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• Q & A

PROSTATE CANCER

• Causes
• Symptoms
• Screening
• Diagnosis
• Treatment

The prostate is a walnut-shaped gland in men that surrounds the urethra at the neck of the bladder. It makes a fluid that is part of the semen and helps regulate bladder control and sexual functioning.

Next to lung cancer, prostate cancer is the most common cancer for men. In fact, it occurs in 1 out of 6 men. Not all prostate cancers are alike. It can be very aggressive in some cases and slow growing and less harmful in others. The good news is 80% of all tumors in the prostate are diagnosed in local or regional stages. Cancers caught this early have a five-year survival rate of 100% while all stages of prostate cancer now have a 92% chance of survival.

Causes

Some men are more prone to prostate cancer because of family history, race and age. Some factors are within our control. The best method of prevention is living a healthy lifestyle and early screening.

Some risk factors include:

• 55 years old and older
• Diet high in saturated fat
• Exposure to heavy metals (e.g., cadmium)
• Race (African American)
• Sedentary lifestyle
• Smoking

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Symptoms

Many men have no symptoms at all, so early screening is crucial. If you experience any of the following symptoms, call your doctor for a more thorough examination.

• Frequent urination, especially at night
• Inability to urinate
• Pain or burning during urination
• Painful ejaculation
• Weak or interrupted urinary flow
• Nagging pain or stiffness in the back, hips, upper thighs, or pelvis

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Screening

There are two routine tests doctors use to screen for prostate cancers. Digital Rectal Examination and Prostate Specific Antigen (PSA) Test.
During a DRE, doctors use a gloved finger inserted in the rectum to feel
for lumps. The PSA is a test to determine the level of prostate specific antigen in the blood. An elevated PSA level and abnormal prostate can
be signs of the disease, but not always. Many times PSA tests produce false positive results. If the signs are there, a doctor can order a biopsy to be sure.

Annual screening should begin at age 50 for low risk men and at age 45 for those with a family history of the disease.

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Diagnosis

If screening is abnormal, a biopsy can help give more definitive answers. During this procedure, doctors insert a biopsy needle through the perineum into the tumor and use a transrectal ultrasound (TRUS) probe, inserted into the rectum, to successfully obtain a tissue sample of both healthy and cancerous cells.

Gleason score
Doctors use the Gleason grading system to determine the cancer’s potential to grow. Pathologists examine tissue samples from two
different areas of the tumor and give a score of 1 to 5 to each sample.
The sum of the two scores yields the Gleason score. A tumor that produces a low score is unlikely to spread, but a higher score suggests an aggressive tumor, that requires aggressive treatment.

Diagnostic Imaging
Doctors can also use the following imaging tests to determine the stage of prostate cancer:

• Ultrasound
• MRI to determine the extent of the tumor in the prostate or surrounding tissues
• CT scan or bone scan to determine if the cancer has spread to lymph nodes, organs or bones
• PET scan to determine the extent of the cancer and how it responds to antitestosterone agents

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Treatment

Watchful waiting
For some patients like the elderly, those in poor health and those with early stage prostate cancer, a wait and see approach is most effective. Doctors can monitor the progress of the patient and if the condition becomes problematic, the best course of action can be taken at the proper time.

Surgery
There are three types of surgery for prostate cancer.

• Cryosurgery- This minimally invasive procedure rapidly freezes the cancer cells with a small metal tool placed inside the tumor. It is recommended for elderly patients, those who can’t tolerate surgery or radiation or for those with prostate confined tumors.
• Transurethral resection of the prostate (TURP) – During this procedure, surgeons 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.
• Radical prostatectomy – During this surgery, the entire prostate gland and some tissue around it are removed. An incision is made in the abdomen or scrotum area.

Side effects from surgery
There may be serious side effects from prostate cancer surgery. Because the prostate gland and the seminal vesicles are removed during a radical prostatectomy, infertility occurs. Men who want to have children should speak with their doctor or to a sperm bank prior to surgery.

Other side effects include incontinence and impotence. Surgeons can use new nerve sparing techniques that may prevent permanent damage to the nerves that control erection or to the opening of the bladder to help men regain potency and urinary control.

Radiation Therapy
Radiation therapy uses high-energy rays to combat cancer cells and decrease their ability to divide. Radiation is usually used in early stages of the disease but in more advanced stages can be used to shrink the tumor or relieve pain.

There are two types of radiation therapy, external or internal.

Intensity Modulated Radiation Therapy is an external radiation method that uses computer-controlled x-rays to deliver precise radiation doses to a tumor or specific areas within the tumor. Treatment is carefully planned and uses 3-D computed tomography (CT) images with computerized dose calculations to precisely shape the radiation beam to the shape of the tumor. The precise nature of this measure exposes healthy tissue to less radiation.

Brachytherapy is an internal radiation method where radioactive seeds are implanted into the prostate to deliver high doses of radiation directly to the tumor. Physicians use ultrasound images to find the best location to implant the seeds. The seeds are permanent, but the radioactivity decreases over time.

High-Dose-Rate Brachytherapy is for patients with more advanced prostate cancer. This temporary form of brachytherapy sends radioactive seeds in and out of the prostate on three occasions over a day-and-a-half. It is always combined with a five to six-week course of intensity modulated radiation therapy.

Hormone Therapy
Hormone Therapy is often used for patients with recurring prostate cancer or whose cancer has spread. It doesn’t cure cancer, but it is used to block production of testosterone, which prostate cancer cells use to grow. Surgeons may surgically remove the testicles to prevent male hormones from being produced or use drugs to decrease the amount of testosterone produced. Anti-androgens can also be administered to block the body’s ability to use testosterone.

Chemotherapy
Chemotherapy uses drugs to treat cancer cells. It is used for patients whose cancer has spread and is not responding to hormone therapy,
but it is not usually a primary treatment for prostate cancer. It is not effective against early stages of the disease and has limited success in advanced stages, but it can help with pain and symptoms associated
with prostate cancer.

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