AMERICAN CANCER SOCIETY - Prostate Cancer Statistics
New Cases: An estimated 180,400 new cases in the US during 2000. Prostate cancer incidence rates remain significantly higher in black men than in white men.
Deaths: An estimated 31,900 deaths in 2000, the second leading cause of cancer death in men. Although mortality rates are declining among white and black men, rates in black men remain more than twice as high as rates in white men.
Early Detection: Men age 50 and older who have at least a 10-year life expectancy should talk with their health care professional about having a digital rectal exam of the prostate gland and a prostate-specific antigen (PSA) blood test every year. Men who are at high risk for prostate cancer (black men or men who have a history of prostate cancer in close family members) should consider beginning these tests at an earlier age.
Survival: Seventy-nine percent of all prostate cancers are discovered in the local and regional stages; the 5-year relative survival rate for patients whose tumors are diagnosed at these stages is 100%. Over the past 20 years, the survival rate for all stages combined has increased from 67% to 92%. Survival after a diagnosis of prostate cancer continues to decline beyond five years. According to the most recent data, 67% of men diagnosed with prostate cancer survive 10 years and 52% survive 15 years.
Cancer is a disease characterized by the uncontrolled growth and potential spread of abnormal cells. The human body is made up of billions of cells and, normally, cells reproduce themselves by dividing so that growth occurs. Occasionally, cells abnormally grow into a mass called a tumor. Some tumors are benign (noncancerous). Others are malignant (cancerous). The growth of a benign tumor may interfere with body functions, such as urinating, but these tumors are seldom life-threatening. Malignant tumors, on the other hand, invade and destroy normal tissue. By a process called metastasis, cells break away from a cancerous tumor and spread through the blood and lymph nodes to other parts of the body, where they form new tumors. Sometimes cancer grows and spreads rapidly. In other cases, it develops and spreads slowly.
The prostate is a walnut-shaped gland that wraps around the urethra, the tube that carries urine from the bladder out through the tip of the penis. As with many other parts of the body, cancer cells can grow inside the prostate. In certain more advanced cases, the cancer can spread beyond the prostate. Prostate cancer is the second most common type of cancer among American men. (Skin cancer is the leading diagnosed cancer among US males.) In 2000, an estimated 180,400 new cases of prostate cancer were diagnosed. To put that number in perspective, there were more estimated new cases of prostate cancer diagnosed in 2000 than there were new cases of AIDS or even breast cancer. The incidence of prostate cancer increases with age The incidence of prostate cancer increases with age. More than 75% of all prostate cancers are diagnosed in men over age 65. Some studies have shown an overall 2- to 3-fold increase in the risk of prostate cancer in men who have a history of this disease in their family. The incidence rate of prostate cancer is nearly two times higher in African-American men than Caucasian men.
The exact cause of prostate cancer is unknown. We do know that prostate cancer is a group of cancerous cells (a tumor) that begins most often in the outer part of the prostate. Early prostate cancer usually does not have any symptoms.If left untreated, prostate cancer may spread from the prostate to nearby lymph nodes, bones, or other organs. This spread is called metastasis. As a result of metastases, many men experience aches and pains in the bones, pelvis, hips, ribs, and back.
Unfortunately, there are often no early warning signs of prostate cancer and without regular screening, prostate cancer can go undetected for years. As the tumor grows, it may spread from the outer part of the prostate to the inner part of the prostate, eventually putting pressure on surrounding parts of the body, such as the urethra. This may block the flow of urine from the bladder and cause other urinary problems, which are usually the first symptoms of prostate cancer. Note: symptoms may not occur until the cancer has developed to an advanced stage
Typical symptoms of prostate cancer
Frequent urination (especially at night)
Weak urinary stream
Inability to urinate
Interruption of urinary stream (stopping and starting)
Pain or burning on urination
Blood in the urine
Prostate cancer shares many symptoms with benign prostatic hyperplasia (BPH) The symptoms of prostate cancer can be similar to those of a benign prostate condition. In fact, it is more likely that any of these symptoms would indicate a non-cancerous prostate enlargement, known as benign prostatic hyperplasia (BPH); an infection; or other conditions, rather than prostate cancer. More than half of the men over age 60 have enlarged prostates.
Determining whether you have prostate cancer generally involves a series of tests and exams. Before starting the testing process, your physician will ask you questions about your medical history, your family history of cancer, and any symptoms you may be having, particularly problems with urination. From there, your doctor will proceed to any one of the tests described below.
Because the prostate lies in front of the rectum, your physician can feel the prostate by inserting a gloved, lubricated finger into the rectum. This simple procedure is called a digital rectal examination (DRE). It allows your physician to determine whether the prostate is enlarged or has lumps or other types of abnormal texture. While this examination may produce momentary discomfort, it causes no significant pain.
