Prostate problems will affect ninety percent of all men by the time the reach the age of eighty and in all too many cases the problem will be that of prostate cancer. But just what is the prostate gland and what does it mean to be diagnosed with prostate cancer? Here we look at the ten questions which are most often asked by men who encounter prostate problems.

1. What is the prostate gland and what does it do?

The prostate gland is situated between the bladder and the rectum, partly surrounding the urethra which carries urine from the bladder out of the body, and forms part of the male reproductive system, making and storing fluid which forms part of a man's semen. The prostate gland is about the size of a walnut in an adult.

2. What is prostate cancer?

Prostate cancer is a form of cancer which normally appears late in life and tends to be slow growing as a result of which many men, despite having prostate cancer, in fact die of other unrelated conditions. This said, prostate cancer is the second commonest form of cancer in the United States today and in 2006 some 235,000 men were diagnosed with the disease and approximately 27,000 men died from it.

3. Who is likely to contract prostate cancer?

Men in general are at risk of contracting prostate cancer although as it is an age related disease it tends to appear only from about middle-age onwards with the risk of contracting the disease increasing with age. Prostate cancer is more likely to appear in black men and where there is a family history of the disease.

4. What are the symptoms of prostate cancer?

In the early stages of the disease there are normally few if any symptoms and it is possible to suffer from prostate cancer for many years without even knowing it. When symptoms do start to appear they are likely to include such things as difficulty in urinating, the need for frequent urination (especially at the night), a poor flow or urine which tends to stop and start, painful urination, blood in the urine or semen, pain when ejaculating and pain in the lower back, hips or upper part of the thighs.

5. Are there other conditions which can mask the presence of prostate cancer?

Many older men suffer from an enlarged prostate which places pressure on both the bladder and the urethra and interferes with the flow of urine and with sexual function, producing many of the same symptoms that are seen in prostate cancer. This condition is not however cancer but is a benign condition known as benign prostatic hyperplasia, or BPH.

It is also quite common for the prostate gland to become infected and inflamed, again producing similar symptoms, and this also benign condition is known as prostatitis.

6. Is it possible to be screened for prostate cancer?

Yes, although current screening is not foolproof. The two most commonly used screening test will indicate the possibility of a developing problem, which may or may not be cancer, and point to the need for further more specific testing.

The tests currently in use are the digital rectal exam (DRE), in which a doctor carries out an investigation of the prostate gland by feeling it with a gloved finger inserted through the rectum to detect the presence of hard or lumpy areas, and a blood test used to detect the presence of a substance which is known as prostate specific antigen (PSA) and which is made by the prostate gland.

7. How reliable are present screening methods?

Neither of the current screening tests is foolproof and both can easily miss prostate cancers. However, the two tests used together can produce quite reasonable results and are certainly preferable to not screening for the condition at all. Research is currently underway to find a more accurate method of screening.

8. How is a diagnosis of prostate cancer made?

There is really only one way to confirm the presence of prostate cancer and this is by carrying out a prostate biopsy. This involves removing a number of small samples of tissue from various different parts of the prostate gland and examining these under a microscope in the laboratory.

9. How is prostate cancer treated?

If prostate cancer is localized (that is to say confined only to the prostate gland) there are at present three main forms of treatment available.

One option is to do nothing and to simply watch and wait. If this seems an odd course of action it should be borne in mind that many prostate cancers appear at a very advanced age and, as long as the cancer remains within the prostate gland and is slow growing, the best option for an elderly patient might well be to do nothing at all.

Where active treatment is carried out this will often be to either treat the prostate gland with radiation to kill the cancer cells or to simply remove the prostate gland surgically.

In cases where cancer has spread outside of the prostate gland there are a wide range of treatment options available depending on the degree of spread. This is however a complex area and beyond the scope of this short article.

10. What is the best treatment for localized prostate cancer?

This is a bit like asking 'how long is a piece of string' as there are a large number of factors which need to be taken into consideration, not the least of which are the patient's own circumstances and wishes.

In the majority of cases however prostate cancer is slow growing and there is usually no need to rush into a treatment plan. This gives patients time to discuss their condition with their doctor, including taking a second or even third opinion if they wish, and also to discuss matters with their partner and family before making any decision.