15 Prostate Cancer Facts You Simply Can't Ignore
Medically reviewed on Apr 12, 2017 by L. Anderson, PharmD.
Prostate Cancer is Common, But Not Always Deadly
The National Cancer Institute estimates 161,360 new cases of prostate cancer in 2017 with about 26,730 deaths. However, because prostate cancer can grow slowly, many more men die of other causes while they have prostate cancer than die as a result of the cancer itself. In fact, data show almost 99% of men diagnosed with prostate cancer will still be alive after 5 years.
However, for some men, prostate cancer may not be noticeable until an advanced stage. Prostate cancer results from the growth of abnormal cells in the prostate gland, usually occurs in older men, and is the most common (non-skin) cancer in U.S. men. The prostate gland produces fluid that makes up part of the semen and is about the size of a walnut. It is located below the bladder and in front of the rectum.
Is Prostate Cancer Screening Needed?
Screening is when your doctor looks for cancer before you have any symptoms. This can help find cancer at an early stage when it may be easier to treat. There is no standard or routine screening test for prostate cancer, although studies evaluating different screening tests are underway.
Two of the most frequently used screening tests used today include the digital rectal exam (DRE) and the prostate-specific antigen (PSA) test. Controversy has existed over if and when these tests should be used. However, the U.S. Preventive Services Task Force (USPSTF) updated their prostate cancer screening recommendations in April 2017. The USPSTF, after reviewing follow-up evidence, is now recommending that men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening to determine if it is an appropriate preventive test. Previously, in 2012, the USPSTF recommended against PSA screening.
How are Screening Tests for Prostate Cancer Performed?
A digital rectal exam (DRE) is an exam of the rectum where the doctor inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or enlargement in the prostate gland. A prostate-specific antigen (PSA) is a blood test. Some doctors might use PSA tests or DREs for screening because they believe these tests will help to detect cancer early and save lives.
Whether or not to be screened is a decision to make in concert with your doctor. If you are screened, PSA levels and a DRE will usually occur every 1 to 2 years starting at age 55 or earlier based on risk factors. Also, check with your insurance to see if the tests are covered.
What Increases My Chances of Having Prostate Cancer?
- Age over 65
- African Americans are twice as likely to die from prostate cancer compared to caucasians.
- Family history of prostate cancer or breast cancer in women; a genetic abnormality (BRCA1/BRCA2 gene) may be responsible for an increased risk in these cancers.
- Unhealthy diet: excess red meat, high-fat dairy products or alcohol intake may increase risk.
What Are the Symptoms of Prostate Cancer?
Many men with prostate cancer have no symptoms at all. If the cancer grows and presses on the urethra (the tube that carries urine out of your body) or spreads to the bladder it can cause a weak urine stream or other urination problems, pain during urination, blood in urine or semen, erection problems, and lower back pain.
Your doctor might suspect prostate cancer if you have any screening tests that are positive, but a positive test does not mean you have cancer. A biopsy might be ordered for further diagnosis. Enlarged prostates felt on digital rectal exams (DREs) and positive prostate-specific antigen (PSA) tests can also be due to benign prostatic hypertrophy (BPH), and not prostate cancer.
What Treatments Are Used for Prostate Cancer?
If the cancer is slow-growing, watchful waiting may be the best option. Actively watching is another option, which may involve regular PSA tests and prostate biopsies. If the cancer has spread just in the prostate area, watchful waiting, external beam radiation or brachytherapy can be used. In brachytherapy, small radioactive pellets are placed permanently into the prostate gland. Surgery to remove the prostate gland (prostatectomy) is another option, as is using anti-androgen drugs and chemotherapy in more advanced cases. Remember, most men diagnosed with prostate cancer do not die from it.
What if My Prostate Cancer Spreads?
There are many options you can discuss with your doctor. Your doctor will stage your cancer to determine if cancer cells have spread within the prostate or to other parts of the body. If the cancer has spread beyond your prostate, doctors may prescribe anti-androgen therapy. Male sex hormones like testosterone can worsen prostate cancer, so anti-androgen therapy reduces the production or blocks the action of testosterone. This therapy is either injected or implanted under the skin.
Examples include Casodex, flutamide, Nilandron, Zytiga, and Xtandi which block androgens. Luteinizing hormone-releasing hormone (LHRH) agonists or antagonists stop the production of testosterone. Choices to consider include Lupron, Eligard, Zoladex, Trelstar, Vantas, and Firmagon.
What Other Treatment Options Are Available?
Prostate cancer can eventually become resistant to anti-androgen therapy. However, there are other treatments available. Taxotere (docetaxel), Jevtana (cabazitaxel), and mitoxantrone are chemotherapy drugs that act to kill cancer cells by disrupting DNA. These drugs are injected into the vein and are given in cycles of treatment and rest periods. A full cycle may be 3 weeks long, but it depends on the drug given. Side effects of "chemo" can vary in severity and type, and include low blood cell counts, nausea/vomiting, diarrhea, hair loss, loss of appetite and mouth sores; however, these drugs may prolong survival in some patients. Speak with your doctor about side effects.
Other Options: Provenge Immunotherapy
Provenge (sipuleucel-T) is a product that stimulates the immune system to help fight prostate cancer cells resistant to anti-androgen therapy. Provenge is mixed with certain immune cells drawn from the patient's blood, and the mixture is later injected back into the patient's body. This type of treatment is called autologous immunotherapy.
