Why is prostate cancer bad

They are also studying whether men can reduce their risk through exercise and by taking certain dietary supplements. Scientists have also studied whether having an inflamed or enlarged prostate, having a vasectomy, smoking, being exposed to radiation or having a sexually transmitted virus might increase prostate cancer risk.

At this time, there is little evidence that these factors contribute to risk. Each year about , men are diagnosed with prostate cancer in the U. Prostate cancer is the third leading cause of cancer death, behind lung cancer and colon cancer, in men in the United States.

The incidence of prostate cancer has nearly doubled over the past 20 years. One possible reason is that, due to a decline in deaths from heart disease, more men are living longer, reaching ages at which the risk of prostate cancer is highest. Prostate cancer is the most common cancer after skin cancer in men in the United States. What is prostate cancer? The prostate contains several types of cells, but nearly all prostate cancers develop from glandular cells, which make fluid that becomes part of semen.

Prostate cancer cells can spread by invading nearby organs and tissues, such as the bladder or rectum, or by traveling through the blood or lymph to other parts of the body.

This is known as metastatic prostate cancer. Other than the lymph nodes near the prostate, the most common site of prostate cancer spread, or metastasis, is the bones, especially in the spine.

In some cases, prostate cancer has already metastasized by the time a man learns he has the disease. Understanding your prostate Your prostate makes and stores seminal fluid — a milky liquid that protects and nourishes sperm. BPH typically develops in the zone of the prostate that surrounds the urethra transition zone. For this reason BPH may cause difficulty with urination. BPH does not lead to or increase the chance of prostate cancer. This is why prostate cancer typically does not interfere with urination as much as BPH does.

Even so, because the prostate is close to the urethra and several other important structures, prostate cancer and its treatment can disrupt normal urinary, bowel and sexual function. More advanced prostate cancer symptoms may include: Weak or interrupted flow of urine Urinating often especially at night Difficulty starting or stopping urination Pain or burning during urination Difficulty getting or sustaining an erection impotence Painful ejaculation Blood in the urine or semen Frequent pain or stiffness in the lower back, hips or upper thighs Many of these symptoms are also seen with noncancerous diseases.

Diagnosing When it is diagnosed early, prostate cancer is curable. Using transrectal ultrasound TRUS and a local anesthetic, the doctor inserts a needle into your prostate through a probe in your rectum. The doctor uses the needle to take about 12 samples of cells. The procedure typically takes no more than 5 to 10 minutes, and you should have very little discomfort. If your biopsy reveals that you are cancer-free, you may still need to continue with routine screenings.

Talk with your doctor about this. If cancer cells are present, certain information available from the biopsy, such as the grade and stage of your cancer, helps your doctor determine the best treatment options for you and the outlook for your recovery. Staging: the TNM system Staging is done as part of the diagnosis process to determine how extensive your cancer is within your prostate and whether it has spread to lymph nodes or other organs.

Prostate cancer is typically staged using the TNM system, which is based on: The extent of the primary t umor T category Whether the cancer has spread to nearby lymph n odes N category The presence or absence of distant m etastasis M category Your PSA level at the time of diagnosis Your Gleason score and the amount of cancer Using this information, prostate cancer is then grouped into stages I through IV, with stage I being the least advanced and stage IV being the most advanced.

Stage I: Cancer is confined to your prostate. With biochemical recurrence, the prostate-specific antigen PSA level has risen after treatment s using surgery or radiation, with no other sign of cancer.

Castration-resistant prostate cancer CRPC is a form of advanced prostate cancer. CRPC means the prostate cancer is growing or spreading even though testosterone levels are low from hormone therapy.

Hormone therapy is also called testosterone depleting therapy or androgen deprivation treatment ADT and can help lower your natural testosterone level. That fuel includes male hormones or androgens like testosterone.

Typically, prostate cancer growth slows down with hormone therapy, at least for some time. If the cancer cells begin to "outsmart" hormone treatment, they can grow even without testosterone.

If this happens, the prostate cancer is considered CRPC. Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread. Cancer cells have spread beyond the prostate. Cancer spread may be seen on imaging studies and may show the cancer has spread. Prostate cancer is metastatic if it has spread to these areas:.

You may be diagnosed with metastatic prostate cancer when you are first diagnosed, after having completed your first treatment or even many years later. It is uncommon to be diagnosed with metastatic prostate cancer on first diagnosis, but it does happen. Metastatic hormone-sensitive prostate cancer mHSPC is when cancer has spread past the prostate into the body and is responsive to hormone therapy or the patient has not yet had hormone therapy.

This means that levels of male sex hormones, including androgens like testosterone, can be reduced to slow cancer growth. Hormone therapy, like ADT, may be used to reduce the levels of these hormones.

Metastatic castration-resistant prostate cancer is when cancer has spread past the prostate into the body and it is able to grow and spread even after treatments were used to lower testosterone levels.

This is disease progression despite medical or surgical castration. Men with advanced prostate cancer may or may not have any signs of sickness. Symptoms depend on the size of new growth and where the cancer has spread in the body. With advanced disease, mainly if you have not had treatment to the prostate itself, you may have problems passing urine or see blood in your urine.

Some men may feel tired, weak or lose weight. When prostate cancer spreads to bones, you may have bone pain. Tell your doctor and nurse about any pain or other symptoms you feel. There are treatments that can help. Advanced cancer may be found before, at the same time or later than the main tumor.

Most men diagnosed with advanced prostate cancer have had biopsy and treatment in the past. When a new tumor is found in someone who has been treated for cancer in the past, usually cancer has spread. Even if you have already been diagnosed with prostate cancer, your health care provider may want to observe changes over time.

