Prostate Cancer in the United States

Prostate cancer is the most common cancer among American men, except for skin cancer. It is the second leading cause of cancer deaths after lung cancer. Dave Wesley, the president of the Sacramento Board of Directors for the American Cancer Society (ACS), and himself a prostate cancer survivor, reports that 220,900 American men are expected to be diagnosed with prostate cancer in 2003. ACS also estimates 28,900 men will die of prostate cancer in the U.S. in 2003. For California, the numbers are also significant: 20,500 diagnoses and 2,700 deaths.

Any man can develop prostate cancer, but for reasons that are not clearly understood, African-American males are twice as likely as white males to develop it. It is less common in Asian and American Indian males.

What is the prostate and what are the symptoms of prostate cancer?

To understand the realities facing men who are diagnosed with prostate cancer, it is helpful to know what the prostate is. The Memorial Sloan-Kettering Cancer Center website states: "The prostate is a walnut-sized gland that makes and stores seminal fluid, a milky liquid that nourishes sperm. Located below the bladder and in front of the rectum, the prostate encircles the upper part of the urethra, which is the tube that empties urine from the bladder. The prostate requires male hormones, like testosterone, to function properly, helping to regulate bladder control and normal sexual functioning."

Symptoms of prostate cancer include frequent urination or an inability to urinate, trouble starting or holding back urine flows, or frequent pain or stiffness in the lower back, hips or upper thighs. However, for many men, an abnormal finding during a routine screening examination is the first indication that they might have prostate cancer. "The simple fact is, for prostate cancer and other cancers, early detection saves lives," Wesley said. "The most common symptom of localized curable prostate cancer is: no symptoms! That's why annual screening is so important."

ACS Guidelines for Prostate Cancer Screening
The Prostate Specific Antigen (PSA) blood test and the Digital Rectal Examination (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years. Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45. For both men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

A PSA score outside the "normal" range of 0-4, an abnormal DRE, or even a rapidly elevating "normal" PSA can all trigger a biopsy, which is required for definitive diagnosis of prostate cancer.

The numerical PSA score and a biopsy are used to determine the stage of the prostate cancer, which in turn guides the choice of treatment. Doctors will look at the PSA level, the PSA velocity (the change year over year), and the size and texture of the prostate gland. Abnormal findings usually result in a referral to a urologist for a possibly biopsy. The biopsy is what is used to definitively diagnose prostate cancer. A pathologist will also determine the relative aggressiveness of the tumor by assigning what is known as a Gleason Score.

ACS Services
The National Cancer Information Center (NCIC) is operated by the ACS out of Austin, Texas, and is staffed with processionals who can answer questions and provide cancer-related information 24 hours a day, 7 days a week, 365 days a year. NCIC can also offer referrals to a "Man to Man" support group or visitor program. The number is 1-800-ACS-2345.

The ACS website is www.cancer.org. There are a variety of resources available here, including cancer-specific information, the survivors network, clinical trials, "Man to Man" referrals and cancer prevention.