Prostate Cancer

Every year more than 180,000 new cases of prostate cancer are diagnosed in the United States. After lung cancer, it ranks as the second leading cause of cancer death in men.

The risk of developing prostate cancer increases with age. More than 75 percent of all prostate cancers occur in men older than 65, although these cancers can develop in those as young as 40. Men who have a family history of early prostate cancer (before age 55) or a personal or family history of enlarged prostate have a greater chance of developing prostate cancer. African-American men are twice as likely to die from it. A diet low in fiber and high in fat and red meat also may be associated with increased risk.

• a weak or interrupted urine flow
• inability to urinate
• difficulty starting or stopping urine flow
• the need to urinate frequently, particularly at night
• a burning sensation during urination
• blood in the urine
• painful ejaculation
• chronic pain in the lower back, hips, or upper thighs

Screening. The two most widely-used tests, the prostate specific antigen (PSA) blood test and the digital rectal exam (DRE), help detect prostate cancer in early stages -- when treatment can be most effective. Given together, both tests supply the doctor with the most accurate information. "Well over 90 percent of men who undergo annual screening with a PSA and DRE and who are found to have prostate cancer have localized disease," says Ian Thompson, M.D., professor and chief of urology at the University of Texas Health Science Center in San Antonio.

The American Urological Association says all men of appropriate age should receive counseling about early detection. The group advocates offering routine prostate cancer tests to men who expect to live 10 years or longer and who are over 50, over 40 and have a family history of the disease, or over 40 and African-American.

The PSA has made a tremendous impact. "Since the inception of the PSA blood test, prostate cancer deaths in the United States have fallen for the first time after having climbed since record keeping began," says Thompson. Doctors consider further evaluation when levels are high.

Though slightly uncomfortable, the DRE is quick. The doctor inserts a gloved, lubricated finger into the rectum to check for any irregular or abnormally firm area.

"A man with an elevated PSA or a suspicious DRE should seek out the care of a urologist," says Thompson. "These specialists are skilled in diagnosing and treating prostate cancer. If a PSA is elevated, a prostate biopsy is the only method to determine if prostate cancer is the cause." This outpatient procedure takes 10 to 15 minutes.

Before the biopsy, anyone taking aspirin, medicine for arthritis, or any medicine that thins the blood needs to inform his doctor. The physician also needs to know whether the patient has a heart murmur or any artificial or transplanted material in his body.

"During the biopsy, the urologist uses a narrow probe that is placed through the rectum and next to the prostate where it takes sound-wave images of the gland," explains Thompson. "After the gland is carefully inspected, biopsies are taken from several separate parts of the gland, using the ultrasound probe for guidance. The biopsies are usually taken with a special instrument that instantaneously removes the tissue." An antibiotic, given around the time of the biopsy, minimizes risk of infection.

Afterward, patients sometimes see a small amount of blood in the urine or stool. The ejaculate can be discolored for several weeks.

If the result of the biopsy is negative, the patient generally undergoes another PSA and DRE six to 12 months later.