Everything to Know about Prostate Cancer

Among the many health issues that men will face during the course of their lives, prostate cancer is one of the most prevalent. The condition ranks as the second most common form of cancer in American men (right behind skin cancer). So far in 2023, the American Cancer Society has estimated that just over 288,000 new cases are diagnosed and almost 35,000 men have lost their lives.

To answer all your questions, Loyola Medicine spoke with Gopal Gupta, MD, an expert in urologic oncology. "Patients should understand that prostate cancer, when detected early, is very survivable and is treated with intent to cure. Even advanced or metastatic disease can be treated with many options to extend life expectancy."

What is prostate cancer?

Like all cancers, the disease begins when cells in the body start to grow out of control. Almost any part of the body can develop cancer cells and spread to other areas. This includes the prostate, a gland that is necessary for the production of semen. Located below the bladder and in front of the rectum, the prostate can also grow as a man ages.

"When a man is diagnosed with prostate cancer, it means they have been diagnosed with cancerous cells in the prostate gland," says Dr. Gupta. "Cancers arise from normal cells that have lost the ability to regulate their growth. They continue to grow and don’t respond to the body's normal signals that regulate cell growth/death. This is almost the identical pattern to cancer cells in all organs."

There are different classifications of cancers, although almost all cases of prostate cancer are adenocarcinomas, meaning the cancer is growing in the glands lining your organs. There are other types of cancer that can develop in the prostate, such as:

• Small cell carcinomas, a highly aggressive form of cancer.
• Neuroendocrine tumors (other than small cell carcinomas), cancers that begin in neuroendocrine cells.
• Transitional cell carcinomas, cancers that begin in transitional cells.
• Sarcomas, cancers that develop from bones or soft tissues.

However, when it comes to prostate cancers, these other cancer types are extremely rare. The vast majority of cases are/will be adenocarcinomas.

What causes prostate cancer?

Unfortunately, researchers are unsure of the exact cause. However, there are various risk factors that seem to increase the chance of developing the disease. Different cancers have different risk factors. These include:

• Age. The chance of young men developing prostate cancer is small. It's estimated that only 10% of cases occur in men younger than 55 years old. Your chances of being diagnosed goes up significantly after turning 65.
• Race/ethnicity. If you are an African American man or of Caribbean descent, you are more likely to develop the disease. For Asian Americans, Hispanics, and Latino men, their chances are lower than their white counterparts. Researchers are unsure why.
• Geography. Men in Asia, Africa, Central America and South America have a lower risk. It's possible that more intensive screenings in Western countries is one reason for the difference.
• Family history. Genetic factors can greatly increase your risk. In fact, having a father or brother that developed prostate cancer more than doubles your own risk. The more relatives you have that were diagnosed, the greater your own chances.

DNA changes in a healthy prostate cell can cause the disease. When certain genes that control how cells divide and grow are changed, this can lead to the growth of cancer. Some gene mutations are inherited while others occur during the course of someone's life and aren't passed down to children. What causes these gene mutations is not completely known although some inherited genes have been linked to hereditary prostate cancer.

Can prostate cancer be prevented?

Most risk factors are uncontrollable. After all, you can't stop aging or choose your race. In that way, there is no way to effectively prevent this disease. However, there are some lifestyle choices that may increase the risk.

How certain lifestyle choices increase someone's risk is still unclear. However, some studies have shown that obese or overweight men have a higher risk, as well as men who consume a lot of dairy products and calcium.

Besides those specific circumstances, the best advice is still the most basic. Lose weight until you're at a reasonable size, stay physically active and follow a healthy eating plan. Eating healthy doesn't mean completely neglecting the foods you love. Instead, add proper foods to your diet, like colorful fruits and veggies, as well as consuming whole grains while limiting processed meats and other foods.

How is prostate cancer diagnosed?

