There
are usually no specific signs or symptoms of
early prostate cancer. That is why prostate screening
is so important. An annual physical examination,
prostate-specific antigen (PSA) blood test, and
digital rectal exam (DRE) provide the best chance
of identifying prostate cancer in its earliest
stages.
Prostate
Cancer Screening Guidelines
- Beginning at age 50, men should undergo
both the digital rectal examination (DRE)
and prostate-specific antigen (PSA) blood
test annually.
- Testing should begin at age 45 for African
American men and those who have had a first
degree relative diagnosed with prostate cancer
at an early age.
- Testing may begin at age 40 for men at extremely
high risk due to multiple first degree relatives
diagnosed with prostate cancer at an early
age.
What
are the symptoms of prostate cancer?
The following are the most common symptoms of
prostate cancer. However, each individual may
experience symptoms differently. Symptoms may
include:
- weak or interrupted flow of urine
- urinating often (especially at night)
- difficulty urinating or holding back urine
- inability to urinate
- pain or burning when urinating
- blood in the urine or semen
- nagging pain in the back, hips, or pelvis
- difficulty having an erection
The symptoms of prostate cancer may resemble
other conditions or medical problems. Always
consult your physician for a diagnosis.
As a man gets older, his prostate may grow bigger
and obstruct the flow of urine, or interfere
with sexual function. An enlarged prostate gland
- a condition called benign prostatic
hyperplasia - may require treatment
with medicine or surgery to relieve symptoms.
This common benign prostate condition, which
is not cancer, can cause many of the same symptoms
as prostate cancer.
What are
risk factors for prostate cancer?
In general, all men are at risk for prostate
cancer. However, there are specific risk factors
that increase the likelihood that certain men
will develop the disease, including the following:
- Age- Age is a risk factor
for prostate cancer, especially men age 50
and older. More than 60 percent of all prostate
cancers are diagnosed in men over the age
of 65.
- Race- Prostate cancer is
nearly 70 percent more common among African-American
men than it is among Caucasian-American men.
Japanese and Chinese men native to their country
have the lowest rates of prostate cancer. Interestingly,
when Chinese and Japanese men immigrate to
the US, they have an increased risk and mortality
rate from prostate cancer, when compared to
their native populations. In Japan, the incidence
of prostate cancer has increased as Western
diets and lifestyles have been adopted.
- Diet- Epidemiological
data suggests that the diet consumed in Western
industrialized countries may be one of the
most important contributory factors for developing
prostate cancer. Studies suggest that men
who eat a high-fat diet may have a greater
chance of developing prostate cancer.
- Obesity- Obesity not only
contributes to diabetes and high cholesterol,
but has also been associated with some common
cancers, including hormone-dependent tumors
such as prostate, breast, and ovarian cancer.
- Environmental exposures-
Some studies show an increased chance for prostate
cancer in men who are farmers, or those exposed
to the metal cadmium while making batteries,
welding, or electroplating. Additional research
is needed in this area to confirm whether this
is a true association.
- Having a vasectomy, BPH (benign
prostatic hyperplasia), or
STD (sexually transmitted disease)-
Researchers have looked at whether men who
have had a vasectomy, BPH, or those who have
been exposed to a sexually transmitted disease
are at increased risk for prostate cancer.
Some studies suggest a link, while others
do not support these claims.
- Family history of prostate cancer-
Having a father or brother with prostate cancer
doubles or triples a man's risk of developing
this disease. The risk is even higher for men
with several affected relatives, particularly
if the relatives were young at the time of
diagnosis.
- Genetic factors- Approximately
5 percent to 10 percent of all prostate cancers
and 45 percent of cases in men younger than
age 55 can be attributed to a cancer susceptibility
gene that is inherited as a dominant trait
(from parent to child).
What
is staging of prostate cancer?
