Dear Doctor: How does prostate cancer happen? And what are the symptoms? I'm only 43, but I worry that I wouldn't recognize the signs if I had it.
Dear Reader: Prostate cancer is one of the most common cancers among men in the United States. It occurs in the prostate gland, a male reproductive organ that sits between the penis and the rectum, just beneath the bladder. The prostate, which is about the size of a golf ball, wraps around the urethra, which is the duct through which urine and semen exit the body. One of the roles of the prostate is to produce fluids that nurture and support sperm, and to propel these fluids into the urethra when needed.
When normal cell division goes awry, the chaotic and uncontrolled growth that results is what we know as cancer. In prostate cancer, the rogue cells use hormones known as androgens, which include testosterone, to fuel their growth. Although prostate cancers begin within the gland, they can spread to nearby regions of the body, including the lymph nodes. Some prostate cancers are slow to grow and can take years to be detected. When slow-growing cancers are identified, the risk they pose may be low enough that physicians recommend careful monitoring, often referred to as "watchful waiting." Other prostate cancers are more aggressive and require swift treatment.
The American Cancer Society estimates that more than 174,650 new cases of prostate cancer will be diagnosed this year, and the disease will claim more than 31,000 lives. As you allude to when mentioning your age, the majority of prostate cancers -- about 60 percent -- are diagnosed in men 65 and older. But race plays a role as well. Prostate cancer affects black men at two to three times the rate of white men and at an earlier age. They are also more likely to die from the disease.
Although a screening tool known as a prostate-specific antigen (PSA) test is effective at detecting certain hormonal changes associated with prostate cancer, it has been overused in the past and led to unnecessary treatment. The U.S. Preventive Task Force recommends that for men between the ages of 55 to 69, prostate cancer screening should be a decision made by patients and doctors working together on a case-by-case basis. However, a survey of prostate cancer outcomes by several colleagues at UCLA determined that, due to their elevated risk, black men would benefit from prostate cancer screening guidelines tailored to their unique and specific needs.
When it comes to symptoms, unfortunately prostate cancer is often largely silent in the early stages. As the cancer becomes more advanced and affects the size and shape of the prostate, the gland's position in the body may lead to symptoms that include:
-- Difficulty urinating.
-- Frequent urination.
-- A diminished stream of urine.
-- Pelvic discomfort.
-- Signs of blood in the semen.
-- Onset of difficulty achieving or maintaining an erection.
-- Discomfort when sitting.
If you develop these symptoms, please talk to your doctor. It doesn't mean that you have cancer, but you will be taking the first step to finding out what, if anything, may be wrong.
Eve Glazier, M.D., MBA, and Elizabeth Ko, M.D