What is Prostate Cancer?
The prostate is a walnut-sized gland that produces and stores seminal fluid. The prostate encircles the upper part of the urethra, the tube that empties urine from the bladder. Located below the bladder and in front of the rectum, this gland helps regulate both bladder control and normal sexual function. Cancer cells can form on the surface or inside the prostate gland.
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 are attributes that intensify the likelihood that an individual will develop cancer. They can include certain kinds of behavior such as smoking, genetic traits and exposure to cancer-causing agents in the environment. Some of these risk factors include:
- 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.
- Diet: Some studies suggest a link between prostate cancer and high-fat diets (especially those high in animal fat).
The importance of early detection cannot be stressed enough. Because many times there are initially no symptoms, the cancer might have spread beyond the prostate by the time a male will notice something is wrong. In turn, this makes treatment much more difficult. As a prostate tumor grows, one of the following symptoms may occur:
- Dull pain in the lower pelvic area
- Urgency of urination
- Difficulty starting urination and/or pain while urinating
- Weak urine flow and dribbling
- Frequent sensation that the bladder is full
- Frequent nighttime urination
- Blood in the urine
- Painful ejaculation
- General pain in the lower back, hips or upper thighs
- Loss of appetite and weight
- Persistent bone pain
Screening and Diagnosis
A physical examination with a general practitioner or internist every year is strongly recommended. Screening for prostate cancer should begin no later than at age 50, especially if a family history of the disease is evident. Doctors use the following methods to diagnose prostate cancer:
- PSA: This is a simple blood test that measures protein levels secreted by the prostate into the bloodstream. If the test shows an elevated PSA level, additional urologic evaluation is needed, even though it does not necessarily mean that cancer is present. 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 following step in diagnosing prostate cancer. Doctors use ultrasound-guided biopsy to collect samples from specific sites in the prostate gland.
Stages of Prostate Cancer
If a diagnosis is made, doctors perform additional tests to stage the cancer, or verify if the cancer has spread and how far. Staging helps doctors create an appropriate treatment plan for each patient.
- Stages I and II: Early prostate cancer is localized. This means that it has not spread (metastasized) outside the prostate gland.
- Stage III: The tumors have grown outside the prostate into the seminal vesicles. Doctors may describe this stage as locally advanced disease.
- Stage IV: The disease has spread to lymph nodes and possibly other tissues or organs.
Common Treatment Options
Because males have increased the frequency of screening, earlier diagnosis has increased. Therefore, breakthroughs in technology and treatment have improved survival rates for many men with prostate cancer.
Treatment plans are individually based on the stage of the cancer, age, overall health, life expectancy, and personal preferences of each patient. Before agreeing on a course of treatment, it is vital that the patient understands the risks and benefits of the different options to determine what is right for him/her. Treatment plans 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 considered to trigger the growth of cancerous cells in the prostate, similar to the way 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. Although hormonal therapy cannot cure prostate cancer, it slows the progression of the disease, shrinks the size of the tumors, or relieves 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 eliminates tumor cells by damaging their genetic material, making it impossible for these cells to continue to grow.
- Surgery: There are surgical alternatives for prostate cancer. These include a procedure called radical prostatectomy, which is removal of the prostate gland. Pelvic lymph nodes may also be discarded 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 typically removed a few weeks after surgery.
Surgery and radiation are excellent options for younger men, those with a life expectancy of at least 10 years, and healthy men who can handle the side effects of treatment and the recovery process. These are time-tested treatments often used in combination or independently.