Prostate cancer occurs when abnormal cells begin to grow in the prostate. There are several types of cells in the prostate, but nearly all prostate cancers start in the gland cells. The prostate is an exocrine gland in the male reproductive system. Excluding all types of skin cancer, prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among men in the United States and Indiana. In Indiana, there were 2,687 new cases of prostate cancer and 603 prostate cancer deaths during 2014 alone.
Who gets Prostate Cancer Most Often?
- Older men. The chance of developing prostate cancer rises rapidly after age 50. According to the American Cancer Society (ACS), about 60 percent of all prostate cancer cases are diagnosed in men age 65 and older. In addition, 97 percent of all cases occur in men age 50 and older.
- African-American men. African-American men and Caribbean men of African descent have the highest documented prostate cancer incidence rates in the world. For unknown reasons, incidence rates in Indiana are about 55 percent higher in blacks than in non-Hispanic whites.
- Men with a family history of prostate cancer. Men with one first-degree relative (a father or brother) with a history of prostate cancer are two to three times more likely to develop the disease. This risk increases if more than one family member is diagnosed with prostate cancer.
Common Signs and Symptoms of Prostate Cancer
It’s important to note that some men have no symptoms at all, and that many symptoms also occur frequently as a result of non-cancerous conditions, such as prostate enlargement or infection. None of these symptoms are specific to prostate cancer. Common symptoms include, but aren’t limited to:
- Difficulty starting urination
- Weak or interrupted flow of urine
- Frequent urination, especially at night
- Difficulty emptying the bladder completely
- Pain or burning during urination
- Blood in the urine or semen
- Painful ejaculation
- Trouble having an erection
- Pain in the back, hips or pelvis that doesn’t go away (this symptom is most associated with advanced prostate cancer since it commonly spreads to the bones)
Not all medical experts agree that screening for prostate cancer will save lives. The controversy focuses on cost of screening, the age groups to be screened, and the potential for serious side effects associated with treatment after diagnosis. Not all forms of prostate cancer need treatment.
The United States Preventive Services Task Force (USPSTF) no longer recommends that men receive the prostate-specific antigen (PSA)–based screening for prostate cancer. Currently, the USPSTF and the ACS recommend that men have a conversation with their health care provider about their personal health and lifestyle, risk for prostate cancer, personal beliefs and preferences for health care, as well as the benefits and harms of PSA screening and any treatment that may result prior to making an informed decision about getting a PSA.
Potential benefits of prostate cancer screening include early detection and increased effectiveness of cancer treatment. Potential risks of prostate cancer screening can include false-positive test results, over-diagnosis, over-treatment and treatment that might lead to serious side effects such as impotence and incontinence. Each man should:
- Understand his risk of prostate cancer
- Understand the risks, benefits, and alternatives to screening
- Participate in the decision to be screened or not at a level he desires
- Make a decision consistent with his preferences and values
Men can take charge of their own health! Staying active, eating well and maintaining a healthy body weight can help prevent prostate cancer. Men can:
- Eat at least five servings of fruits and vegetables each day.
- Limit intake of red meats, especially processed meats such as hot dogs, bologna and lunch meat.
- Avoid excessive consumption of dairy products by consuming three or less servings per day, and calcium (less than 1,500 mg per day).
- Include recommended levels of lycopene (antioxidants that help prevent damage to DNA which are found in tomatoes, pink grapefruit, and watermelon) and vitamin E in your diet.
- Meet recommended levels of physical activity (cdc.gov/physicalactivity/everyone/guidelines/index.html).
Due to advances in treatment and earlier screenings, more and more people are living after a cancer diagnosis. The ACS defines a cancer survivor as any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life. According to the Indiana State Cancer Registry, as of December 31, 2014, there were an estimated 300,626 cancer survivors for all cancers combined; the four highest-burden cancers in the state (breast, colorectal, lung and prostate) account for approximately 56 percent of these survivors. Survivorship, like cancer itself, is complex and can be difficult to navigate.
