Prostate Cancer

Prostate cancer at a glance

• Prostate cancer occurs when cells grow out of control in the prostate and become cancerous, possibly forming tumors.
• Cancer of the prostate, the male’s gland that produces some of the seminal fluid that carries sperm in ejaculation, is the second most common cancer among American men, according to the National Cancer Institute.
• Prostate cancer grows slowly and is associated with age, as most men with the cancer are over age 65.
• Early stage prostate cancer can show no symptoms, and the main symptoms of advanced stage cancers are difficulties urinating, blood in urine and frequent urges to urinate.
• Treatment options include surveillance (“watchful waiting”), radiation, chemotherapy and hormone therapy.

What is prostate cancer?

Prostate cancer happens when cells in the prostate grow uncontrollably and mutate. Depending on the type of prostate cancer, it may grow very slowly or quite rapidly. The prostate gland is located under the male bladder and in front of the rectum.

Women do not have prostate glands. The prostate, which becomes larger with age, generates part of the fluid that makes up the semen that transports sperm for female fertilization.

Prostate cancer most often develops in the gland cells that produce the seminal fluid. This kind of cancer is called an adenocarcinoma, which is by far the most common type of prostate cancer. Other more rare types of prostate cancer are small cell carcinomas, sarcomas, transitional cell carcinomas and neuroendocrine tumors.

Prostate cancer is the second most common cancer among American men, with non-melanoma skin cancer being the most common. Prostate cancer is the third leading cause of cancer-related deaths overall, and according to the American Cancer Society (ACS), an American man has about a 1 in 9 chance of getting prostate cancer at some time.

The majority of cases happen to men older than 50, with 6 out of 10 diagnosed cases occurring in men over age 65. Average age of diagnosis is 66, and the disease rarely occurs in men under age 40.

Even though it is the second most common form of cancer death in men, most men who get prostate cancer do not die from it, partly because most prostate cancers grow very slowly and men tend to get it late in life.

A steady increase in widespread screening for prostate cancer by men has resulted in the majority of new prostate cancers being found early when they haven’t spread beyond the prostate gland. This has led to a reduction in prostate cancer-related deaths.

Causes of prostate cancer

Oncologists don’t know what causes prostate cancer, much like they don’t what causes most forms of cancer. But they have identified a number of risk factors for getting prostate cancer.

• Age – Average age at diagnosis is 66 and the chance of getting the disease increases quickly after age 50.
• Race – African-American men get prostate cancer more often than Caucasian men, as do Jamaicans of African heritage. Hispanic and Asian men are at less risk than Caucasians.
• Family history – The chance of getting prostate cancer doubles if a man’s father or brother has had prostate cancer. The risk increases if several relatives have had prostate cancer.
• Geographic location – Prostate cancer is less common in Africa, Asia and South and Central America but more common in North America, the Caribbean, Europe and Australia.
• Lifestyle – Dietary risks are unclear but it appears that men consuming a high-fat diet, including a lot of red meat but low in fruits and vegetables, may increase a man’s risk. Obesity, smoking, certain chemical exposures and sexually transmitted infections also contribute to increased risks.
• Genes – Mutations in the BRCA1 and BRCA2 genes increase a man’s risk for prostate cancer, as does having Lynch syndrome, but genetic causes don’t account for many cases overall.

Having a risk factor, or several, does not mean a person will get prostate cancer. In numerous cases people with one or more risk factors never get cancer. While in other cases, those who get cancer may have had no known risk factors.

Screening and diagnosis of prostate cancer

Prostate cancer can often be found early by prostate screening, which is testing to find cancer in patients before symptoms are present. Screening, such as the prostate-specific antigen (PSA) evaluation, can detect the cancer at an early stage when it is more likely to respond to treatment. A detailed explanation of screening & diagnosis of prostate cancer can be found by clicking the button below.
Prostate Cancer Screening & Diagnosis

Symptoms of prostate cancer

Usually, prostate cancer at an early stage of development does not present any symptoms. When symptoms are present, most often due to later stage cancer, they include the following:

• Urination issues, such as frequently needing to go (particularly at night), weak urine stream, slow flow and pain during urination
• Blood may appear in semen or in urine
• Pain in the pelvis, back or hips resulting from cancer that has spread to bones
• Numbness or weakness in the feet or legs
• Loss of bowel or bladder control when the cancer presses against the spinal cord.

