Prostate Cancer

Overview

Prostate is a walnut sized gland in men, located just beneath the urinary bladder and surrounding the initial part of urethra. The prostate gland undergoes many changes with age, the commonest of which is a non-cancerous increase in size. But chances of prostate cancer also increase with age. At present, prostate cancer is the most common cancer diagnosed in men in the United States. It is estimated that every 1 in 6 men above 50 years will be affected by prostate cancer in his lifetime.

Symptoms of Prostate Cancer

Early stage prostate cancer does not produce any symptoms. It is mostly diagnosed on prostate cancer screening through a PSA (prostate specific antigen) blood test or a digital rectal examination (DRE). Symptoms of advanced prostate cancer that has spread to the bones or nearby structures such as the bladder include:

 

  • Dull pain in the lower pelvic area
  • Persistent bone pain
  • Anemia and weight loss
  • Cancer extending into the bladder may cause:
  • frequent urination
  • inability to pass urine
  • pain on urination
  • weakened urine flow
  • blood in the urine or semen
  • painful ejaculation
  • A large tumor or enlarged lymph nodes can compress the ureters resulting in backup of urine in the kidneys (hydronephrosis) and renal failure, though such cases are now uncommon.  

Risk Factors for Prostate Cancer

The three important risk factors for prostate cancer are:

 

  • Age:  Men over the age of 50 (40 if they are African-American ) have a higher risk of developing prostate cancer. Ninety-five percent cases are diagnosed between the ages of 45-89.
  • Race: African-American men are at higher risk than Caucasians. Asians are at the lowest risk.
  • Genetics: History of prostate cancer in a first-degree relative puts you  at greater risk of developing the disease.

Some other risk factors thought to be associated with prostate cancer are:

  • Smoking
  • More red meat and high-fat dairy in diet
  • Low fruit and vegetable consumption
  • Undergoing vasectomy, but the connection is not proven

Diagnosis of Prostate cancer

  • The best way to detect early stage prostate cancer is a PSA (prostate specific antigen) blood tests and a digital rectal exam (DRE). Some authorities recommend annual screening beginning at age 50 in Caucasian and Asian men and from age 40 in African-American men or men with a positive family history of prostate cancer.
  • PSA Tests: PSA is a protein produced by prostate cells, which can be detected in the blood. It may be elevated because of prostate cancer, benign prostate enlargement, or chronic prostate inflammation. Your urologists can tell using some more refined PSA test measures whether further testing for cancer is necessary.
  • Digital Rectal Exam (DRE): A physician assesses the prostate gland through the rectal wall. Cancers are felt as a firm, hard, asymmetrical or stony growth.
  • Transrectal Ultrasound and Prostate Biopsy: Diagnosis of prostate cancer can be confirmed on an ultrasound and biopsy. Prostate ultrasound is done by inserting a probe into the rectum. A biopsy needle is inserted along the ultrasound probe and a sample of prostate tissue is removed for diagnosis.This procedure is done under local anesthesia in the office and takes approximately 15 minutes.

Treatment of Prostate cancer

Treatment for prostate cancer depends on the extent of disease, patient’s age at the time of diagnosis and other coexisting conditions.

 

  • Expectant management: Because cancer treatment has many risks and side effects, wait-and-watch is a reasonable approach in some patients with prostate cancer. For example:
  • Patients more than 75 years of age with a localized prostate cancer that is not producing any symptoms.
  • Patients with other serious diseases because of which they are unlikely to live for more than 5 years.

In such cases it is important that a patient clearly understand his options and the risks and benefits involved. Regular follow-up with repeat PSA levels to detect any rapid changes in the tumor is recommended.

  • Surgery: Complete removal of the prostate gland (radical prostatectomy) in early stages prevents the cancer from spreading. It may be performed as an open procedure or robotically (da Vinci robotic prostatectomy). The main drawback with radical prostatectomy is loss of urinary control and erection, though they can be preserved in a large number of cases depending on the technique used, age of the patient, preoperative erectile function, extent of the tumor and the surgeon’s expertise.
  • Radiation Therapy: Radiation may be delivered by an external tube or permanent implants in the prostate (brachytherapy). Brachytherapy can deliver high doses of radiation with minimum side effects.
  • Hormone Therapy: It works by stopping the production of testosterone in the body. It is very helpful in advanced or metastatic prostate cancer or to improve outcomes for men undergoing radiation therapy.
  • Cryosurgery: It is a new technique that involves freezing the prostate using several percutaneous probes. The long-term efficacy of the procedure is not known.
  • Immunotherapy (Provenge): It is a FDA approved therapy for men with advanced stage prostate cancer that does not respond to hormone therapy. It uses cells from a patient’s own immune system with a protein that produces an immune response to prostate cancer.
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