Prostate Cancer

Prostate cancer is the second-leading cause of cancer deaths among men in the United States. Each year, more than 200,000 men are affected by this disease. Fortunately, most prostate cancers are slow growing and when detected at an early stage most can be cured. It is estimated that 99% of men diagnosed with localized or regional prostate cancer survive at least five years, while only 33% of those with metastases at diagnosis survive 5 years. These statistics highlight the need for regular screening for prostate cancer in order to identify it early.

Risk Factors

Factors that may increase your risk of prostate cancer include:

  • Family history - having a brother, father, grandfather, son or cousin with prostate cancer
  • Age - 90% of prostate cancers are diagnosed in men 50 and older
  • Race - African Americans are at greater risk
  • Diet and lifestyle - obesity and/or a diet high in saturated fats, sugar and red meat

Please note that an enlarged prostate (benign prostatic hyperplasia or BPH) does not increase your risk of prostate cancer.

Symptoms and Screening

Early stage prostate cancer often has no warning signs, making regular screening tests such as PSA (prostate specific antigen) and digital rectal exams (DRE) critically important. While urinary symptoms such as weakened urinary stream or frequency are often associated with BPH, they may also be caused by prostate cancer.

During the DRE, your physician will insert a gloved finger into your rectum to feel the size, shape and texture of your prostate. The PSA test determines the level of PSA in a blood sample; high levels may indicate prostate cancer, an enlarged prostate, or prostate infection. It is important to note that men with normal levels of PSA also may have prostate cancer.

These tests are recommended yearly for all Caucasian men starting at age 50; African American men and anyone with a family history should be tested yearly starting at age 40. Many urologists recommend that even men without risk factors get a baseline PSA at age 40 to 45.

Diagnosis and Staging

Following a thorough history and physical examination, your doctor will need to perform a biopsy of the prostate. This is done in the office by placing a probe in the rectum and using Lidocaine to numb the area around the prostate. Under ultrasound guidance, a special needle is then used to take small slivers of tissue from the prostate. If cancer is found, one or more of the following tests may be ordered:

  • CT Scan or MRI
  • Chest X-ray
  • Bone scan

Your cancer will be assigned a grade (called a “Gleason Score") that helps your doctor predict how the cancer may progress. Your initial PSA level will also factor into the risk of disease progression and recurrence. In its early stages (T1 and T2), prostate cancer is usually confined to the prostate itself. As the cancer advances, it may move outside the prostate to surrounding tissues, lymph nodes, bones or other parts of the body (Stage T3 or T4). You can read more about prostate cancer staging here.

Treatment

Treatment will depend on a number of factors, including your age, overall health, and the extent to which the cancer has spread. When appropriate, your urologist will collaborate with other specialized doctors to provide one or more of the following:

Surgery - the entire prostate is removed including the seminal vesicles and usually the pelvic lymph nodes. The surgery is usually performed laparoscopically, where several small incisions replace one larger one. This results in less pain, less blood loss, and a faster recovery.

Robotic-Assisted Laparoscopic Prostatectomy (RALP) a robot is used to assist the surgeon by translating his or her hand movements into smaller, more precise movements of tiny instruments inside the body, taking surgery beyond the limits of the human hand.

Radical Retropubic Prostatectomy (RRP) – the traditional approach to removing the prostate and through a larger incision made from the belly button to the pubic bone. With the advent of robotic and laparoscopic surgery, this approach is less commonly used.

Perineal Prostatectomy – in this procedure, the prostate is removed through an incision in the perineum (the area between the scrotum and rectum).

Radiation therapy - using high energy X-rays to destroy cancer cells and shrink tumors.

IMRT / IGRT – this therapy offers highly targeted radiation to maximize tumor shrinkage while minimizing damage to surrounding tissues.

Brachytherapy – small radioactive seeds are placed into prostate that emit radiation over several months to destroy cancer cells.

External Beam Radiation – radiation is delivered to the prostate and pelvis. This may also be used after removal of the prostate if the pathology is unfavorable or recurrence is found.

Hormone therapy – an injection is given to decrease production of testosterone, the male hormone that can fuel prostate cancer growth. This may be used in conjunction with other treatment options such as surgery or radiation.

Cryotherapy - freezing cancer cells to destroy them by placing a needle into the prostate and creating an “ice ball” the gland to destroy cancerous cells. This may be used as primary therapy or as salvage therapy if another treatment has failed.

Chemotherapy - sometimes recommended for men who have progressive prostate cancer or cancer that is not responding to other therapy.

Immunotherapy - medication is used to help your immune system fight cancer.

Active Surveillance – sometimes referred to as “Watchful Waiting”. This is an option for patients with early stage cancers, advanced age, or with serious unrelated health problems in which no initial treatment is given and the cancer is simply observed. As prostate cancer typically has a slow growth pattern, many men will “outlive” their prostate cancer and never require treatment. Others may be able to delay their treatment until a later time based on serial PSA values and repeat biopsy results.

Follow Up

Treatment for prostate cancer is often curative but continued surveillance is important as the cancer can recur even years after treatment. Serial PSA checks and exams may be able to detect a recurrence of cancer earlier that can be managed with follow up therapy. Too often, men assume that once the prostate is “out” (i.e. after surgery) that they no longer need to be followed. This is completely false and routine surveillance is still needed no matter what treatment option was chosen.

Urology Website Design & Medical Website Design by Vital Element, Inc.