When prostate cancer is diagnosed, tests will
be performed to determine how much cancer is
present, and if the cancer has spread from the
prostate to other parts of the body. This is
called staging, and is an important step toward
planning a treatment program.
The Gleason score, a system of grading prostate
cancer tissue based on how it looks under a microscope,
is the most common grading system for prostate
cancer used in the United States. Gleason scores
range from 2 to 10 and indicate how likely it
is that a tumor will spread. A low Gleason score
means the cancer tissue is similar to normal
prostate tissue and the tumor is less likely
to spread; a high Gleason score means the cancer
tissue is very abnormal and the tumor is more
likely to spread. The Gleason grading system
allows patients with similar tumors to be compared
in studies and provides useful information for
patient treatment options.
What
are the different stages of prostate cancer?
As defined by the National Cancer Institute
(NCI), the stages of prostate cancer include
the following:
Stage I (sometimes referred
to as Stage A)
- tumor cells are found in less than 5 percent
of prostate tissue removed, and the cells
are not very aggressive in nature
Stage II (sometimes referred
to as Stage B)
- tumor cells are found in less than 5 percent
of prostate tissue removed, and the cells
are more aggressive in nature
or
- the tumor is larger in size, but is confined
to the prostate gland
Stage III (sometimes referred
to as Stage C)
- the tumor has grown through the capsule
which surrounds the prostate gland, and may
involve seminal vesicles (tubes that carry
sperm)
Stage IV (sometimes referred
to as Stage D1 or D2)
- the tumor has spread to other structures
beyond the seminal vesicles to any other
organ or structure
Recurrent (sometimes referred
to as Stage D3)
- the cancer has come back (recurred) after
treatment; it may recur in the prostate or
in another part of the body
How
is prostate cancer diagnosed?
A tissue sample of the prostate must be sent
to the laboratory for a definitive diagnosis.
In addition to the digital rectal examination
(DRE) and PSA (prostate-specific antigen) blood
test, diagnostic procedures may include the following:
- transrectal ultrasound (TRUS) -
a test using sound wave echoes to create
an image of the prostate gland to visually
inspect for abnormal conditions such as gland
enlargement, nodules, penetration of tumor
through capsule of the gland, and/or invasion
of seminal vesicles; may also be used for
guidance of needle biopsies of the prostate
gland and/or guiding the nitrogen probes
in cryosurgery.
- computed tomography scan (also
called a CT or CAT scan) - a diagnostic
imaging procedure that uses a combination
of x-rays and computer technology to produce
cross-sectional images (often called slices),
both horizontally and vertically, of the
body. A CT scan shows detailed images of
any part of the body, including the bones,
muscles, fat, and organs. CT scans are more
detailed than general x-rays.
- magnetic resonance imaging (MRI) -
a diagnostic procedure that uses a combination
of large magnets, radiofrequencies, and a computer
to produce detailed images of organs and structures
within the body.
- radionuclide bone scan -
a nuclear imaging method that helps to show
whether the cancer has spread from the prostate
gland to the bones. The procedure involves
an injection of radioactive material that helps
to locate diseased bone cells throughout the
entire body, suggesting possible metastatic
cancer.
- (lymph node and/or prostate) biopsy -
a procedure in which tissue samples are removed
(with a needle or during surgery) from the
prostate for examination under a microscope,
to determine if cancer or other abnormal cells
are present. The diagnosis of cancer is confirmed
only by a biopsy.
Treatments
options for prostate Cancer:
Each patient’s course of treatment is
individualized. As no two cancers are exactly
alike, so no two courses of treatment are necessarily
alike. Treatment options for prostate cancer
include the following:
Expectant therapy is to “watch and wait”
while carefully observing and monitoring the
prostate cancer. This may be recommended if
the prostate cancer is in a very early stage,
expecially in the cases of older men with small
tumors that are expected to grow very slowly;
confined to one area of the prostate; and not
causing any symptoms or other medical problems.