The following tests are used to diagnose and track prostate cancer:. Only the prostate and prostate cancers make PSA. It is used to stage cancer, plan treatment and track how well treatment is going. A rapid rise in PSA may be a sign something is wrong. In addition, your doctor may want to test the level of testosterone in your blood.

Advanced cancer may be found before, at the same time, or later than the main tumor. This test is also used to screen for and stage cancer, or track how well treatment is going. During this test, the doctor feels for an abnormal shape, consistency, nodularity or thickness to the gland.

For this exam, the health care provider puts a lubricated gloved finger into the rectum. Men diagnosed with advanced prostate cancer from the beginning may start with a prostate biopsy. It is also used to grade and stage the cancer. Most men diagnosed with advanced prostate cancer have had a prostate biopsy in the past. When a new tumor is found in someone who has been treated before, it is usually cancer that has spread.

A biopsy is a tissue sample taken from your prostate or other organs to look for cancer cells. There are many approaches to prostate biopsies. These can be done through a probe placed in the rectum, through the skin of the perineum already between the scrotum and rectum and may use a specialized imaging device, such as MRI.

The biopsy removes small pieces of tissue for review under a microscope. The biopsy takes 10 to 20 minutes. A pathologist a doctor who classifies disease looks for cancer cells within the samples. If cancer is seen, the pathologist will "grade" the tumor. Prostate cancer is grouped into four stages. The stages are defined by how much and how quickly the cancer cells are growing. If a biopsy finds cancer, the pathologist gives it a grade. The most common grading system is called the Gleason grading system.

The Gleason score is a measure of how quickly the cancer cells can grow and affect other tissue. Biopsy samples are taken from the prostate and given a Gleason Grade by a pathologist. Lower grades are given to samples with small, closely packed cells. Higher grades are given to samples with more spread out cells. The Gleason Score is set by adding together the two most common grades found in a biopsy sample.

The Gleason score will help your doctor understand if the cancer is as a low-, intermediate- or high-risk disease. The risk assessment is the risk of recurrence after treatment. Generally, Gleason scores of 6 are treated as low risk cancers. There are two types of these scores. Gleason scores of 8 and above are treated as high-risk cancers. Some of these high-risk tumors may have already spread by the time they are found. See More See Less. The T, N, M score is a measure of how far the prostate cancer has spread in the body.

The T tumor score rates the size and extent of the original tumor. The N nodes score rates whether the cancer has spread into nearby lymph nodes. The M metastasis score rates whether the cancer has spread to distant sites. Tumors found only in the prostate are more successfully treated than those that have metastasized spread outside the prostate.

Tumors that have metastasized are incurable and require drug based therapies to treat the whole body. The goal of advanced prostate cancer treatment is to shrink or control tumor growth and control symptoms.

There are many treatment choices for advanced prostate cancer. Which treatment to use, and when, will depend on discussions with your doctor. It is best to talk to your doctor about how to handle side effects before you choose a plan. Hormone therapy is a treatment that lowers a man's testosterone, or hormone, levels. This therapy is also called ADT.

Testosterone, an important male sex hormone, is the main fuel for prostate cancer cells, so reducing its levels may slow the growth of those cells. Hormone therapy may help slow prostate cancer growth in men when prostate cancer has metastasized spread away from the prostate or returned after other treatments.

Some treatments may be used to shrink or control a local tumor that has not spread. There are several types of hormone therapy for prostate cancer treatment, including medications and surgery. Your doctor may prescribe a variety of therapies over time. Surgery to remove the testicles for hormone therapy is called orchiectomy or castration. When the testicles are removed, it stops the body from making the hormones that fuel prostate cancer.

It is rarely used as a treatment choice in the United States. Men who choose this therapy want a one-time surgical treatment. They must be willing to have their testicles permanently removed and must be healthy enough to have surgery. This surgery allows the patient to go home the same day. The surgeon makes a small cut in the scrotum sac that holds the testicles. The testicles are detached from blood vessels and removed. The vas deferens tube that carries sperm to the prostate before ejaculation is detached.

Then the sac is sewn up. There are multiple benefits to undergoing orchiectomy to treat advanced prostate cancer. It is not expensive. It is simple and has few risks. It only needs to be performed once. It is effective right away. Testosterone levels drop dramatically. Side effects to your body include infection and bleeding. Removing the testicles means the body stops making testosterone, so there is also a chance of the side effects listed below for hormone therapy. Other side effects of this surgery may be about body image due to the look of the genital area after surgery.

Some men choose to have artificial testicles or saline implants placed in the scrotum to help the scrotum look the same as before surgery. Some men choose another surgery called subcapsular orchiectomy. This removes the glands inside the testicles, but it leaves the testicles themselves, so the scrotum looks normal.

There are different types of hormone therapy available as injections or as pills that can be taken by mouth. Some of these therapies stop the body from producing luteinizing-hormone-releasing-hormone LHRH, also called gonadotrophin releasing hormone, or GnRH. LHRH triggers the body to make testosterone. The likelihood of recurrence depends on the extent and aggressiveness of the cancer.

Several online tools have been assembled to help predict the likelihood of recurrence. Try inputting your own information into the Han Tables prediction tool. Prostate cancer recurrence is determined by rising PSA levels following treatment. Use the following guide to gauge recurrence:. Clinicians use the change in PSA over time as a marker for the aggressiveness of the recurrence.

After a certain amount of time, the cancer will become visible radiographically e. Prostate cancer can recur locally in the pelvis or elsewhere in the body. The location of the recurrence is determined by these radiographic scans.

Stage IV Prostate Cancer Prognosis Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. How We Treat Prostate Cancer The prognosis for metastatic prostate cancer can be discouraging, but some treatment centers—like the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer—specialize in innovative, individualized therapy with the potential to improve outcomes.