Hi, I’m Dr. Scholz, I’m a medical oncologist who specializes in prostate cancer. At the PCRI we get questions from a variety of sources, and one common recurring theme is “How does prostate cancer work?” And I think that’s a fair question. It’s a mystery to many people. How does it cause illness? Where does it come from?
The problem is uncontrolled growth of cells originating in the prostate gland, a small gland down in the lower pelvis that makes semen. What is oftentimes confusing about prostate cancer is that many of these little growing tumors are very low-grade and never spread, but some of them can and there are therefore many different types—higher-grade types that can spread, lower-grade types that don’t.
So what is the harm if it spreads? Well if these little cells jump into say a lymph node or into the bones they can multiply there, create tumors, and create malfunction of that area of the body just through their size pushing on things, getting in the way, and this is what can actually make someone experience pain or feel sick, and when it gets out of control it can cause death.
One thing to really make sure that you understand is that a spot of prostate cancer in the bones is not the same as a bone cancer. A spot of prostate cancer in the liver is not the same as a liver cancer. The cells behave differently when they come from the prostate gland. What’s really important is that they tend to respond beautifully to the blockade of testosterone so-called “hormone blockade.” Hormone blockade doesn’t work for any other type of cancer. Hormone blockade is usually very effective and men can go into remissions for many many years, whereas if they had a cancer coming from the liver or coming from the bone those hormone treatments would be totally ineffective.
I think a good closing thought on prostate cancer is to realize that the very worst prostate cancers are almost always better than the very best cancers from any other part of the body. So prostate cancer is sort of a stand alone disease that grows so slowly in most cases it would probably be more considered a chronic illness than an actual cancer. Unfortunately, we’re all familiar with people that have had lung cancers and pancreas cancers and have become sick and passed away within 6, 12, 18 months of diagnosis. That is almost unheard of with prostate cancer. If you look at the American Cancer Society’s website they say for all men diagnosed—early and advanced—five-year survival rates are 99%, 10 year survival rates are 98%, 15 year survival rates are 94%. These are remarkable survival rates and since survival is so excellent often times we need to balance the intensity of treatment with the potential benefits for cure since not all types of prostate cancer actually need to be cured.