Note that theses symptoms are also present with benign prostatic hyperplasia (BPH), also known as an enlarged prostate.

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Treatment of prostate cancer

Once prostate cancer has been diagnosed (see link above), oncologists can choose from several treatment options. It’s important to think carefully about each choice and weigh the benefits of each treatment against the possible risks and side effects. Common treatment options follow.

Watchful waiting

This may be recommended if the prostate cancer grows slowly and if the man is older and/or has other serious health problems.

Surgery

This is the most common treatment option if the cancer has not spread to other parts of the body (metastasized). A radical prostatectomy is the main surgical treatment, which removes the prostate gland plus the surrounding tissue. This type of surgery can be done in the following different ways.

• Retropubic prostatectomy – under general or spinal anesthesia, a small incision is made in the lower abdomen from the belly button to the pubic bone. A catheter is inserted in the penis to drain the bladder and stays in place for one to two weeks while the incision heals. The man is able to urinate on his own after the catheter is removed.
• Perineal prostatectomy – under general or spinal anesthesia, an incision is made between the scrotum and anus. This procedure usually involves a quicker recovery time and is less painful than a retropubic surgery. Similar to a retropubic surgery, a catheter is placed in the penis for one to two weeks and removed after the incision is healed. Surgeons perform a perineal prostatectomy less often due to a higher risk of erection problems as a side effect.
• Laparoscopic prostatectomy – makes several small incisions through which a tube with a camera is inserted, allowing the surgeon to view the area as he or she uses long surgical tools to remove the prostate. In robotic laparoscopic prostatectomy, the surgeon can use a control panel to move robotic arms that hold the tools or use the tools directly. The benefits of laparoscopic surgery are less blood loss and a shorter hospital stay.

Risks and side effects of any type of prostatectomy include blood clots in the lungs, damage to nearby organs, infections at the site of surgery and reactions to the anesthesia. Men might also experience urinary incontinence or erectile dysfunction as a side effect.

Radiation therapy

This is often used for cancer that is still just in the prostate gland. It may also be used in conjunction with other treatments on cancer that has grown outside of the prostate. The two main types of radiation therapy are external beam radiation and internal radiation (brachytherapy).

External radiation focuses the beam on the prostate gland from outside the body with a machine, whereas internal radiation uses small radioactive “seeds” placed directly into the prostate that give off certain amounts of radiation for weeks or months.

Risks and side effects of radiation therapy include tiredness, rectal irritation such as uncomfortable urination or bowel incontinence, dry skin, hair loss and urinary problems such as incontinence or frequent urination.

Cryotherapy

Oncologists often treat early-stage cancer with cryotherapy. Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells, inserting hollow needles that inject a gas that freezes the prostate cells. Cryotherapy is considered a less invasive surgery, but includes side effects such as blood in urine for a day or two, soreness and erectile dysfunction.

Hormone therapy

This is often used to reduce the level of male hormones (androgens) if the prostate cancer has spread too far to be cured by surgery or radiation. Types of hormonal therapy include surgical castration, which reduces hormone production, and several kinds of medications that act on hormone levels.

Some side effects of hormone therapy include erectile dysfunction, hot flashes, weight gain, fatigue, depression or anemia (low red blood cell count).

Chemotherapy

Chemo involves various anti-cancer drugs that are injected into a vein or taken by mouth. The drugs attack cells that are dividing quickly, which is why they work against cancer cells. This treatment is often used if hormone therapy doesn’t work and if the cancer has spread to distant organs. Because other cells in the body divide quickly, such as cells in the bone marrow, lining of the mouth and intestines, and hair follicles, these cells can also be affected by chemo. Side effects can include mouth sores, diarrhea, hair loss, nausea and fatigue.

These treatments are usually done one at a time, but in some cases can be combined. Oncologists and patients should discuss these options.

Clinical Trials

Clinical trials are research studies that help physicians find new, promising treatments and procedures for patients. They offer access to a newer, state-of-the art treatment option. But they may not be the best choice for everyone.

Patients interested in a clinical trial should discuss possible options with their doctor. California Cancer Associates for Research and Excellence have ongoing clinical trials for different types of cancers.