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The prostate is a gland in the male reproductive system, sitting just below
the bladder, making fluid that forms part of semen. Prostate cancer starts in
its cells and is one of the most common cancers there is.
It is also two different diseases wearing one name. **It often grows very
slowly**, and where it does not spread it may never cause a serious problem.
Sometimes it grows quickly and spreads, and that version is serious. Almost
everything confusing about prostate cancer — why screening is debated, why
"do nothing and watch" is a listed treatment — follows from those two
sentences.
Who is more likely to get it
Researchers do not know what causes it. They know it involves changes in DNA,
sometimes inherited and sometimes acquired during life, and that the cause of
those changes is often unknown.
| Factor | |
|---|---|
| Age | Risk rises with age; it is rare under 50 |
| Family history | Higher with a parent, sibling or child who has had it |
| Race | African Americans are more likely to get it, at a younger age, in a more serious form, and are more likely to die from it |
Anyone who has a prostate can develop it.
Symptoms, and why they mislead
Often there are none, especially early. Where they appear: a weak urine
stream, or one that is hard to start or starts and stops; a sudden urgent
need; urinating often, especially at night; pain or burning; blood in urine or
semen; persistent pain in the lower back, hips or pelvis; painful ejaculation.
**Most of those are also caused by an enlarged prostate, which is not
cancer.** Symptoms are a reason to talk to a provider, not a diagnosis.
Have that conversation if you have symptoms that could be prostate cancer, if
you are at high risk, or if a screening test suggests something.
Testing
- Digital rectal exam — the provider feels the prostate for lumps through
the rectal wall. - PSA blood test — a high prostate-specific antigen level can signal
cancer, but many other things raise it too. - Imaging — ultrasound or MRI pictures of the prostate.
If those suggest cancer, a biopsy follows, and a biopsy is the only way to
diagnose prostate cancer: a hollow needle takes prostate tissue, which is
examined under a microscope.
Treatment, beginning with watching
Options depend on age, general health and how serious the cancer is.
Observation comes in two distinct forms, and the difference matters:
| What it involves | What triggers treatment | |
|---|---|---|
| Watchful waiting | Little or no testing | Symptoms beginning or changing — and then the treatment relieves the symptoms, not the cancer |
| Active surveillance | Regular tests to see whether the cancer has changed | Evidence of growth, or symptoms — and then treatment aims to cure |
Beyond observation: surgery to remove the gland where the cancer has not
spread beyond it; radiation therapy; hormone therapy, which blocks the
hormones the cancer cells need, by medicine or by removing the testicles;
chemotherapy, by mouth, injection, cream or IV; targeted therapy,
which attacks specific cancer cells and spares healthy ones better than
radiation or chemotherapy does; and immunotherapy, which enlists your own
immune system.
Some prostate cancers may be prevented by being at a healthy weight, quitting
smoking, getting enough exercise and eating well.
Source: National Cancer Institute, via MedlinePlus.
Licence : CC0 1.0 (domaine public) · Adapté de medlineplus.gov
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