Prostate Cancer

Prostate cancer is the most common cancer in men.  One in nine men will experience prostate cancer during their life.  However, most men survive prostate cancer (40 out of 41 men survive prostate cancer).  Most cases of prostate cancer occur in the older years.  Prostate cancer is rare in men under 40.  In fact, more than half of all prostate cancers are diagnosed in men over 65 years of age. [i] 

A whole host of ideas have been put forth as to what increases the risk of prostate cancer.  These have ranged from past history of prostatitis, sexually transmitted infections, vasectomies, chemical exposures, and in addition to other potential causes.  There has often been conflicting results in studies with some showing an increased risk of prostate cancers and others not showing prostate cancer.  This could be due to the fact that so many men get prostate cancer that it can be hard to determine if something caused the cancer other than simply being male and having a prostate.  However, a family history of prostate cancer has been linked to the risk of developing prostate cancer.  So know your family history of prostate cancer (father, grandfathers, brothers, uncles). 

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SYMPTOMS

Prostate cancer symptoms mimic symptoms of other disorders and ailments.  The following symptoms are outlined by the American Cancer Society:

  • Problems urinating (symptoms similar to BPH)

  • Blood in the urine or semen (red/pink semen)

  • Erectile dysfunction

  • Weakness/numbness in the legs

  • Pain in the bones

 

However, these symptoms are found in other common disorders in men so most often, they do not indicate cancer.  At the same time, these symptoms can be dismissed too easily.  This is why an annual physical by a healthcare provider is so important.  They can run blood test such as a PSA (prostate specific antigen) that can indicate cancer.  They can also perform a digital rectal exam to feel the prostate since cancer in the prostate can sometimes be felt as nodules within the prostate on physical exam.

 

Survival from prostate cncer is very high – 99%.  In fact, in men whose prostate

cancer is confined to the prostate or the nearby tissues, the survival rate is nearly 100%.  However, if the cancer spreads to other areas of the body, the survival rate drops to 29%.  So catching prostate cancer early is critical.

 

Main reasons why men often don’t seek treatment are often because they mistake their symptoms for other disorders or the fact that they don’t want to have a physical exam.  Not seeing a provider can increase the chances of not surviving prostate cancer since untreated cancers are more likely to spread.

 

 

DIAGNOSIS

If a patient has a high PSA or abnormal finding on a digital rectal exam, then diagnostic tests can be performed.  Diagnosis is often made by performing a prostate biopsy.  A biopsy involves collecting samples of prostate tissue through rectum with a small needle.  This is a procedure that can be performed in a clinic and does not require sedation (see below).  Imaging scans such as a CT, MRI, or bone scan can be used to look for the spread of the cancer.

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TREATMENT

Treatments vary depending on the type and stage of cancer.  In some mild cases, simply watching and waiting by performing regular monitoring is felt to be the best option for some men.  Since prostate cancers grow slowly, a fairly small cancer confined to the prostate may simply be “watched” and monitored regularly to track its growth.  Medical or other treatments are then added when necessary.

The first medication treatment is often focused around reducing testosterone levels and is called hormone therapy.  In most prostate cancers, testosterone actually “tells” cancer cells to grow.  Reducing testosterone levels decreases the growth and spread of prostate cancers.  A common drug used is called leuprolide.  This medication is a gonandotropin releasing hormone agent (GnRH).  It tricks the pituitary gland into not sending chemical signals to the testicles to make testosterone.  So when the testicles stop making testosterone, then testosterone levels drop and prostate cancer growth slows.  For some men, GnRH agents may not sufficiently reduce testosterone levels, so testosterone blocking medications can be used.

Other medication treatments can involve chemotherapy or biologic therapy to help reduce the size or eradicate the cancer.  The type of chemotherapy depends upon the type of prostate cancer as well as how far the cancer has spread.  It can also depend on the side effects of these medications and the individual outcomes a clinician and patient want to achieve.

 

Other therapies can include some of the following:

  • Radiation therapy can also be used to target cancer tissues. 

  • Cryotherapy, where very cold temperatures are used to kill cancer cells in the prostate.

  • Vaccine treatment can help the immune system attack the prostate cancer cells

  • Surgery to remove the prostate or affected lymph nodes can also be performed.

 

Early detection through by having an annual physical and blood tests can help catch prostate cancer early.  The earlier prostate cancer is caught, the less invasive cancer treatments tend to be.

[i] The information and statistics in this chapter were based on information gathered from the American Cancer Society website at www. cancer.org/cancer/prostate-cancer (last viewed 2/2/19).

Images on this page from top to bottom include:

  1. Kateryna Kon/Shutterstock.com

  2. Rumruay/Shutterstock.com