PROSTATE CANCER

Definition: Prostate Cancer
Definition: Prostate Gland
Disorders
Symptoms
Physical Examination
PSA (Prostate Specific Antigen)
Therapies
Discomforts or Incapacities

Prostate cancer is a malignancy which develops in the prostate gland. Approximately 50% of men over 50 years old and 70% of men over 70 years old have prostate cancer. There are about 230,000 new cases of prostate cancer yearly. There are also 25,000 to 35,000 deaths directly due to prostate cancer.

The prostate gland is a small gland located beneath the urinary bladder in men. Its function is to provide nutrients and a transport mechanism for sperm. It surrounds the urethra, which is the conduit which drains urine from the bladder. The prostate gland has no other major function.

What disorders can affect the prostate gland?

1. Infection: This disorder can affect the young, middle aged, and elderly. Bacterial infections are the most common. Symptoms include pain with urination, back pain, fever, chills, and blood in the urine. Treatment usually is antibiotic therapy, and may be relatively easy, moderately difficult or difficult.
   
2. Malignancy: See below discussion.

When men approach the age of 50 years they should be advised by their physician that they are getting to the age when prostate cancer may affect them. They should be advised that a physical examination of the prostate should be part of a complete medical work-up. Also, a PSA blood test should be carried out.

A patient with prostate cancer may experience a wide range of symptoms, or no symptoms at all. Some of the symptoms include difficulty urinating, bloody urine, frequent urination, back pain (bone pain), erectile dysfunction, and other less specific problems.

The physical examination allows the physician to palpate the prostate gland through the rectum to determine prostate gland size and texture. If there are lumps (nodules) this would suggest the presence of a malignancy. Even without lumps or enlargements cancer could be present.

PSA (prostate specific antigen) is a protein found in all prostate gland cells. With abnormal growth of the prostate or with proliferation of malignant cells within or outside of the prostate, the levels of PSA in the blood stream rise. An incremental but consistent rise in PSA levels over a few months may indicate that a cancer may be present. Most authorities say that in normal men, a PSA of less than 4 ng/ml is acceptable, however, if someone has a PSA of 2ng/ml which a few months later is 4 or 5ng/ml, the rise is significant and further follow-up should be done.

When the cancer has been diagnosed by biopsy, the next step the physician takes is the staging procedure. This entails testing to see if the cancer is confined to the prostate or has spread to other organs. This can usually be accomplished by certain blood chemistry tests, nuclear scans, and x-ray procedures.

When prostate cancer is diagnosed and accurately staged there are a few acceptable routes to take:

1. Watchful waiting: This treatment plan should be reserved for those patients who have significant additional illness which could compromise the safety of the patient if surgery is to be undertaken. It should not be used if the patient is otherwise healthy and relatively young. By waiting too long the prostate cancer cells might invade beyond the prostate into other organs, making it much more difficult to treat, and many times impossible to cure.
   
2. Brachytherapy: Recently, urologists and radiation therapy physicians have added this procedure as an acceptable alternative to surgery for prostate cancer confined to the prostate. It involves instilling multiple radioactive “seeds” into the substance of the gland, and allowing them to remain inside the gland. These “seeds” emit radioactivity which “kills” the malignant cells. Cures can be achieved with this procedure.
   
3. Radical prostatectomy: This is a fairly major surgical procedure requiring the removal of the entire prostate gland, seminal vesicles and adjacent lymph nodes. If the cancer is confined to the prostate, then there can likely be a complete cure of the cancer.
   
4. Other therapies:

• Hormone therapy: This may be combined with other therapies if the cancer has spread. The hormones involved are those that work against the male hormones (androgens).
  
• External beam radiation therapy (EBRT): This radiation procedure can be used when the cancer is confined to the prostate, but more frequently is used when it has spread to bone and may result in fractures in weight-bearing areas.
  
• Cryotherapies: This category of therapies presently is considered experimental.

As with all therapies for major diseases, the treatments may result in loss of some functions which can result in discomforts or incapacities. Erectile dysfunction (ED), urinary incontinence, and possibly other morbidities may result. The urologist can be of help in treating these conditions. When selecting the appropriate treatments, we all must weigh the risks and the benefits of each treatment.

When confronted with the possibility of the presence of a malignancy of the prostate, the patient must seek out a reputable urologist to provide expert counseling so the patient can wisely select the best procedure(s) to obtain the best results.

W. A. Boade, MD
12.20.04

These articles are intended for informational purposes only and should not be used to make diagnosis of any condition. We encourage you to seek examination and treatment by your trained health professional