What
is Prostate Cancer?
The prostate is a walnut-sized gland in the male reproductive
system, situated below the bladder and in front of the
rectum. Although the cause of prostate cancer is unknown,
the disease is thought to develop from abnormal cell
growth within the prostate.
One theory believes prostate cancer begins with very
small changes in the size and shape of the prostate
gland cells.
According to the American Cancer Society and National
Cancer Institute:
- Prostate cancer is the second-leading cause of
cancer deaths in men, second to lung cancer
- While one man in six will get prostate cancer during
his lifetime, only one man in 33 will die of this
disease
- More than 85 percent of all prostate cancer is found
in the local or regional stages - while it is still
confined to the prostate, or after it has spread to
pelvic lymph nodes but not to other organs or bones
- Nearly 100 percent of these patients will survive
at least five years, while 34 percent of men with
the most advanced stages of the disease will survive
at least five years
- African-American men are twice as likely to develop
and die from prostate cancer as Caucasian men
Risk Factors
- Age - More than 70 percent of men diagnosed
with prostate cancer each year are age 65 or older
- Family History - According to the National
Cancer Institute, a genetic link for prostate cancer
may exist in some families, particularly those with
men who were diagnosed with the disease before age
60. If your father or another close male relative
has prostate cancer, you may face a greater risk of
developing it yourself
- Diet - Some studies suggest a link between
prostate cancer and high-fat diets (especially those
high in animal fat)
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Common Symptoms
Although medical professionals stress the importance
of early detection, many men are reluctant to see their
doctor for proper screening. But by the time you notice
something is wrong, the cancer might have spread beyond
the prostate, making it harder to treat. As a prostate
tumor grows, it may cause one or more of the following
symptoms:
- Dull pain in your lower pelvic area
- Urgency of urination
- Difficulty starting urination and/or pain
while urinating
- Weak urine flow and dribbling
- Frequent sensation that your bladder is full
- Frequent nighttime urination
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- Blood in the urine
- Painful ejaculation
- General pain in your lower back, hips or upper
thighs
- Loss of appetite and weight
- Persistent bone pain
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Source: American Urological Association
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Screening and
Diagnosis
It is recommend that you have a physical examination
with a general practitioner or internist every year
and begin screening for prostate cancer at age 50-or
sooner if you have a family history of the disease or
other risk factors. Doctors use the following methods
to diagnose prostate cancer:
- PSA: A simple blood test that measures protein
levels secreted by the prostate into the bloodstream.
If your test shows an elevated PSA level, additional
urologic evaluation is needed. You may not necessarily
have cancer, however. The PSA level could be elevated
due to other conditions, such as benign prostate enlargement
or urinary tract infection.
- Digital rectal examination (DRE): By inserting
a gloved, lubricated finger into the rectum, doctors
can feel for lumps on the prostate.
- Biopsy: After an initial examination and
blood test, a biopsy is the next step in diagnosing
prostate cancer. Doctors use ultrasound-guided biopsy
to collect samples from specific sites in the prostate
gland.
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Stages of Prostate
Cancer
Once a diagnosis is made, doctors conduct additional
tests to stage the cancer, or determine if the cancer
has spread and how far. Staging helps your doctor develop
an appropriate treatment plan.
- Early prostate cancer, Stages I and II, is localized,
meaning it has not spread (metastasized) outside the
prostate gland
- In Stage III prostate cancer, the tumors have grown
outside the prostate into the seminal vesicles. Doctors
may describe this stage as locally advanced disease
- In Stage IV, the disease has spread to lymph nodes
and possibly other tissues or organs
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Common Treatment Options
Although the prevalence rates have not changed much
over the past decade or so, the frequency of screening
and earlier diagnosis has increased. These factors,
along with breakthroughs in technology and treatment,
have improved survival rates for many men with prostate
cancer.
Your treatment plan will be based on the stage of the
cancer, your age, overall health, life expectancy, and
personal preferences. Before you agree on a course of
treatment, you should understand the risks and benefits
of the different options, and consult with your health
care provider and your loved ones to determine what
is right for you. Your treatment plan may include:
- Watchful waiting - Doctors often recommend
watchful waiting or observation for elderly men or
those with pre-existing medical conditions who may
be unable to tolerate surgery or radiation.
- Hormonal therapy - Hormonal therapy aims
to lower the serum testosterone level in men with
prostate cancer. Testosterone is believed to trigger
the growth of cancerous cells in the prostate, much
like estrogen is thought to stimulate the onset of
breast cancer in some women. Types of hormonal therapy
include surgical removal of the testicles, where testosterone
is produced, and injections of medicines that prevent
the testicles from producing testosterone or block
testosterone from entering the prostate. Hormonal
therapy cannot cure prostate cancer. Instead, the
treatment is designed to slow the progression of the
disease, shrink the size of the tumors, or relieve
the discomfort associated with advanced prostate cancer.
-
Radiation therapy
Radiation therapy is a non-surgical method of treatment
of cancer and other diseases using penetrating beams
of high-energy waves called x-rays or gamma rays.
Radiation injures or destroys tumor cells by damaging
their genetic material, making it impossible for these
cells to continue to grow. There are two types of
radiation therapy:
- External
beam radiation therapy - Specialized medical
equipment is used to deliver radiation to the
tumor site from outside the body. Intensity Modulated
Radiation Therapy (IMRT) is an advanced, precise
method of external beam radiation therapy that
is commonly used to treat prostate cancer. High
doses of radiation are delivered directly to the
tumor while sparing surrounding healthy tissue.
IMRT allows doctors to customize the radiation
dose by modulating, or varying, the amount of
radiation dose given to different parts of the
treatment area. This modulation is done in highly
accurate, three-dimensional detail, according
to the shape, size and location of the tumor.
- Internal
radiation therapy - Radioactive material is
placed in the body near the cancer cells (also
called implant radiation or brachytherapy).
- Surgery - Surgical alternatives for prostate
cancer include a procedure called radical prostatectomy,
which is removal of the prostate gland. Pelvic lymph
nodes may also be removed if the cancer has spread
to this region. Prostatectomy is performed under general
anesthesia and requires a brief hospital stay. Patients
are sent home with a urinary catheter, which is usually
removed a few weeks after surgery.
Surgery and radiation are time-tested treatments often
used in combination or independently. These are excellent
options for younger men, those with a life expectancy
of at least 10 years, and healthy men who can tolerate
treatment side effects and the recovery process.
