Diseases of the Prostate 

Prostate cancer is the most common type of cancer among men, with the risk gradually increasing with age and typically occurring in men in their forties and above. Black males develop prostate cancer more frequently than white males. This year alone, an estimated 200,000 new prostate cancers will be diagnosed within the United States. Among men, prostate cancer is the second leading cause of cancer fatalities.  

It is important to note that most men who receive a prostate cancer diagnosis do not actually die from the disease. 

Although the cause of prostate cancer cannot always be determined, there are known risk factors for developing the disease. For example, black men and those with family members who have or have had the disease have greater odds of developing prostate cancer. 

All men of the age of 50 and beyond should have a PSA blood test and digital rectal exam, according to the American Cancer Society 

Elevated PSA levels may mean that prostate cancer is present. Men in higher risk groups should start testing earlier, at the age of 45 years old. 

What is the prostate? 

The prostate is a gland found within a man’s reproductive system, located just under the bladder and in front of the rectum. It is roughly the size of a walnut, surrounding a section of the urethra. Your prostate manufactures one component of your semen fluid. 

Key Points 

• The disease involves the presence of malignant cancer cells within prostate tissues. 
• Symptoms of prostate cancer include frequent urination or a week urine flow. 

• Prostate cancer diagnosis involves examination of the prostate and blood. 
• Prostate cancer can be diagnosed, and the grade of the cancer learned, using a biopsy. 

What are the symptoms of prostate cancer? 

The following symptoms may be due to prostate cancer or certain other medical conditions. Check with Dr. Antun if you should experience any of the following symptoms: 

• Interrupted or weak urine flow 
• Sudden urination urge 
• Frequent urination, particularly at night time 

• Difficulty beginning the flow of urine 
• Difficulty completely emptying the bladder 
• Burning or pain during urination 
• Blood found in the urine or semen 
• Ongoing pain in the hips, pelvis or back 

• Shortness of breath, rapid heartbeat, fatigue, or dizziness 

Some symptoms consistent with prostate cancer may be also due to other types of medical conditions. For example, the prostate tends to grow larger with age, potentially blocking the bladder or urethra. This could lead to difficulty with urination or sexual dysfunction. Known as benign prostatic hyperplasia (BPH), the condition may require surgery. 

The following types of tests may be used to help diagnose prostate cancer: 

Physical Examination and Medical History 

A bodily exam can be conducted to look for overall signs of health, including detecting disease symptoms like lumps. A history of your past illnesses and health habits may also be taken. 

Digital Rectal Exam 

An examination of the rectum. The doctor or nurse will check the prostate through the rectum for the detection of lumps or abnormal signs. 

Prostate-Specific Antigen (PSA) Test 

This test involves the measurement of the level of PSA within your blood. Your prostate makes PSA, which may be at higher than normal levels for prostate cancer sufferers. However, PSA levels may also be elevated among men with a prostate infection or inflammation. 

Transrectal Ultrasound 

This examination involves the use of a small probe placed within the rectum for checking the prostate. Ultrasound is transmitted through the probe to develop the visualization of body tissues known as a sonogram. 

Biopsy 

If prostate cancer is suspected, your doctor may also use a transrectal biopsy to help with the diagnosis. This involves tissue removal from the prostate using a thin needle passed into the prostate. Later, the tissue will be viewed by a pathologist under a microscope for the detection of cancer cells. 

Gleason Score 

Some of the testing that you may undergo is used to develop what is known as a Gleason Score, which ranges from six to ten. A score of six indicates a low-grade cancer, while a score of eight or above indicates a high-grade cancer. 

Factors determining prognosis and treatment options: 

• The stage of prostate cancer and whether it has spread beyond the initial site 
• The age of the patient 
• Whether the cancer is newly diagnosed or has recurred 

Ways Cancer Spreads 

There are three ways that cancer can metastasize, or spread beyond its initial location. 

• Tissue. Cancer began spreading from its initial location into surrounding regions. 
• Lymph system. Cancer began spreading from its initial location by traveling within the lymph system. The lymph carries it into other parts of the body. 
• The blood. Cancer gets into the bloodstream, allowing it to travel throughout the body. 

Cancer can spread from its starting location to other parts of the body. 

Metastatis is the term for cancer spreading to another part of the body. It occurs when cancer cells begin breaking away from their initial location, known as the primary tumor, traveling throughout the lymph system or bloodstream. 

Stages of Prostate Cancer 

As with most types of cancer, prostate cancer is graded by the category, or stage, that it is in at any given time. 

Stage I Cancer 

The cancer will not be detected with a digital rectal exam and is detected only using a needle biopsy when the patient has a high PSA level. Or a tissue sample may reveal the cancer, often when another procedure is performed, such as a procedure for benign prostatic hyperplasia. 

Stage II Cancer 

The cancer has progressed even more when it reaches stage II, but it will not have spread beyond the prostate. 

In this stage of cancer: 

• The cancer occurs in no more than one half of one side of the prostate. 
• The cancer is located in the majority of one side of the prostate. 

Stage III Prostate Cancer 

Stage III is when the cancer is located in either, or both, sides of prostate. It may have also metastasized to surrounding tissue or organs like the bladder, rectum or pelvic wall. 

Stage IV Cancer 

This is when cancer has spread to lymph nodes nearby. It may have also spread to distant lymph nodes and into the bones. 

Types of Treatments for Prostate Cancer 

• Active surveillance, commonly known as watchful waiting 
• Surgery 
• Hormone therapy 
• Radiation therapy 
• Chemotherapy 

• Biphosphonate therapy 
• Immunotherapy 

Benign Prostatic Hyperplasia (BPH) 

Prostate enlargement is known as benign prostatic hyperplasia (BPH). This condition develops when prostate gland cells begin multiplying. This leads to swelling within your prostate gland, squeezing the urethra and limiting urine flow. It is important to understand that BPH and prostate cancer are not the same condition. Having BPH does not mean that you have an increased risk of developing cancer. But it may lead to unpleasant symptoms that can impact your quality of life. Once you have reached the age of 50, your odds of developing BPH go up significantly. 

Symptoms of BPH 

If you are developing BPH symptoms, they are typically mild at first. Some symptoms include: 

• Bladder not emptying completely 
• Frequent urination, particularly at night 
• Dribbling during urinary stream, rather than vigorous flow 
• Urinary incontinence, meaning urine leakage 

• Feeling the need to strain while urinating 
• Weakened urinary stream 
• Urination that is painful 
• Sudden urges to urinate 
• Blood found in urine 

Treating BPH 

Self-care is the start of treating BPH when detected early. If your symptoms do not alleviate by caring for yourself, Dr. Antun may prescribe a medication or recommend surgery. The type of prescribed treatment that he recommends is also influenced by your age and overall health. 

Natural Treatments for BPH 

You can initiate certain actions or lifestyle changes to help alleviate BPH symptoms, including: 

• Urinating once you feel the urge 

• Avoiding medications like antihistamines and over-the-counter decongestants that can make it difficult to urinate 
• Avoiding caffeine and alcohol, particularly late at night 
• Lowering your level of stress 
• Regular exercise 
• Practicing Kegel exercises for strengthening pelvic muscles 

BPH versus Prostate Cancer 

As mentioned earlier, BPH is not the same thing as prostate cancer, although they do share a number of symptoms. Prostate cancer is a more severe type of disease than BPH. Prostate cancer typically requires treatment. So please be sure to contact Dr. Antun if you have BPH symptoms, so that prostate cancer can be ruled out.