The following are some of the different surgical
options used to treat prostate cancer:
 radical
prostatectomy -
an open-surgery procedure in which the
entire prostate gland and some tissue around
it are removed. This surgery involves an
incision in either the abdomen or the scrotum
area.
transurethral
resection of the prostate
(TURP) - surgery
to remove part of the prostate
gland that surrounds the
urethra by using a small
tool that is placed inside
the prostate through the
urethra. There is no incision
with this method.
cryosurgery -
a procedure that
involves killing
the cancer by freezing
the cells with
a small, metal
tool placed in
the tumor.
Radiation therapy uses high-energy rays to
stop tumors from growing. Radiation is often
used to treat prostate cancer that is still
confined to the prostate gland, or has spread
only to nearby tissue. If the disease is advanced,
radiation may be used to reduce the size of
the tumor and to provide relief from symptoms.
(more info)
External radiation from a device
such as a linear accelerator is generally given
five days a week for five to seven weeks with
an extra boost of radiation at the end of treatment.
Radiation treatments are painless and usually
last a few minutes.
Patients also may receive internal radiation therapy,
a procedure to implant small radioactive “seeds” in
or near the tumor. The seed implantation, also
called brachytherapy, is an outpatient procedure
that takes place in the operating room. The
seeds (each about the size of a grain of rice)
are placed in the prostate gland using needles
under ultrasound guidance. Patients require
only one trip to the hospital and may return
to their normal activities the following day.
The implanted seeds may be left in permanently
or may be only temporary. The seeds emit small
amounts of radiation for a period of weeks
or months.
Radiation oncologists at
Huntington Hospital have begun using a new isotope to
treat prostate cancer with radioactive seed
implantation. Huntington is the only site on
Long Island using Cesium-131, an isotope that
has a shorter half-life than Iodine-125 and
Palladium-103, which have been in use for the
past several decades.
In recognition of its successful,
high volume seed implantation program, Huntington
was selected as the only Long Island facility
to pioneer the use of Cesium-131. Its shorter
half-life means that it is not radioactive
for as long as Palladium or Iodine. As a result,
treatment is enhanced because patients receive
a higher and more evenly distributed dose of
radiation. This more intense dose of treatment
delivered over a shorter time period often
results in fewer side effects.
Produced mainly in the testicles, the male hormone
testosterone causes prostate cancer cells to
grow. Reducing testosterone levels can make the
prostate cancer shrink and become less active.
The goal of hormone therapy is to lower the level
of male hormones in the body, particularly testosterone.
Hormone therapy does not cure the cancer, and
is often used to treat persons whose cancer has
spread or recurred after treatment.
Most studies show that hormone therapy works
better if it is started early.
Hormone therapy can include orchiectomy, which
is surgery to remove the testicles. The most
common type of hormone therapy uses injections
of lutenizing hormone releasing hormone (LHRH)
to prevent the testicles from producing testosterone.
Because the adrenal glands also produce small
amounts of male hormones, patients also may take
an antiandrogen, a drug that blocks the effect
of any remaining male hormones.
• Possible Side Effects of Treatment
Doctors try to plan therapy to keep side effects
to a minimum but if they do occur, it is important
to contact your doctor so that they can be treated
and reduced. Although side effects vary from
person to person, they often include low blood
counts, hair loss, fatigue, and digestive problems
including loss of appetite, and nausea, vomiting
and diarrhea. Some treatments for prostate cancer
also may result in temporary or permanent incontinence
or impotence. Most side effects cease when treatment
is ended. It is extremely important that you
keep your doctor informed about side effects
so that they may be medically minimized. |
The prostate is a male sex gland about the
size of a walnut, located below the bladder
and in front of the rectum. It surrounds the
upper part of the urethra, the tube that empties
urine from the bladder. Its primary role is
to produce part of the fluid needed for ejaculation.
The prostate needs male hormones, such as testosterone,
to function.