In clinical trials, Provenge showed an increase in overall survival of 4.1 months. The median survival for patients receiving Provenge treatments was 25.8 months, as compared to 21.7 months for those who did not receive the treatment. In studies, the most common side effects reported were chills, fever, nausea, and headache, but they appear to be short-lived. More serious effects, reported in 25% of patients, might involve acute infusion reactions and rarely stroke.
Jevtana Approved for Advanced Prostate Cancer
Jevtana (cabazitaxel) is Sanofi's microtubule inhibitor indicated in combination with prednisone for treatment of patients with hormone-refractory metastatic prostate cancer.
Jevtana, approved in June of 2010, is given via an intravenous (IV) infusion every three weeks. In clinical studies, a 30% reduction in risk of death was seen among patients taking Jevtana in combination with prednisone compared to those taking mitoxantrone and prednisone. Side effects can be severe and may include low red and white blood cell counts, diarrhea, fatigue, nausea/vomiting, constipation, stomach pain, nerve pain, loss of appetite, fever, shortness of breath, bad taste, cough, joint pain, and hair loss.
Zytiga Use in Late-Stage Prostate Cancer
Zytiga (abiraterone) is Janssen Biotech's CYP17 inhibitor indicated for the treatment of metastatic castration-resistant prostate cancer.
Zytiga decreases the production of testosterone, and is approved in combination with prednisone. Zytiga can be used before or after already receiving chemotherapy. In studies in men who had not received chemotherapy, patients had a median overall survival of 35.3 months compared with 30.1 months for those receiving the placebo. Progression-free survival was also extended.
Common side effects include fatigue, joint swelling or discomfort, swelling caused by fluid retention, hot flush, diarrhea, high blood pressure, and vomiting, among others.
Xtandi Shows Clear Benefit in Advanced Prostate Cancer
In 2012, the FDA approved Astellas' oral Xtandi (enzalutamide) for use in men with metastatic castration-resistant prostate cancer. Xtandi is an anti-androgen hormone therapy.
Research studies were done in 1,199 patients with metastatic castration-resistant prostate cancer who had received prior treatment with docetaxel. The median overall survival (the length of time before death) for patients receiving Xtandi was 18.4 months, compared with 13.6 months for the patients who received placebo.
Common side effects may include weakness or fatigue, back pain, diarrhea, and headache among many others. Seizures were reported in roughly 1 percent of those receiving Xtandi, and treatment was stopped in these patients.
Xofigo for Advanced Prostate Cancer with Bone Metastases
Xofigo (radium Ra 223) is a drug that contains a radioactive substance. It is injected into the blood to help fight advanced prostate cancer that has spread to the bones. Once the drug reaches the bone, it delivers radiation to kill the cancer cells.
Xofigo, approved in May 2013, was evaluated in a clinical trial of 809 men with symptomatic castration-resistant prostate cancer. The study was designed to measure overall survival (length of time before death). Men receiving Xofigo lived a median of 14 months compared to a median of 11.2 months for men receiving placebo - or a median of 2.8 months longer. Studies have reported increased quality of life. The most common side effect with Xofigo is diarrhea.
Are There Ways to Prevent Prostate Cancer?
Eating a diet rich in fruits and vegetables and low fat foods may help to lower the risk of prostate cancer, and possibly other cancers. Studies have also been done with certain medications to see if they could help prevent prostate cancer.
One study in nearly 19,000 men showed that Proscar (finasteride), a drug usually prescribed for benign prostatic hypertrophy (BPH), lowered the risk of low-grade prostate cancer by a third, but no effect on overall survival (extending life) was shown. Proscar did not increase the risk of developing high-grade cancers.
Doctors may have differing opinions on use of finasteride to help lower the risk of low-grade prostate cancer; there is always a concern of over-treatment, drug side effects, and added costs in prostate cancer.
Are Guidelines Available for Prostate Cancer?
Recent guidelines help doctors and patients decide on a treatment course for anti-androgen resistant, metastatic prostate cancer. New therapies can add to survival time and quality of life, but may have serious side effects, so talk to your doctor about the best course.
The evidence-based guidelines are based on a review of 56 clinical trials. Experts suggest to continue hormone-deprivation therapy indefinitely, and offer patients one of three treatment options -- abiraterone (Zytiga)/prednisone, enzalutamide (Xtandi), or radium-223 (Xofigo, if cancer has spread to the bones only) -- in addition to hormone deprivation, among other recommendations. Patients and healthcare providers should discuss palliative care early on in treatment.
Finished: 15 Prostate Cancer Facts You Simply Can't Ignore
- National Cancer Institute (NCI). Prostate Cancer. Accessed 2/7/2017 at http://www.cancer.gov/types/prostate
- U.S. Preventive Services Task Force (USPSTF). Prostate Cancer: Screening Release Date: April 2017. Accessed 4/12/2017 at https://www.uspreventiveservicestaskforce.org/
- National Comprehensive Cancer Network (NCCN). Guidelines for Patients 2016. Prostate Cancer. Accessed 2/7/2017 at https://www.nccn.org/patients/guidelines/prostate/#72