Prostate cancer refers to the growth of abnormal (malignant or cancerous) cells in the prostate gland. The prostate gland is part of the male reproductive system. Along with other smaller glands, it produces fluid (also known as semen) that carries sperm and provides them with nutrition.
- The prostate gland is located at the base of a man's bladder. It surrounds the tube through which urine is drained to the outside of the body. It also carries semen that is released during sexual relations.
- The prostate is normally the size of a walnut. The size usually increases with age. Assuming cancer is not present, this enlargement is called benign prostatic hyperplasia (BPH). Infections or tumors can also increase the size of the prostate.
- Because of its location, an enlarged prostate can block the flow of urine from the bladder through the urethra.
- The back section of the gland is located next to the rectum. Cancer most often develops in this section.
- Nerves that control erectile function are located on both sides of the gland. These nerves can be damaged by some prostate cancer treatments.
A prostate biopsy is needed to determine if enlargement of a prostate is due to cancer or BPH.
- BPH does not increase a man's risk for prostate cancer.
- Prostate specific antigen (PSA) is a blood test that can be used to monitor the prostate.
- Although it may be used to screen for prostate cancer, PSA levels can be elevated for reasons other than prostate cancer. These reasons include BPH, a recent prostate exam, infection or sexual intercourse.
Your healthcare provider will look to see if your prostate cancer has spread to other areas of the body. This process is called “staging.” In advanced cases, prostate cancer can involve the bones and other organs.
- Metastatic prostate cancer is cancer that started in the prostate and has spread to other organs and tissues.
- In early stages of prostate cancer, it is usually not necessary to do imaging studies to check for spread of the disease. This is because the spread of prostate cancer is quite rare in early stages.
Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.
- What does the cancer look like under the microscope?
- Does the cancer invade tissues and organs outside the prostate gland?
- How large is the primary cancer in the prostate?
- Has the cancer spread to lymph glands or anywhere else in the body?
- Is the cancer associated with abnormal blood tests?
A prostatectomy is the removal of the prostate gland and surrounding tissue. It can be done through a single large incision or several small incisions in the abdomen. It is usually done when cancer is only found in the prostate gland and has not spread to other tissues. There are four different ways the prostate gland can be removed. Which type of prostatectomy your healthcare provider recommends will depend on your individual circumstances.
- Radical retropubic prostatectomy is removal of the prostate through an incision that goes from the belly button to just above the pubic hairline.
- Laparoscopic radical prostatectomy is removal of the prostate using small instruments and a camera inserted into several small incisions in the abdomen.
- Robotic-assisted laparoscopic prostatectomy is when the prostate is removed by robotic arms controlled by a surgeon using a computer. The robotic arms use small instruments and a camera that are inserted into several small incisions in the abdomen.
- Radical perineal prostatectomy is removal of the prostate through a small incision made between the anus and the scrotum. There is less blood loss with this type of surgery, but there is greater risk of damage to the nerves in the area.
After the surgery, a catheter will be placed into the penis to drain urine from the bladder. A drain may also be placed near the incision to drain excess fluid from the area.
Many factors increase a man's chance of prostate cancer. Risk factors for prostate cancer include:
- Age – You are over 65.
- Family history – Your father or brother has a history of prostate cancer.
- Race – You are African-American.
- Alcohol use – You drink an excessive amount of alcohol.
- Agent Orange and cadmium – You were exposed to Agent Orange or cadmium.
- Diet – Your diet is high in fat, especially animal fat.
- Occupation – You are a farmer, tire plant worker or painter.
It is important to note that having risk factors for prostate cancer does not mean you are sure to develop it. In fact, other than age, most men with prostate cancer have no identifiable risk factors.
- Eating a diet that is vegetarian, or low in fat and high in omega-3 fatty acids, can help decrease your risk of developing prostate cancer.
- Studies have shown no increased risk for prostate cancer after a vasectomy.
Prostate cancer is often a very slow-growing cancer. Very small prostate cancers may not cause any symptoms. However, the treatments for prostate cancer (such as surgery or radiation) can have significant unwanted side effects. Some of the symptoms that can be seen in the early stages of prostate cancer can also be caused by other non-cancerous prostate problems. These symptoms include:
- Difficulty stopping or starting urination
- A urine flow that is slower than normal
- Leaking of urine, especially after urinating
- Having to strain to push urine out
- Difficulty emptying the bladder
- Bloody urine or semen
- More frequent urination with increased urination at night
- Urgent need to urinate
- Inability to urinate
- Painful or burning urination
- Painful ejaculation
- Erectile dysfunction (difficulty having or sustaining an erection)
As the cancer advances, swelling in the lower legs and pain in the bones can develop. This pain is typically in the lower back and hip area.
