Urologic Oncology FAQsCommon Prostate Cancer Questions What is the prostate gland? The prostate is a gland about the size of a walnut. It is located beneath the bladder and in front of the rectum. It encircles the upper part of the urethra, the tube that empties urine from the bladder. The prostate produces most of the fluid in which sperm travel. As men ages, the cells in the prostate may form tumors or other benign (non-cancerous) growths. If the prostate grows too large, the flow of urine may be affected. Who is at risk for prostate cancer? The causes of prostate cancer are not well understood yet. However, studies have found the following risk factors to be associated with prostate cancer: Age - This is the most common risk factor. More than 70% of men diagnosed with prostate cancer are over the age of 65. Family history of prostate cancer - A man's risk for developing prostate cancer is higher if his father or brother has had the disease. Race - This disease is much more common in African American men than in white men. It is less common in Asian and American Indian men. Diet - Some evidence suggests that a diet high in animal fat may increase the risk of prostate cancer while high consumption of vegetables may decrease the risk. What are the symptoms of prostate cancer? Prostate cancer often does not cause symptoms for a number of years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include: Frequent urination, especially at night Difficulty starting or holding back urination Inability to urine Weak or interrupted flow of urine Painful or burning urination Blood in urine or semen Painful ejaculation Frequent pain or stiffness in the lower back, hips, or upper thighs Are there any screening tests for prostate cancer? Yes, there are two tests being used to detect prostate cancer. Digital rectal exam (DRE) - the doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities in the prostate gland. Blood test for prostate-specific antigen (PSA) - a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, benign prostatic hyperplasia (BPH) or infection in the prostate. Why is PSA testing used to detect prostate cancer? The PSA test, as originally conceived, was a fairly easy test to interpret. Its use in screening has traditionally been from age 50 to age 70, and, for statistical reasons, a value of "4" was chosen as the 'worry' level. Since the late 1980s, when the test was popularly introduced, the use and understanding of this test has changed. There no doubt will be further changes and suggestions regarding the PSA test. What is clear is that PSA testing has been part of the reason we have found more early cancer, when hope of cure is high. What is the normal PSA value? The normal PSA range is usually from 0 to 4.0 ng/mL; however, there is some medical evidence that it may be beneficial to lower the upper bound to 2.5 ng/mL. Several factors are considered when a physician evaluates a PSA test result, including one's age, size of prostate, and the results of his previous PSA tests, if any. How reliable are the screening tests for prostate cancer? Neither of the screening tests for prostate cancer is perfect. Most men with mildly elevated PSA levels do not have prostate cancer and many men with prostate cancer have normal levels of PSA. The DRE can also miss many prostate cancers. Combining both DRE and PSA tests will yield more accurate results than any one alone. How do I ensure an accurate reading for my initial PSA test and subsequent screening? Refrain from sexual activity for at least one day before the test. Make sure to keep a copy of all your PSA results. Have the same laboratory technology used to perform the test, if possible. For the interpretation of the result, seek a broad evaluation rather than looking at one number, without the context of previous results. When do I need to start thinking about having a PSA test? At this time, one possible sensible approach may be to obtain a baseline PSA test at age 35, when prostate cancer is clinically essentially non-existent. Repeat the test at age 40, along with a digital rectal examination (DRE) and use both the actual number of the PSA as well as the change from age 35 in the interpretation. If both numbers are below 0.5, perhaps repeat the PSA at age 45, unless there is a strong positive family history or racial disposition to prostate cancer, which might lead to repeat in 2 years. What should I expect on my first visit to the urologist? Your first visit to a urologist will be similar to any first visits with a new physician. Personal medical history will be taken followed by a physical exam, including a DRE. In addition, a blood test will be ordered for your PSA (free and total) level. It would be helpful to bring with you any previous PSA records, prostate biopsy or ultrasound reports.