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?
Radiation therapy involves the use of various forms of radiation, or high-energy x-ray beams, to kill cancer cells in a specific area of the body. It can be used:
- To cure a cancer that cannot be removed by surgery
- As an alternative to surgery
- To decrease symptoms that are related to a progressive cancer or large tumor
- Before surgery to make a tumor smaller
- After surgery to prevent cancer from returning
- At the same time as chemotherapy
The x-ray beams given during radiation treatments must pass through normal tissue on their way to the cancer and out of the body. This can result in damage to normal organs and tissues.
- Radiation oncologists plan treatments to minimize exposure to normal organs.
- The treatments must be given daily over several weeks because normal tissues do not tolerate a large dosage given at one time.
Radiation therapy can be given in various ways. The way it is given depends on what type of cancer you have and where it is located in your body. Some types of radiation therapy include:
- Three-dimensional (3D) conformal radiation, which uses a beam that goes straight through the body. The patient's position is changed so the beam goes through from two or three different angles. The approach is planned to allow the maximum exposure of radiation to the tumor.
- Intensity-modulated radiation therapy (IMRT) uses hundreds of angles to accomplish the same task. It is far more expensive and is used when many angles are necessary. This approach helps to spare an important organ that is not affected by the cancer. In IMRT, the intensity of the beam is varied to conform to the shape of the tumor. The aim is to limit damage to surrounding healthy tissues, while effectively treating the cancer. IMRT is a valuable technique for treating a small percentage of cancerous tumors, but adds little value in the treatment of others. IMRT may not be covered by your health plan unless certain criteria are met.
- Prostate cancer is often treated by placing radioactive seeds or pellets into the prostate. This is called brachytherapy. It is often done when the tumor is small and grows slowly. The seeds give out a low dose of radiation over a long period, usually several months. They are not typically removed. However, in some cases (high-dose radiation), the seeds are removed when the treatment is finished.
- The decision to administer radiation therapy will depend on the individual circumstances.
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. This is usually given to control the growth and symptoms of a 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)
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.
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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 have 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 radiation therapy?
- How will radiation improve my prognosis?
- What specific precautions do I need to take after receiving radiation therapy?
- What are the possible complications?
- How will I feel after radiation therapy? Will I have to modify my activity?
- What type of radiation will I receive? What symptoms should I report to my healthcare provider before my next appointment?
- Is there a reason you are recommending one form of radiation therapy over another?
- Will I be receiving other treatments along with the radiation therapy?
- What other specialists will need to get involved?
It is important you understand all home care instructions (including medications and side effects) and follow-up plans. Do not forget to make arrangements for help at home.