Contact your healthcare provider if you have any of the above symptoms. Your healthcare provider will perform a physical exam of your prostate (digital rectal exam) and may order a PSA level or biopsy.
- Discuss the pros and cons of having digital rectal exams (DRE) and PSA testing with your healthcare provider.
- In some cases, a bone scan and CT scan may be ordered to see if there are signs of cancer in the other organs.
The treatment for prostate cancer is based on many factors that include:
- Your age, general health and personal preferences
- The size and grade of the tumor
- How fast the tumor is growing
- Whether the cancer has spread to other parts of the body
Treatments are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:
- Surgery to remove the cancer
- Radiation to kill the cancer cells
Some of the systemic treatments for prostate cancer include:
- Chemotherapy to kill cancer cells is usually given to control the growth and symptoms of cancer that is not curable. It is often given after hormonal therapy.
- Hormone therapy to block the effect of hormones that increase cancer growth.
- Targeted or biologic therapies to interfere with the changes in cells that help sustain the cancer. Targeted therapy has been approved for some cases of prostate cancer.
Treatment for prostate cancer usually involves a combination of local and systemic treatments.
- Radiation and chemotherapy are usually given in a doctor's clinic or hospital by specially trained medical people.
- In some cases, you may be able to receive chemo at home with the help of specially trained nurses.
Since prostate cancer often grows slowly, experts may not agree on whether early detection and treatment will prolong life. As an alternative, prostate cancer treatment can also involve “watchful waiting” or “active surveillance.”
- Watchful waiting means a decision has been made to treat cancer symptoms, if present, but not the cancer. This is an option for elderly men with a short life expectancy or men with complex medical conditions. A decision to treat the cancer may be made if it causes significant symptoms or appears to be acting more aggressively.
- Active surveillance means a decision has been made to monitor the growth or spread of the cancer through digital rectal exams (DRE), PSA testing and biopsy. It is indicated in younger men in good health who decide that the risks of other treatments outweigh the benefits.
To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:
- Your primary care physician
- A urologist or surgeon with experience in prostate cancer
- A medical oncologist (a doctor who specializes in the treatment of cancer)
- A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
If your healthcare provider recommends a prostatectomy, prior to the surgery you should tell them about any medications you are taking (including over-the-counter medications and supplements). You should also ask about specific instructions you should follow before and after the surgery. These may include:
- Medications you should not take before the procedure, such as blood thinners
- Regular medications you should continue to take on the day of your procedure
- How many hours you should stop eating and drinking before the procedure
If you are a smoker, you should quit smoking. It can interfere with your recovery from surgical procedures.
During your surgery, you will receive anesthesia to keep you comfortable and pain free.
- General anesthesia is the most common type of anesthesia for a prostatectomy.
- With this type of anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.
You may need pain medication and help at home while you recover.
It is important to remember that the total cost of this care path does not include all possible medications, labwork or imaging studies. Those charges can add up. If your healthcare provider recommends any labwork or imaging studies you may need to search for their costs separately.
You should contact your healthcare provider if you have symptoms of prostate cancer or want to discuss the pros and cons of prostate cancer screening. Be prepared to discuss any symptoms you have and how long you've had them.
- Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
- Make a list of your medications (including over-the-counter).
- Write down any questions, symptoms or concerns you want to talk about.
- If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).
What should I ask my healthcare provider before having a prostatectomy?
- What is my diagnosis and reason for the surgery? Are there any alternatives or less invasive options? What are the benefits and risks of each?
- Are “Watchful Waiting” or “Active Surveillance” an option for me?
- Will I be receiving other treatments before or after my surgery?
- What are the possible complications for this surgery?
- What happens if I do not go through with the surgery?
- What is your experience in doing this type of surgery? What is your complication rate?
- Will I need anesthesia? What are the possible side effects?
- How will I feel after the surgery? Will I have to modify my activity?
- How long do to I have to avoid sexual intercourse?
After your surgery, you should know what you had done, what medication was given and what symptoms you should report to your healthcare provider after discharge. You should also understand all home care instructions (including medications and side effects) and follow-up plans. Your surgeon should also communicate with your primary care physician.