Prostate Cancer: An Overview

If you have been told that you have prostate cancer, your first reaction might well have been panic, numbness, or despair. Many people experience a whirl of emotions after receiving a cancer diagnosis. It's normal to react this way. However, men who have had prostate cancer will often talk positively about how their diagnosis and recovery affected them emotionally.

Even though you might find this hard to believe right now — there are thousands of prostate cancer survivors who will tell you that having had prostate cancer eventually had a positive effect on them. They educated themselves about the disease and treatments, and they discovered that knowledge is power. They learned to use that power for their own health and well-being. They forged new relationships and strengthened existing ones. They spoke to loved ones about their deepest feelings and greatest fears. They came to develop a greater appreciation of life.

The Prostate Gland

To better understand prostate cancer, let's first examine the role of the prostate gland itself. The prostate is a muscular gland about the size and shape of a walnut. It is part of the urinary and reproductive systems and is located in the pelvis below the urinary bladder, just in front of the rectum. The urethra, a tube that carries urine and semen out of the body through the penis, runs through the prostate.

Prostate Gland

Because the prostate is actually several small glands encased in the prostate capsule, it is sometimes described as having zones. Of these, the peripheral zone, or outer zone, is the largest and is where most prostate cancer begins. The central zone surrounds the ejaculatory ducts; less than 5 percent of prostate cancers originate here, but are usually more aggressive tumors. The transition zone, or innermost zone, surrounds the urethra; this is the area of the gland that grows as men age, often causing obstruction symptoms.

The Prostate and Urination

The health of the prostate can affect your ability to urinate. Because the prostate surrounds the urethra, prostate enlargement can squeeze the urethra, making urination difficult.

The urinary tract begins at the kidneys, the body's main filters. They cleanse impurities from about forty-five gallons of water every day. Most of this water is recirculated through the body, producing only about two quarts of waste in the form of urine.

Prostate Gland Side View

Urine travels to the urinary bladder through tubes Called ureters. The bladder, located above the prostate, holds about a pint of urine. Urine empties into the urethra, which carries it through a muscle called the urinary sphincter and out through the penis. The urinary sphincter is responsible for continence, your ability to control the flow of urine.

The Prostate and Reproduction

Your prostate gland is small. About the size of an English walnut, it weighs between twenty and forty grams. By comparison, a first-class letter weighs about thirty grams. Small as it is, the prostate is essential for normal human reproduction. It adds important fluid and nutrients to sperm during ejaculation. To function properly, the prostate depends on male hormones, chiefly testosterone. This hormone is produced starting at puberty and is responsible for the traits usually associated with men such as body hair, deep voice, and muscles.

Prostate Gland Frontal View

The prostate alone does not fuel the reproductive process. The testicles produce sperm and most of the testosterone upon which the prostate depends. Just before the male orgasm, muscles squeeze seminal fluid from the prostate and from the seminal vesicles. During ejaculation, sperm, carried by the seminal fluid, travel through the urethra and exit the penis.

Prostate Cancer

The general term cancer refers to a collection of cells that are growing out of control. Cancer cells grow past normal limits, and they don't die when they should. Instead, they divide and spread, sometimes uncontrollably. Such a growth is said to be malignant. These cancer cells can break away from a malignant tumor site and spread, or metastasize, to other organs. Cancer destroys normal tissue and creates new tumors as it spreads.

Cancer spreads through the body's lymphatic system. Lymph is a fluid that bathes every living cell in the body. The lymphatic system fights cancer cells, killing and disposing of them. Sometimes, however, there are more cancer cells than the lymphatic system can handle, and the lymph vessels themselves become vehicles for spreading cancer.

Typically, prostate cancer starts in the outer zone of the prostate gland. Male hormones, especially testosterone, stimulate growth of both normal and cancerous cells in the prostate.

Stages of Prostate Cancer

When prostate cancer is diagnosed, the stage of the cancer is described as being local, regional, or distant. Local stage means the tumor is "localized" and there is no sign the cancer has spread outside the prostate. Regional stage refers to cancer that has spread from the prostate to nearby tissues. Distant stage refers to cancer that has spread to distant lymph nodes, bones, or other organs.

Survival Rates by Stage

• Local stage: about 4 out of 5 prostate cancers are found in this early stage. The 5-year survival rate for local stage prostate cancer is nearly 100 percent.

• Regional stage: the 5-year survival rate for regional stage prostate cancer is approximately 98 percent.

• Distant stage: the 5-year survival rate for distant stage prostate cancer is about 29 percent.

Most men with prostate cancer will live long, full lives. Many will never know they have it and will eventually die from unrelated causes.

Symptoms of Prostate Cancer

Early prostate cancer has no symptoms. You could be feeling quite well when you are diagnosed. For most men, the diagnosis comes as a complete surprise.

Malignant tumors in the prostate generally start out very small. It usually takes years for prostate cancers to grow large enough to obstruct the flow of urine. Fortunately, modern diagnostic methods can detect prostate cancer long before symptoms have a chance to develop.

Still, one or more of the following symptoms can indicate prostate cancer:

• Getting up at night to urinate

• Frequent urination during the day

• Weak or interrupted urinary flow

• Difficulty starting the urine stream

• Straining to urinate

• Feeling an urgent need to urinate

• Dribbling, leakage

• Pain or burning during urination

• Hematuria — blood in the urine

• Pain during ejaculation

• Less ejaculate...