Prostate Cancer: Symptoms, Tests and Treatments

By Jane Farrell

Here, an update from the federal Food and Drug Administration (FDA) about an all-too-widespread cancer among men.

Prostate cancer is the most common cancer among men and the second most common cause of cancer-related deaths among American men. African-American men are more likely to get prostate cancer and twice as likely to die from the disease.

The FDA regulates screening tests and treatments for prostate cancer to ensure their safety and effectiveness.

The prostate is part of the male reproductive system that makes semen. The walnut-sized gland is located beneath the bladder and surrounds the upper part of the urethra, the tube that carries urine from the bladder.

Signs and Symptoms

Prostate cancer is frequently a very slow growing disease, often causing no symptoms until it is in an advanced stage. At that point, symptoms may include difficulty starting urination, weak or interrupted flow of urine, and frequent urination, especially at night.

However, these symptoms can have many other causes than prostate cancer, such as a benign enlarged prostate. If you have any concerns about any of these symptoms, you should contact your health care professional. Most men with prostate cancer die of other causes, and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads outside the prostate, it is dangerous. While the disease is rare before age 50, experts believe that most elderly men have traces of it.

Treatments

In 2004, FDA approved docetaxel, the first chemotherapy for metastatic prostate cancer that showed a survival benefit, after years of research failed to find a treatment that would prolong the lives of metastatic prostate cancer patients. Metastatic is a term used to describe a cancer that spreads from the original location to other areas of the body.

“When prostate cancer metastasizes to another location in the body, it is in most cases incurable and the goal of treatment is to improve a patient’s symptoms or function, or to extend the length of the patient’s life, ” says Daniel Suzman, M.D., a medical officer in FDA’s Office of Hematology and Oncology Products in the Center for Drug Evaluation and Research. Since docetaxel, FDA has approved five additional therapies, all of which have shown improvements in survival.

In addition, two major trials have shown that adding docetaxel to hormonal therapy for men with metastatic disease that had not previously been treated improved their survival.

According to Suzman, that’s become a standard of care for men who have a high burden of disease (such as cancer that has spread to the soft tissues or to many spots in the bone) and are a good candidate for chemotherapy. Docetaxel can cause serious side effects that may lead to death such as low white blood cell counts (neutropenia), and serious allergic reactions. Common side effects include low blood cell counts, infection, nosebleeds, decrease appetite, weight gain, rash, hair loss, and nerve pain.

Screening and Tests

Risk of prostate cancer can be measured through prostate-specific antigen (PSA) testing. PSA is a protein produced by cells of the prostate gland. Because of the widespread use of PSA testing in the United States, prostate cancer is often detected early. In some cases, the prostate cancer found can be very slow growing.

In most of these cases, the prostate cancer may not require treatment, and the use of PSA testing to screen for prostate cancer is controversial, Suzman says. Side effects from treatment of prostate cancer with surgery or radiation therapy can include urinary incontinence, erectile dysfunction, and bowel problems.

The U.S. Preventative Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, currently recommends against PSA-based screening for prostate cancer due to the lack of data that screening increases survival rates, and because of the risk of over-treatment, leading to side effects in men who otherwise would never have experienced any symptoms. However, a revision to the screening recommendation from the USPSTF currently under review would recommend individualized discussion of the risks and benefits in men between 55 and 69 years old, while continuing to recommend against screening men 70 years and older.

Emerging Research

One promising area of research is related to preventing overtreatment of patients with prostate cancer that is still localized to the prostate and who have a low risk of becoming symptomatic or dying from the condition. Careful selection of these men to ensure that they are low-risk is crucial. There is increasing evidence that close surveillance and repeated biopsies may safely allow these patients to delay definitive therapy (surgery or radiation). “There is a need to reduce the burden to patients of overtreatment if the prostate cancer is slow growing,” Suzman says.

This article appears on the FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.