Prostate Cancer

The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Cancer that grows in the prostate gland is called prostate cancer. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes.

Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer.

Prostate cancer staging

Prostate cancers are grouped according to how quickly they spread and how different they are from the surrounding prostate tissue. This is called staging. According to the A-B-C-D staging system or the Whitmore-Jewett system:
• Stage A: Tumor is not felt on physical examination, and is usually detected by accident after prostate surgery is done for other reasons.
• Stage B: Tumor is only in the prostate and usually detected during a physical exam or with a blood test (PSA test).
• Stage C: Tumor has spread beyond the prostate but is not in the lymph nodes.
• Stage D: Tumor has spread (metastasized) to lymph nodes or other parts of the body, such as the bone and lungs.

This system also contains several substages.

Symptoms

Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms. While most of the symptoms listed below can be associated with prostate cancer, they are more likely to be associated with non-cancerous conditions.
• Urinary hesitancy (delayed or slowed start of urinary stream)
• Urinary dribbling, especially immediately after urinating
• Urinary retention
• Pain with urination
• Pain with ejaculation
• Lower back pain
• Pain with bowel movement

Screening

You should contact your healthcare provider if you are a man older than 50 and have:
• Never been screened for prostate cancer (by rectal exam and PSA level determination)
• Not had regular, annual exams
• A family history of prostate cancer

Diagnosis

A rectal exam often reveals an enlarged prostate with a hard, irregular surface. A number of tests may be done to confirm the diagnosis of prostate cancer. Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test.

• PSA (prostate specific antigen) test may be high, although non-cancerous enlargement of the prostate can also increase PSA levels. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope.
• Free PSA may help tell the difference between benign prostatic hyperplasia (BPH) and prostate cancer.
• Urinalysis may show blood in the urine.
• Urine or prostatic fluid cytology may reveal unusual cells.
• Prostate biopsy confirms the diagnosis.
• CT scans may be done to see if the cancer has spread.
• Chest X-rays and bone scans may be performed to determine whether prostate cancer has spread.
• A newer test called AMACR is more sensitive for determining the presence of prostate cancer than the PSA test.

Treatments

The appropriate treatment of prostate cancer is often controversial. Treatment options vary based on the stage of the tumor. In the early stages, surgery and radiation therapy may be used to remove or kill the tumor.

Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy. Other treatments include radiation therapy, hormonal therapy, proton therapy, cryosurgery, or some combination of these. Some of these treatment options are discussed below.

• Surgery: Surgery is usually only recommended after thorough evaluation and discussion of all treatment options. You should discuss the benefits and risks of the procedure with your urologist. Removal of prostate gland (radical prostatectomy) is often recommended for treatment of stage A and B prostate cancers. A second surgical procedure used is called orchiectomy. Orchiectomy alters hormone production and may be recommended for metastatic cancer.

• Radiation therapy: Radiation therapy is used primarily to treat prostate cancers classified as stages A, B, or C. Whether radiation is as good as prostate removal is a debatable topic, and the decision about which to choose can be difficult. In patients whose health makes the risk of surgery unacceptably high, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal. Radiation is sometimes used for pain relief when cancer has spread to the bone.

• Medications: Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Since prostate tumors require testosterone to grow, reducing the testosterone level often works very well in preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. Hormone manipulation may also be done by surgically removing the testes.

Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.

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