According to the Indiana Cancer Facts and Figures 2015 report, there are three phases of cancer survival – the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival. More often than not, the terms “survivor” and “survivorship” are associated with the transitional period after treatment ends; however, survivorship includes a wide range of cancer experiences and paths3, including:
- Living cancer-free for the remainder of life;
- Living cancer-free for many years, but experiencing one or more serious, late complications of treatment;
- Living cancer-free for many years, but dying after a late recurrence;
- Living cancer-free after the first cancer is treated, but developing a second cancer;
- Living with intermittent periods of active disease requiring treatment; and
- Living with cancer continuously without a disease-free period.
The preferred path for most cancer patients is to receive treatment and be “cured.” This is the primary goal of all cancer treatment, when possible. For many cancer patients, the initial course of treatment is successful and the cancer does not return.
Many cancer survivors must still cope with the mid- and long-term effects of treatment, as well as any psychological effects – such as fear of returning disease. It is important that cancer patients, caregivers, and survivors have the information and support needed to help minimize these effects and improve quality of life and treatment.
The ACS indicates that, nationwide, the majority of prostate cancers are discovered at a local or regional stage, for which the five-year survival rate is close to 100 percent. Over the past 25 years, the five-year survival rate for all stages combined has increased from 68 percent to almost 100 percent. According to the most recent data, the 10- and 15-year survival rates are 98 percent and 94 percent, respectively.
Careful observation (also called active surveillance) is appropriate for many patients, particularly men with less aggressive tumors and for older men. There are variations in treatment options based on age at diagnosis, stage of cancer, grade of cancer, as well as other medical conditions. Other treatment options include surgery, external beam radiation, or radioactive seed implants. More advanced disease is treated with hormonal therapy, chemotherapy, radiation therapy, and/or other treatments.
In 2006, the Institute of Medicine (IOM) issued a report titled From Cancer Patient to Cancer Survivor: Lost in Transition. The report recommends that every cancer patient receives an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to the IOM recommendation, many groups have now developed various types of “care plans” to help improve the quality of care of survivors as they move beyond their cancer treatment.
A treatment summary is critical for cancer survivors. The summary should describe the cancer diagnosis and medical treatments that were received (or that may be needed moving forward). Not only does the treatment summary provide survivors with a record of cancer treatments, but it helps survivors talk with other health care providers who may not have been part of the cancer care team.
According to the ACS, in addition to a treatment summary, a survivorship care plan should include a description of what follow-up appointments and tests will be needed and when they will be needed, a description of preventive measures that can be taken to help stay well, a description of any possible side effects from cancer treatments and ways to manage those side effects, and a description of ways to manage physical and mental health.
There are several organizations that assist with the development of survivorship care plans, including the American Society of Clinical Oncology, Journey Forward and LIVESTRONG Care Plan. A list of additional organizations can be found on the ACS website.
- Prostate Cancer Fact Sheet — Use this fact sheet to educate your partners and communities. The fact sheet provides information and statistics on the prostate cancer burden in Indiana.
- Sample Press Release for Prostate Cancer Awareness Month (September) — This press release is designed to be customized and sent to local media outlets. County level data are available using the Indiana State Cancer Registry Statistics Report Generator.
- Sample Social Media Messages — These sample messages can be customized, or used as they are to promote awareness, prevention, and early detection.
- 2015 Indiana Facts and Figures: Prostate Cancer — Provides current statistics and information on prostate cancer in Indiana in convenient PDF form. This can be linked to documents, websites, presentations, or through social media.
- Indiana Cancer Control Plan (ICCP) 2010-2014 — Provides a roadmap for cancer control in Indiana. The ICCP includes six focus areas: primary prevention, early detection, treatment, quality of life, data, and advocacy. This can be linked to documents, websites, presentations, or through social media.
Additional and online resources:
- Indiana State Department of Health
- Indiana Cancer Consortium
- Centers for Disease Control and Prevention
- Prostate Cancer Foundation
- Little Red Door Cancer Agency
- American Cancer Society
- National Cancer Institute
- Institute of Medicine
- National Cancer Survivorship Resource Center
- George Washington Cancer Institute
- National Coalition for Cancer Survivorship
- The Patient Advocate Foundation
- American Society of Clinical Oncology: Cancer Treatment and Survivorship Care Plans
- Journey Forward
- LIVESTRONG Care Plan