Other than skin cancer, prostate cancer is the most common cancer in American men. The latest American Cancer Society estimates for prostate cancer in the United States for 2012 show about 241,740 new cases of prostate cancer will be diagnosed. About 1 man in 6 will be diagnosed with prostate cancer during his lifetime.
Men with family history of prostate cancer have a much higher chance of developing prostate cancer down the road. Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man's blood. Another way to find prostate cancer early is the digital rectal exam (DRE). These tests should be done after age 50.
The prostate is a gland found only in males. It is located in front of the rectum and below the urinary bladder. The size of the prostate varies with age. In younger men, it is about the size of a walnut, but it can be much larger in older men.
The prostate's job is to make some of the fluid that protects and nourishes sperm cells in semen, making the semen more liquid. Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate.
Several types of cells are found in the prostate, but almost all prostate cancers develop from the gland cells. Gland cells make the prostate fluid that is added to the semen. The medical term for a cancer that starts in gland cells is adenocarcinoma.
"Other types of cancer can also start in the prostate gland, including sarcomas, small cell carcinomas and transitional cell carcinomas," says Alexander Calenda, MD, urologist at Kent Hospital. "These types of prostate cancer are so rare that if you have prostate cancer it is almost certain to be an adenocarcinoma."
Some prostate cancers can grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men (and even some younger men) who died of other diseases also had prostate cancer that never affected them during their lives. In many cases neither they, nor their doctors, even knew they had it.
Prostatic intraepithelial neoplasia (PIN)
In this condition, there are changes in how the prostate gland cells look under the microscope, but the abnormal cells don't look like they are growing into other parts of the prostate (like cancer cells would). Based on how abnormal the patterns of cells look, they are classified as:
- Low-grade PIN: the patterns of prostate cells appear almost normal.
- High-grade PIN: the patterns of cells look more abnormal and begin to appear in the prostates of some men as early as their 20s. Almost half of all men have PIN by the time they reach 50. Many men begin to develop low-grade PIN at an early age but do not necessarily develop prostate cancer. The importance of low-grade PIN in relation to prostate cancer is still unclear. If a finding of low-grade PIN is reported on a prostate biopsy, the follow-up for patients is usually the same as if nothing abnormal was seen.
If high-grade PIN has been found on your prostate biopsy, there is about a 20 to 30 percent chance that you also have cancer in another area of your prostate. This is why doctors often watch men with high-grade PIN carefully and may advise them to have a repeat prostate biopsy, especially if the original biopsy did not take samples from all parts of the prostate.