Editor's note: Because prostate cancer is one of the most common types of cancer in men, more and more men and their loved ones are taking steps to understand it, prevent it, and make wise and informed decisions if a prostate cancer diagnosis is made.

The Mayo Clinic, one of the most trusted sources of health information, has a well-written, sympathetic explanation of prostate cancer on its Web site, www.mayoclinic.org.

We will share excerpts from this information in a two-installment article.

Prostate cancer is cancer that occurs in a man's prostate—a small, walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer usually grows slowly, and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

Prostate cancer that is detected early, when it's still confined to the prostate gland, has a better chance of successful treatment.

Prostate cancer may not cause signs or symptoms in its early stages. Prostate cancer that is more advanced may cause signs and symptoms:

• Trouble urinating
• Decreased force in the stream of urine
  
• Blood in your urine
  
• Blood in your semen
  
• Swelling in your legs
  
• Discomfort in the pelvic area
  
• Bone pain

Make an appointment with your doctor if you have any signs or symptoms that worry you, and ask your doctor about the benefits and risks of regular prostate cancer screening. Medical organizations differ on their recommendations for prostate cancer screening, but many advise men in their 50s to discuss the issue with their doctors (see sidebar).

CausesIt's not clear what causes prostate cancer. Doctors know that prostate cancer begins when some cells in your prostate become abnormal. Mutations in the DNA of abnormal cells cause the cells to grow and divide more rapidly than normal cells. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can break off and spread (metastasize) to other parts of the body.

Factors that can increase your risk of prostate cancer include:

Older age. Prostate cancer is most common in men over 65.

Race. Black men have a greater risk of prostate cancer than do men of other races. It's not clear why this is.

Family history of prostate cancer. If men in your family have had prostate cancer, your risk may be increased.
Obesity. Obese men diagnosed with prostate cancer are more likely to have advanced disease that's more difficult to treat.

Complications

Complications of prostate cancer and its treatments include:

Cancer that spreads. Prostate cancer can spread to nearby organs or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to other areas of the body is more difficult to treat than cancer that is confined to the prostate.

Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type of incontinence, how severe it is, and the likelihood that it will improve over time. Treatment options may include medications, catheters, and surgery.

Erectile dysfunction. Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation, and hormone treatments. Medications, vacuum devices that assist in achieving erection, and surgery are available to treat erectile dysfunction.

Checking it out

If you have signs or symptoms that worry you, start by seeing your family doctor or a general practitioner. If your doctor suspects you may have a problem with your prostate, you may be referred to a urinary tract specialist (urologist). If you're diagnosed with prostate cancer, you may be referred to a cancer specialist (oncologist) or a specialist who uses radiation therapy to treat cancer (radiation oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready:

Be aware of pre-appointment restrictions. When you make the appointment, ask whether there's anything you need to do in advance, such as restricting your diet.

Write down any symptoms you're experiencing, including any that seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including major stresses or recent life changes.

Make a list of all medications, as well as any vitamins or supplements, that you're taking.

Take a family member or friend along, if possible. It can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something you missed or forgot.

Write down questions to ask. Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For prostate cancer, some basic questions to ask your doctor include:

• Do I have prostate cancer?
  
• How large is my prostate cancer?
  
• Has my prostate cancer spread beyond my prostate?
  
• What is my Gleason score?
  
• What is my PSA level?
  
• Will I need more tests?
  
• What are my treatment options?
  
• Is there one treatment option you think is best for me?
  
• Do I need cancer treatment right away, or is it possible to wait and see whether the cancer grows?
  
• What are the potential side effects of each treatment?
  
• What is the chance that my prostate cancer will be cured with treatment?
  
• If you had a friend or family member in my situation, what would you recommend?
  
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions you've prepared, don't hesitate to ask questions at any time if you don't understand something.

Screening for prostate cancer

Most prostate cancer is discovered through routine screening. Still, testing men who have no prostate symptoms for prostate cancer is controversial. Medical organizations don't agree on whether screening has benefits. Some medical organizations recommend that men begin prostate cancer screening in their 50s, or sooner if they have risk factors. Other organizations advise against screening. Discuss your situation, and the benefits and risks of screening, with your doctor. Together you can decide whether prostate cancer screening is appropriate for you.

Prostate screening tests might include:

• Digital rectal exam. During a digital rectal exam, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape, or size of your gland, you may need more tests.
• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance naturally produced by your prostate gland. It's normal for a small amount of PSA to enter your bloodstream. However, a higher-than-normal level may indicate prostate infection, inflammation, enlargement, or cancer.

PSA testing combined with digital rectal examination helps identify prostate cancers at their earliest stages, but studies haven't proven that these tests save lives. For that reason, there is much debate surrounding prostate cancer screening (see sidebar).

Diagnosing prostate cancer

If an abnormality is detected on a digital rectal exam or PSA test, your doctor may recommend tests to determine whether you have prostate cancer:

• Transrectal ultrasound. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to make a picture of your prostate gland.
• Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of suspicious cells from your prostate. Prostate biopsy is often done using a thin needle inserted into the prostate to collect tissue. The tissue sample is analyzed in a laboratory to determine whether cancer cells are present.

Determining whether prostate cancer is aggressive

When a biopsy confirms the presence of cancer, the next step, called "grading," determines how aggressive the cancer is. The tissue samples are studied and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly. More aggressive cancer cells have a higher grade.

The most common scale used to evaluate the grade of prostate cancer cells is a Gleason score. Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).

Determining how far the cancer has spread

If a cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. Many men won't require these additional tests, but if your doctor suspects that your cancer may have spread beyond your prostate, imaging tests such as bone scan, ultrasound, computerized tomography (CT) scan, and magnetic resonance imaging (MRI) may be recommended.

When testing is complete, your doctor assigns your cancer a stage. This helps determine your treatment options. The prostate cancer stages are:

• Stage I. Very early cancer that your doctor can't feel, confined to a microscopic area.
  
• Stage II. Your cancer can be felt, but it remains confined to your prostate gland.
  
• Stage III. Your cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  
• Stage IV. Your cancer has spread to lymph nodes, bones, lungs, or other organs.

Your prostate cancer treatment options depend on how fast your cancer is growing, how much it has spread, your overall health, and the benefits and potential side effects of treatment.

Watchful waiting

For men diagnosed with very early-stage prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend watchful waiting, which is sometimes called "active surveillance." In watchful waiting, regular follow-up blood tests, rectal exams, and possibly biopsies may be performed to monitor progression of your cancer.

Watchful waiting may be an option for cancer that isn't causing symptoms, is expected to grow very slowly, and is confined to a small area of the prostate. Watchful waiting may also be considered for a man who has another serious health condition or is at an advanced age that makes cancer treatment more difficult. Watchful waiting carries a risk that the cancer may grow and spread between checkups, making it more difficult to treat.

If tests show that your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation.

To be continued in February.

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