prostate, it most likely develops in nearby lymph nodes first and then travels to the bones. The cancer may also spread to the liver or other organs.

Risk Factors

According to the American Cancer Society, a risk factor is anything that affects the chances of developing a disease, such as prostate cancer. There are modifiable risk factors, like diet or smoking status, which can be changed by an individual. Unmodifiable risk factors include the person’s family history, age, or genetics. Having one or more risk factors does not mean you will get prostate cancer. Some prostate cancer patients had no risk factors prior to diagnosis. Understanding your individual risk and communicating with your primary health care provider is important to make informed decisions on your health and screening practices. 

Prostate cancer is rare in men under 40 and the odds of developing the disease increase after age 50. 60% of prostate cancers are found in men over the age of 65, while 40% are found in men under 65. There are an estimated 5,400 new cases of prostate cancer in Georgia each year.

Prostate cancer occurs more often in African American men and Caribbean men of African ancestry. African American men have the highest incidence and death rates. African American men are more than twice as likely to die of prostate cancer than white men (ACS).

Prostate cancer is most prevalent in North America, Northwestern Europe, Australia, and Caribbean islands.

Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. (The risk is higher for men who have a brother with the disease than for those who have a father with it.) The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.

Inherited gene changes may raise the risk of prostate cancer

Screenings & Surveillance

GPCC recommends that African American men with a family history of prostate cancer obtain a baseline prostate specific antigen (PSA) blood test along with a digital rectal exam (DRE) by age 35, and men of other races can begin at age 40. These tests can be performed quickly and easily in a physician’s office, clinic, or other medical facilities. Free testing is available at a number of Georgia facilities. Download the GPCC Playbook to learn more.

Support for our Recommendations:

Recommendations by large health entities recommend age 50 to begin prostate cancer screening. The American Urological Association Foundation as well as prostate cancer survivor organizations believe delaying screening until age 50 can be risky. The American Urological Association Foundation (AUAF) is a group of doctors who are the most aware and well-informed about the nature of prostate cancer, which is why GPCC and the AUAF support early screening or consulting with a urologist to discuss what is appropriate for you and your individual care.

GPCC recommends that African American men with a family history of prostate cancer obtain a baseline prostate specific antigen (PSA) blood test along with a digital rectal exam (DRE) by age 35, and men of other races can begin at age 40. These tests can be performed quickly and easily in a physician’s office, clinic, or other medical facilities. Free testing is available at a number of Georgia facilities. Download the GPCC Playbook to learn more.

Support for our Recommendations:

Recommendations by large health entities recommend age 50 to begin prostate cancer screening. The American Urological Association Foundation as well as prostate cancer survivor organizations believe delaying screening until age 50 can be risky. The American Urological Association Foundation (AUAF) is a group of doctors who are the most aware and well-informed about the nature of prostate cancer, which is why GPCC and the AUAF support early screening or consulting with a urologist to discuss what is appropriate for you and your individual care.

Screening Components

Prostate Specific Antigen (PSA) Tests: PSA is a protein that the prostate produces normally. Healthy and cancerous cells create PSA. A blood test is used to assess the level of PSA in the blood. A higher-than-normal level of PSA might indicate a problem with the prostate, including cancer.

Digital Rectal Exam (DRE): a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities of the prostate.

An abnormal age-adjusted prostate specific antigen (PSA) test or abnormal digital rectal (DRE) exam is an indication of prostate cancer but does not mean cancer is present. Abnormal findings of either test should be followed by a biopsy of the prostate cells to determine whether they are in fact cancerous.

Biopsy: a biopsy is a procedure in which a sample of tissue is taken from the prostate and then viewed under a microscope to check for abnormalities.

Prostate Health Index (phi): still being studied, phi is a new, more precise blood test that better distinguishes an aggressive cancer from a low-risk cancer.

Diagnosis

The stage of your cancer is an assessment of where the cancer is located, whether it has spread to another area of your body (metastasized), and how it affects the rest of the body. It may be called the T-stage for prostate cancers.

Different types of cancer have varying success rates for treatment. Prostate cancer has a near 100% survival rate for early diagnosis and is overall, highly treatable.

