Carlos G. Arcangeli, MD & Mark A. Rosen, MD

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Prostate Cancer Overview

What is the prostate?

The prostate contains cells that make some of the seminal fluid. This fluid protects and nourishes the sperm. Male hormones cause the prostate gland to develop in the fetus. The prostate enlarges when boys go through puberty. The prostate is made of glands and ducts that make some of the fluid that makes up the semen. The prostate stays the same size for roughly 3 decades and then the inner part of the prostate begins to enlarge in most men in their late 40s or early 50s. This is called benign prostate hypertrophy, or BPH, and occurs to some degree in all men. BPH is not prostate cancer and does not increase the risk of prostate cancer. If male hormones are removed, the prostate gland will not grow to full size, or it could shrink.

What is prostate cancer?

In some men genetic changes occur in the prostate glands which may progress to form prostate cancer. Some doctors believe that prostate cancer begins with very small changes in the size and shape of the prostate gland cells. These changes are known as PIN (prostatic intraepithelial neoplasia). These changes are grouped as either low-grade (almost normal) or high-grade (abnormal). PIN is thought to be a pre-malignant condition that may precede some or all prostate cancers.

Most prostate cancers probably start to grow when men are in the early 50s, but a small number of men will have prostate cancer in their 40s. Prostate cancer is very rare prior to age 40. Prostate cancers grow very slowly for many years before they become large enough to raise the PSA blood test or can be felt with an exam. In some men the tiny cancers may grow so slowly that they will never become clinically detectable, and autopsy studies show that many elderly men who died of other diseases also had prostate cancer that neither they nor their doctor were aware of. Most prostate cancers grow slowly compared to other cancers such as lung cancer or colon cancer, but there is wide variation between patients. It is possible to estimate fairly accurately how aggressive prostate cancers are after they are diagnosed by assigning a grade (also known as the Gleason Score).

Who gets prostate cancer?

Prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be about 230,900 new cases of prostate cancer in the United States in the year 2004, and about 29,900 men will die of prostate cancer this year. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. While 1 man in 6 will get clinically detectabale prostate cancer during his lifetime, only 1 man in 32 will die of prostate cancer. The death rate for prostate cancer is going down because of earlier detection and effective treatment. Men with a family history of prostate cancer have a higher chance of developing prostate cancer. African-American men are more likely to have prostate cancer and to die of it than are white or Asian men. The reasons for this are still not known but are possibly related to less access to medical care for socio-economic reasons, and also possibly to genetic differences.