Most cases are found early without the patient ever having symptoms. These screening tests are used to find the disease in older men. While there are a number of screening tests, the two most common are:

• Prostate-specific antigen (PSA) blood test. This blood test measures the level of PSA in your blood. Men with a level above 4 ng/mL of blood may have the disease.
• Digital rectal exam (DRE). Despite the name, a DRE is mostly physical. A doctor will enter the rectum with a gloved and lubricated finger to feel the prostate, looking for bumps or hard areas that might be cancer. While a DRE is less effective than a PSA blood test, a DRE can find prostate cancer in men with normal levels of PSA.

"On top of PSA and DRE, there are several FDA-approved blood/urine/radiology tests that can be supplemented for the purpose of diagnosis," says Dr. Gupta. "If a person has a strong family history or has African American ancestry, initial PSA testing is recommended at 40 years old. Otherwise, PSA testing is recommended at 55 years old. This can be tailored to be on an annual basis or every two years depending on risk factors."

Your doctor may recommend one or both of these screenings since early stage prostate cancer usually causes no symptoms. However, more advanced prostate cancers can cause certain symptoms so it's important to be aware of them. They can include:

• Problems urinating
• Blood in urine or semen
• Erectile dysfunction
• Pain in the hips, back, or chest
• Weakness or numbness in the legs
• Loss of bladder control

Unfortunately, it can be difficult to diagnose prostate cancer from these symptoms alone as many of them are likely caused by other conditions.

How is prostate cancer treated?

It's important to know that a diagnosis is not a death sentence. In fact, prostate cancer has one of the highest survival rates, especially if caught early. It's estimated that the 5-year relative survival rate in the United States is 97%.

Due to this high survival rate and various other factors, like the speed of the cancer growth and your overall health, your doctor may not even recommend treatment. For some, treatment may never be needed. Instead, regular blood tests, rectal exams and prostate biopsies may be performed to regularly check on the progression of the disease.

However, if intervention is necessary, surgery and radiation therapy are the two most common forms of treatment. Surgery involves removing the prostate gland, some surrounding tissue and possibly a few lymph nodes. Your doctor may recommend surgery if the cancer is confined to the prostate.

For radiation therapy, high-powered energy is used to kill the cancer cells. It may be used in conjunction with surgery to kill any cancer cells that might remain after the operation. Usually, radiation therapy is done several times a week over the course of multiple months.

Of course, these aren’t the only treatments. Some other options include:

• Freezing or heating prostate tissue
• Hormone therapy
• Chemotherapy
• Immunotherapy
• Targeted drug therapy

"Knowledge is power! Literally. Loyola is a leader in prostate cancer detection, treatment and survivorship," says Dr. Gupta. "We offer all the diagnostic modalities and have medical oncology partners who work in a multidisciplinary fashion to individualize treatment options to get the best outcomes for all of our patients regardless of stage."

Why choose Loyola?

The treatment(s) your doctor recommends will depend on many factors. At Loyola, our physicians have vast experience with prostate cancer. The Urology department at Loyola Medicine has one of the most comprehensive and advanced teams in the nation, with primary and specialty care offices conveniently located throughout Chicago’s western and southwestern suburbs.

Recently, Loyola has transitioned our prostate biopsy practice and minimally invasive urologic surgery treatments to Gottlieb Memorial Hospital. We are very excited to offer all of our diagnostic and treatment options at Gottlieb.

To make an appointment, call 888-584-7888 or schedule an appointment online.

Gopal Gupta, MD is a urologist at Loyola Medicine who received his B.S. in Biological Chemistry from the University of Chicago in 1996 and his M.D. from the University of Illinois at Chicago in 2002. He then performed his residency in urologic surgery at the University of Maryland Medical Center until 2008. Between 2008 and 2011, Dr. Gupta completed a fellowship in urologic oncology at the National Cancer Institute in Maryland.

His primary clinical research interests pertain to bladder, kidney and prostate cancer. Dr. Gupta performs minimally-invasive surgeries using the da Vinci Robotic Surgery platform. He strives to push the cutting edge of technology while optimizing cancer outcomes.

Book an appointment today to see Dr. Gupta or another Loyola physician by self-scheduling an in-person or virtual appointment using myLoyola.