The Gleason Grade refers to the degree of aggressiveness of a particular tumor based on the appearance of the tissue under a microscope. The Gleason grading system assigns a numerical score to each of the two largest areas of cancer in the tissue samples. The lowest possible combined Gleason Grade is 2, and the highest possible Gleason Grade is 10.

The Gleason grading process assigns a number ranging from 1–5 based on the degree of “cell differentiation” within the tissue sample from very well differentiated (i.e., least cancerous, most normal looking [grade 1] to very poorly differentiated and most cancerous [grade 5]).

Gleason Grades 1 and 2 closely resemble normal prostate tissue – in which the cells appear round, orderly and with defined borders. In grade 2, the cells are more loosely aggregated.

In Gleason Grade 3 cells are beginning to lose their defined borders and are starting to group together into clumps.

Gleason Grade 4 is identified by loss of normal cell structure and a more pronounced clumping together of cancerous cells.

Gleason Grade 5 means that the cells have lost most, or all of their normal characteristics are very poorly differentiated and have essentially merged together into cancerous islands of cells.

Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score (also called the Gleason sum). More information is available at cancer.org.

Georgia is home to a National Cancer Institute designated cancer center as well as many other highly rated regional hospitals.

Georgia CORE’s list of Cancer Centers in Georgia

Choosing Services

            The National Cancer Institute’s guide to getting care.

Finding the right doctor and care team can be a challenge, but it doesn’t have to be.

*Not an endorsement or recommendation etc. It is important to GPCC to provide resources for anyone who may be facing prostate cancer in the state of Georgia. This list is for information purposes only and is not an endorsement of any kind.

Contrary to men’s greatest fears, life does not end at diagnosis. Many men, their families, and loved ones may feel hopeless after the big reveal. GPCC works every day to support patients, survivors, and everyone affected by prostate cancer. You have taken the first steps already, let us provide guidance and resources to you in this process.

  • Help coping with the emotions surrounding illness and treatment
  • Peer support, counseling, medications
  • What treatment options are available to you and how to access them 
  • How to self-manage your illness and programs to support you
  • How to minimize the impact of the disease by adapting behaviors
  • Patient education and counseling with your physician and healthcare team
  • Support to change behaviors like smoking, diet, and exercise
  • Minimizing disruptions at work, with family, and other areas of life
  • Education for family and caregivers
  • Assistance for daily living
  • Legal assistance
  • Financial assistance
  • Education about your insurance and how to use your benefits
  • Planning and counseling surrounding your care
  • Access to supplemental resources like grants or funding
  • Logistical help
  • Getting your medications
  • Transportation to and from treatment and appointments

My Prostate Cancer Coach

My Cancer Coach provides information about personalized prostate cancer treatment options to help manage your care. Get started today! Available on the Apple App Store and the Google Play store.

View your treatment guide, take notes, manage appointments, look up cancer-related terms, or track questions you have for your care team.

This Is Living With Cancer (Not prostate specific)

If you or a loved one is living with cancer, join a network of support and resources;  access it through your phone whenever. Living With is a support tool designed for patients and loved ones, you can invite your family and friends to connect on your journey through the app.

Cancer Graph – Symptom & Side Effects Tracker

Designed by cancer survivors and caregivers, this app helps you track your symptoms and side effects over time – from days to years. Rate your symptoms by severity, time of day, frequency, and more to give your care team an accurate description of what you are feeling.

Playbook

Are you worried about developing prostate cancer? Have you been diagnosed, and you feel unprepared
to manage? Get off the bench and onto the playing field with the Prostate Health Playbook. You’ll find a step-by-step guide for getting in the game.

 “African Americans participating in research – CAU has data on their survey about AA men that can The Prostate Cancer Registry provides a unique opportunity for prostate cancer survivors to share their hard-won experiences for the benefit of others battling the disease, or those who may do battle with it in the future. This takes the form of a web-based registry developed by the Center for Cancer Research and Therapeutic Development (CCRTD), at Clark Atlanta University. This registry is designed to gather information about prostate cancer survivors’ experiences and needs in order to fuel important research.”

RESPOND

A national study looking at the underlying factors contributing to African American men having higher risk for prostate cancer. Any African American man diagnosed with prostate cancer since January 2010 may apply.

All of Us

A historic effort to gather data from one million or more people in the US to accelerate research and improve health.

