Prostate Cancer

The prostate is the gland below a man’s bladder that produces fluid for semen. Prostate cancer is the third most common cause of death from cancer in men of all ages. It is rare in men younger than 40.
Levels of a substance called prostate specific antigen (PSA) is often high in men with prostate cancer. However, PSA can also be high with other prostate conditions .Since the PSA test became common, most prostate cancers are found before they cause symptoms. Symptoms of prostate cancer may include

  • Problems passing urine, such as pain, difficulty starting or stopping the stream, or dribbling.
  • Low back pain.
  • Pain with ejaculation.

Prostate cancer treatment often depends on the stage of the cancer. How fast the cancer grows and how different it is from surrounding tissue helps determine the stage. Treatment may include surgery, radiation therapy, chemotherapy or control of hormones that affect the cancer.
Prostate cancer occurs when the cells of the prostate begin to grow uncontrollably. When caught and treated early, prostate cancer has a cure rate of over 90%.
Yet being diagnosed with prostate cancer can be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the life of the man diagnosed, but also the lives of his family members in significant ways for many years to come.

How Does a Doctor Diagnose Prostate Cancer?

Several years ago, the major way of diagnosing relatively early prostate cancer was through a digital rectal examination, in which the physician inserts a gloved finger into the rectum and feels a hard nodule on the prostate. A biopsy of the nodule would confirm the diagnosis. Sometimes the diagnosis would be made of advanced prostate cancer when the patient presented to the doctor with bone pain and further workup revealed that he had prostate cancer with spread to the bone or bone metastases already. Today, however, the diagnosis of prostate cancer is being made much earlier most of the time because of a simple blood test called the prostate specific antigen or PSA. Next week I’ll discuss the pros and cons of the PSA, another procedure called the transrectal ultrasound of the prostate, the pros and cons of biopsy of the prostate and the staging and grading of prostate cancer.

Prostate Cancer Symptoms

If the cancer is caught at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms that might indicate the presence of prostate cancer, including:

  • A need to urinate frequently, especially at night;
  • Difficulty starting urination or holding back urine;
  • Weak or interrupted flow of urine;
  • Painful or burning urination;
  • Difficulty in having an erection;
  • Painful ejaculation;
  • Blood in urine or semen; or
  • Frequent pain or stiffness in the lower back, hips, or upper thighs.

Because these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms.

Treatment

There is no “one size fits all” treatment for prostate cancer, so each man must learn as much as he can about various treatment options and, in conjunction with his physicians, make his own decision about what is best for him.
For most men, the decision will rest on a combination of clinical and psychological factors. Men diagnosed with localized prostate cancer today will likely live for many years, so any decision that is made now will likely reverberate for a long time. Careful consideration of the different options is an important first step in deciding on the best treatment course.
Consultation with all three types of prostate cancer specialists—a urologist, a radiation oncologist and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes.

  • Active Surveillance.
  • Prostatectomy (Surgery).
  • Other Surgical Procedures.
  • Radiation Therapy.
  • hormona Therapy.
  • Clemotherapy.
  • Emerging Therapies.

These three treatment are generally accepted for men with localized prostate cancer: radical prostatectomy, radiation therapy, and surveillance (also called watchful waiting).

Radical prostatectomy

Is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection.

Radiation therapy

Involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered by implanting radioactive seeds in the prostate using a needle.

Surveillance

Taking a wait-and-see approach, may be recommended for patients with early-stage prostate cancer, particularly those who are older or have other serious medical conditions. These patients have regular examinations. If there is evidence of cancer growth, active treatment may be recommended.

Risk Factors

Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:

  • Age. As you get older, your risk of prostate cancer increases. After age 50, your chance of having prostate cancer increases substantially.
  • Race or ethnicity. For reasons that aren’t well understood, African-American men have a higher risk of developing and dying of prostate cancer.
  • Family history. If a close family member — your father or brother — has prostate cancer, your risk of the disease is greater than that of the average American man.
  • Diet. A high-fat diet and obesity may increase your risk of prostate cancer. Researchers theorize that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells.
  • Surgery to become infertile (vasectomy). Although some studies suggest that men who’ve had a vasectomy are at increased risk for prostate cancer, no conclusive evidence to support such research has been found. Research on this issue is ongoing.
  • High levels of testosterone. Because testosterone naturally stimulates the growth of the prostate gland, men who have high levels of testosterone, such as those with hypogonadism or men who use testosterone therapy, are more likely to develop prostate cancer than are men who have lower levels of testosterone. Long-term testosterone treatment could cause prostate gland enlargement (benign prostatic hyperplasia). Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present.

Sources: Mayo Clinic, Prostate Cancer Foundation

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