PROSTATE-SPECIFIC ANTIGEN (PSA) TEST
Used in addition to the digital rectal examination (DRE), a PSA test increases the likelihood of prostate cancer detection. PSA is the abbreviation for prostate-specific antigen, a substance produced by the prostate cells. A PSA test measures the level of PSA in the bloodstream. Very little PSA escapes from a healthy prostate into the bloodstream, but certain prostate conditions can cause larger amounts of PSA to leak into the blood. Two possible causes of a high PSA level are: 1) a benign enlargement of the prostate called benign prostatic hyperplasia (BPH), and 2) prostate cancer. A high level of PSA in the bloodstream is a warning sign that prostate cancer may be present. But since other kinds of prostate disease can also cause high PSA levels, PSA testing by itself cannot confirm the presence of prostate cancer. A high PSA level only indicates the possibility of prostate cancer and the need for additional evaluation by your physician. Conversely, a low PSA level does not always mean that prostate cancer is not present. An early stage of prostate cancer may be present that has not yet caused the PSA to increase in the bloodstream. Men over the age of 50, and those men over the age of 40 who are in high-risk groups, such as African-American men and/or men with a family history of prostate cancer, should have a PSA blood test and digital rectal examination once every year. Any man who develops persistent urinary symptoms should contact his physician.
If the results of the digital rectal exam (DRE) and/or the prostate-specific antigen (PSA) test are suspicious, a biopsy may be necessary. In a biopsy, a small amount of tissue is removed from the prostate with a needle. This tissue is then examined under a microscope for cancer cells. Only a biopsy can definitely confirm the presence of prostate cancer. A biopsy of the prostate can be performed in the physician's office and usually causes no more discomfort than a visit to the dentist. No anesthesia is required. Keep in mind that it is still possible to have cancer, even if the biopsy is negative, because the cancer cells may not have progressed enough to be detected by a microscope. If the biopsy is taken and prostate cancer is found, the tumor is graded in the medical lab. The grade indicates how different the cancer cells appear, compared with normal cells, when seen through a microscope. Sometimes you will hear the grade referred to as the Gleason grade. A Gleason grade ranges from 1 through 5 and is based on how much the arrangement of the cancer cells mimics the way the normal prostate cells form the glands of the prostate. To get a Gleason score of 1 the cancer cell clusters must resemble the small, regular, evenly spaced glands of normal prostate tissue. If the cancer cells seem to be spread haphazardly throughout the prostate, it receives a Gleason grade of 5. Prostate cancers often have areas with different grades. Therefore, a grade is assigned to the two areas that make up most of the cancer. These two grades are added together to yield a Gleason score between 2 and 10. Scores of 2 through 4 are often grouped together as low, 5 and 6 are intermediate, and scores of 7 to 10 are considered high.
Once prostate cancer is discovered, the physician must estimate the size and location of the cancer (how far it has already spread). This assessment is called staging of the tumor. Staging is necessary for you and your physician to decide what type of treatment, if any, is most appropriate. Currently there are two different systems for staging prostate cancer. The traditional methods classify the disease into four clinical categories rated A through D. The second system is called TNM, which stands for Tumor-Nodes-Metastases, and is considered the most accepted staging system to date.
Stage A is early cancer. The tumor is located within the prostate gland and cannot be detected by a digital rectal examination.
In Stage B, the tumor is considered to be within the prostate but is large enough to be felt during a digital rectal examination.
In Stage C, prostate cancer is more advanced. It indicates that the tumor has spread outside the prostate to some surrounding areas, but has not spread to other organs. This stage of prostate cancer can usually be detected by a digital rectal examination.
In Stage D, the cancer has spread to the nearby organs and usually to distant sites, such as the bones or lymph nodes.
The Tumor-Node-Metastases (TNM) system breaks down the staging of prostate cancer in significantly more categories than the A-D staging system does. As a result, the TNM system is much more complex and technical. The chart below lists all of the TNM stages. Be sure to consult your physician regarding which staging system is best for you.
TNM STAGING
Primary Tumor,
Clinical (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Clinically inapparent tumor not palpable nor visible by imaging
T1a Tumor incidental histologic finding in 5% or less of tissue resected
T1b Tumor incidental histologic finding in more than 5% of tissue resected
T1c Tumor identified by needle biopsy (eg., because of elevated PSA)
T2 Tumor confined within prostate
T2a Tumor involves one lobe
T2b Tumor involves both lobes
T3 Tumor extends through the prostate capsule
T3a Extracapsular extension (unilateral or bilateral)
T3b Tumor invades seminal vesicles(s)
T4 Tumor is fixed or invades adjacent structures other than seminal vesicles; bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall.
Lymph Node
Status (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional lymph node or nodes
Distant Metastases
(M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Non-regional lymph nodes(s)
M1b Bone(s)
M1c Other site(s)
Remember: Detection of the disease when it's at an early stage offers the best opportunity for successful treatment of prostate cancer. In other words, if the disease is diagnosed when it is confined to the prostate and is treated promptly, complete recovery can be achieved. This means having your physician check you for prostate cancer yearly, especially if you are at least 50 years of age or are considered to be at high risk.
You are at high risk for prostate cancer if one or more of the following factors pertain to you:
African-American race
Increasing age
Family history of prostate cancer
A high-fat diet
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