Count Me In

A nonprofit organization bringing patients and researchers together as partners to accelerate discovery surrounding cancer. 

CareOncology

A combination of medicines designed to stop cancer from growing and spreading. This protocol is used in combination with standard care.

NCI – Clinical Trials

A clinical trial finder sponsored by the National Cancer Institutes.

AUAF Clinical Trial Finder

            A list of private and publicly funded clinical trials searchable by urological condition.

Winship Cancer Institute Trial Finder

            Emory Winship Cancer Center’s trial finder tool.

Treatments

A man diagnosed with localized or locally advanced prostate cancer has several treatment options.

A program of active surveillance has two goals:

  • To provide definitive treatment for men with localized cancers that are likely to progress; and,
  • To reduce the risk of treatment-related, quality-of-life side effects such as incontinence and impotence for men with cancers that are not likely to progress.

Active surveillance is not appropriate for every prostate cancer patient. Good candidates are men  with a lower grade localized prostate cancer, a low PSA level, a low Gleason Score, and an appropriate clinical stage. Additional factors that men need to consider their age, general health, life expectancy, psychological makeup and then family’s history.

A typical program of active surveillance may include the following: a review of the candidate criteria described above; a discussion with your urologist regarding all possible treatment options; and, if appropriate, an active surveillance plan customized to your specific situation. The plan would typically include periodic physical exams and PSA testing as well as periodic biopsies as appropriate.

Choosing the best treatment for localized prostate cancer is generally based on the man’s age, the stage and grade of the cancer, the man’s general health and the man’s evaluation of the risks and benefits of each therapy option.

While there have been many studies of this, no local treatment option has been shown to have a distinct survival advantage for all patients. However, physicians may prefer a specific treatment depending on their specialty. One study found that 93% of urologists recommended surgery (also known as “radical prostatectomy”); and 72% of radiation oncologists recommended radiation. Patients should always seek a second opinion or the opinion of different specialists (e.g., urologists, radiation oncologists and medical oncologists) if they are uncertain about which treatment to pursue. Additionally, active surveillance, in which PSA levels are monitored but no treatment is performed, may be an option for some men.

Your goal is to be able to react quickly to seek additional treatment promptly if a worsening of the cancer occurs.

A radical prostatectomy is the surgical removal of the entire prostate gland. Many experts tend to recommend surgery when the cancer is thought to be contained within the prostate, such as in stage T1 and T2 cancers, and when the man is relatively young and healthy. During surgery, the entire prostate gland plus some surrounding tissue is removed. The surgery is almost always performed under general anesthesia. It is important to note that the experience and skill of the surgeon can be a major factor in the success of the surgery. This is true in all surgical procedures but is particularly true with a radical prostatectomy because of the challenging location of the prostate and the critical anatomy near the prostate.

An increasingly popular alternative to a radical prostatectomy is robotic surgery. It is less invasive and has a quicker recovery time.  Some proponents claim that is less likely to lead to incontinence or impotence. Clearly outcomes will vary from one patient to another.

If you choose surgery, be sure that you know the experience level and skill of the surgeon. Ask about the surgeon’s training and how many prostatectomies he or she performs on a regular basis. A skilled and experienced surgeon will have performed hundreds of prostatectomies and will typically perform multiple prostatectomies each week. Also, know the hospital.

Radiation involves the killing of cancer cells and surrounding tissues with radioactive material. Radiation therapy can be particularly appealing for men who are not good candidates for surgery because of their age, ill health or advanced disease stage. However, even for those who qualify for surgery, there may be distinct reasons why radiation is the best treatment option. After evaluating the benefits, risks and potential side effects of various local treatment options, some men may decide that some form of radiation therapy is the best treatment option for them.

There are two major categories of radiation therapy:

  • External beam radiation (EBR), which is a non-invasive procedure in which high-intensity beams of radiation are directed at the target area; and
  • Brachytherapy, which involves the implantation of radioactive metal seeds or pellets into the prostate either permanently or temporarily.

Based on the most recent data, cure rates appear to be similar to those of radical prostatectomy in patients with low-grade and low stage localized prostate cancer. In more advanced disease, radiation is sometimes used to treat a wider area surrounding the prostate and to include irradiation of regional lymph nodes to destroy locally advanced cancer.

