Prostate cancer is the most common type of cancer in men, with more than 200,000 new cases diagnosed each year. At about 40,000 deaths per year, it is the second leading cause of death from cancer in men. Men with a family history of prostate cancer and African American men are at a higher risk for getting prostate cancer. Prostate cancer tends to be more aggressive in African American men.
Signs and symptoms
Early prostate cancer seldom causes any noticeable changes in urinary habits. Most men with early prostate cancer may not even know they have it. If the cancer does produce symptoms, they may be similar to those for benign prostatic hyperplasia (BPH)--frequent nighttime urination; a weak urinary stream; strong urges to urinate. Some symptoms are unique to advanced prostate cancer, such as bone pain, which happens if the cancer has spread to the bones.
The American Urological Association (AUA) recommends that beginning at age 50 (age 40 if there is a family history of prostate cancer), men undergo a yearly PSA check and digital rectal exam (DRE).
PSA level is determined by a blood test that can detect prostate cancer before there are any symptoms. The digital rectal exam allows the doctor to examine the prostate through the rectal wall, feeling for areas of hardness. Your urologist may order a free PSA to help improve the accuracy of the PSA test.
It has been shown that PSA testing can lead to detecting prostate cancer at a stage when it is more likely to be cured, and that prostate cancer treatment can lengthen life; however, there is disagreement in the medical community regarding PSA testing. Most urologists feel that prostate cancer should be diagnosed early and treated aggressively. One should discuss the specific risks and benefits of prostate cancer detection with his doctor.
If the digital rectal exam or the PSA is abnormal, and the man has a life expectancy of greater than ten years, the urologist will recommend a prostate biopsy. Using ultrasound and a needle, several samples are taken from the prostate through the rectal wall from both standard locations and from areas that look suspicious. The biopsies are evaluated to determine how aggressive the prostate cancer might be. The cancer is rated using a scale ranging from 2 to 10 (2 is the least aggressive, 10 is the most aggressive). The urologist may also decide to obtain a CT scan of the pelvis, an MRI, or a bone scan. These tests evaluate whether the prostate cancer has spread to any areas outside the prostate.
Treatment depends upon many factors: results of the biopsy, whether or not lymph nodes or bone are involved, the patient's general health, and the patient's preference for treatment. At present, there is no chemotherapy regimen that has been shown to be effective in treating early prostate cancer. The three basic treatment options are:
- Hormonal therapy (androgen deprivation) is used to either shrink prostate before radiation or surgery, or to slow the progression of cancer that remains following radiation or surgery. Possible side effects of androgen deprivation therapy include hot flashes, loss of sex drive, loss of facial hair, breast enlargement, decrease in muscle strength, and osteoporosis (if used for many years). Androgen deprivation can also be achieved by orchiectomy (surgical removal of both testicles) since the testicles are the main producers of androgen.
- Radiation therapy can be performed by x-rays (proton), or by "seeds" that are implanted in the prostate. Side effects of radiation therapy may include: skin irritation, rectal irritation, urinary urgency and frequency, and impotence. If radiation therapy fails, surgery could be performed which removes the prostate gland, or the gland can be treated by cryotherapy or freezing.
- Surgery to attempt to cure prostate cancer is called a prostatectomy. The prostate, the seminal vesicles (which lay along the side of the prostate), and possibly the pelvic lymph nodes are removed. Side effects may include impotence, loss of urinary control, and scarring which causes restricted urine flow.
A minimally invasive prostate cancer surgery (robotic prostatectomy) is now availabe, most patients are able to go home the next day. No treatment can guarantee that all of the cancer has been destroyed or removed. It is believed by most prostate cancer specialists that radical prostatectomy offers the greatest chance of long-term cure.