Focal laser ablation (FLA) of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility.

Download the GPCC Playbook to learn more.

Cryotherapy involves the destruction of the prostate tissue by a freezing process in which the entire prostate is turned into an “ice ball.” Probes containing liquid nitrogen or freezing argon gas are inserted into the prostate, causing cancer cells within the prostate to be destroyed as they thaw. Ultrasound imaging is used to ensure that the entire prostate has been frozen. The urethra is heated during the process so that it won’t be destroyed during the freezing process. <br>

Cryotherapy requires less time in the hospital than some other treatments and is less invasive than radical prostatectomy. However, erectile dysfunction, urinary problems and rectal damage may occur. There is not a large volume of data on the long-term effectiveness of cryotherapy as it is a relatively recent therapy in the U.S.

Most prostate cancer cells thrive on male hormones (androgens) such as testosterone. Androgens provide fuel to the fire of prostate cancer cell growth. Hormonal (or hormone-suppression) therapy is designed to turn off the production of the male hormones, or androgens.

If prostate cancer is diagnosed at an advanced stage (when it has spread beyond the prostate) or if the cancer returns after localized therapy such as surgery or radiation, additional treatment with hormonal therapy is typically initiated.

Recent studies have also shown that hormonal therapy, initiated prior to and following radiation therapy, may be more beneficial than radiation alone.

Proton therapy or proton beam therapy is a medical procedure. More specifically, it is a type of particle therapy that uses a beam of protons to radiate diseased tissue, most often in the treatment of cancer. Proton therapy’s chief advantage over other types of external beam radiotherapy is that as a charged particle the dose is deposited over a narrow range and there is minimal exit dose. (Source: Wikipedia.org) This treatment is relatively new compared to the first five approaches.

In October 2015 the FDA authorized a HIFU device for the ablation of prostate tissue. The treatment is administered through a trans-rectal probe and uses heat developed by focusing ultrasound waves into localized prostate tumors to kill cancerous cells. Promising results have been reported in people with prostate cancer. These treatments are performed under ultrasound imaging guidance, which allows for treatment planning and some minimal indication of the energy deposition. This is an outpatient procedure that usually lasts 1–3 hours. The standard ultrasound treatment of prostate cancer ablates the entire prostate, including the prostatic urethra. The urethra has regenerative ability that derives from a different type of tissue (bladder squamous-type epithelium) rather than prostatic tissue (glandular, fibrotic and muscular). While the urethra is an important anatomical structure, the sphincter and bladder neck are more important to maintaining the urinary function. During focused ultrasound treatment the sphincter and bladder neck are identified and not ablated.

Resources

69% of people had false beliefs or a lack of awareness about early-stage prostate cancer having no symptoms. Educate yourself today!

Surveys & CAU Video

Clark Atlanta University’s Center for Cancer Research and Therapeutic Development (CCRTD) has created a prostate cancer registry that captures information from patients and survivors throughout the process. The goal of the program is to create a unified voice of the lived experience of prostate cancer to advance the understanding of challenges universally impacting men, and specifically African American prostate cancer survivors.

https://vimeo.com/333576077

CAU Prostate Cancer Registry

Cancer Quest YouTube Channel

Your experience matters! If you or a loved on suffered from prostate cancer, you have experience and knowledge that could save a life. Consider becoming a peer mentor today. No one should suffer alone in silence when we can be stronger together.

Emory’s Peer Partners Program – Newly diagnosed men benefit from the social support of their peers. Survivors: Your experience may help others! Become a peer mentor today.

Survivors – Find survivorship support in your area.

It takes a village to tackle a challenge as big as prostate cancer. You are not alone in this experience! Others have faced it and overcome it. It’s very possible that you can, too!

Prostate cancer survivors are available to talk to you. Find support and community in these resources.

Cancer Support Community

“The cancer support community is a nonprofit network of organizations worldwide dedicated to ensuring that all people impacted by cancer are empowered by knowledge, strengthened by action, and sustained by community.”

Emory 

Find cancer-specific support groups open to patients, caregivers, survivors, friends and family members, and support persons unless otherwise noted.

Northside Hospital

Hosts a prostate cancer networking group monthly as well as other resources.

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