PREVENTION

Understanding Prostate Cancer -- Prevention

How Do I Know If I Have Prostate Cancer?

The best way to detect prostate cancer in its early stages is with regular digital prostate examinations and PSA blood tests. Because most malignant prostate tumors originate in the part of the gland nearest the rectum, many cancers can be detected during routine rectal examinations. Many doctors recommend an annual rectal exam, supplemented by a prostate-specific antigen (PSA) blood test, starting at age 50 for most men. The screenings are recommended beginning at age 40 for African Americans and those with a family history of prostate cancer.

PSA is a protein whose blood level tends to increase in the presence of prostate cancer, making it a valuable tool in detecting early prostate cancer. Together, the two screening measures offer the best chance of detecting prostate cancer while it is localized and most treatable. Prostate cancer may also be discovered incidentally during treatment for urinary problems. Because of the possibility of a false-positive PSA reading, it is important to discuss this test with your doctor before having one. An elevated PSA does not mean that you have cancer. Rather, it raises questions that need to be addressed and explained. There are a number of causes of an elevated PSA, and cancer is only one of them.

If routine screening arouses suspicion and/or PSA levels are elevated, a doctor may perform biopsies of the prostate guided by an ultrasound instrument inserted in your rectum (transrectal ultrasound). X-rays of the urinary tract, along with blood and urine studies, are performed routinely to aid diagnosis. Performing a biopsy will confirm whether or not cancer is present: Guided by ultrasound images, the doctor inserts a needle into the prostate and extracts small slivers of tissue from the suspicious area. Sometimes biopsies are instead obtained through a cystoscope, a narrow telescope passed through the urethra. A pathologist then studies the sample under a microscope to determine whether cancer cells are present. In order to determine if the cancer has spread outside the prostate gland, doctors may arrange CT scans, bone scans, chest X-rays, or other imaging tests.

What Are the Treatments?

Since prostate cancer is often slow growing and may not be fatal in many men, some men -- after discussing the options with their doctors -- opt for "watchful waiting." Watchful waiting involves monitoring the prostate cancer for signs that it is becoming more aggressive but otherwise not treating it. This approach is recommended more commonly for men who are older or suffer from other life-threatening conditions. In these cases, the cancer may be growing so slowly that it's not likely to be fatal.

Once the decision is made to treat a cancer, other factors, such as a patient's age and general health, affect the type of treatment given. Decisions about how to treat this cancer are complex, and many men seek a second opinion before making a treatment decision.

Depending on when the disease is diagnosed, treatment includes a single therapy or some combination of radiation therapy, surgery, hormone therapy, and rarely chemotherapy. Localized prostate cancer usually can be cured with surgery, radiation therapy, or cryosurgery -- freezing malignant cells with liquid nitrogen. The choice is made on a case-by-case basis and depends on many factors.

The standard operation -- a radical prostatectomy -- involves the removal of the prostate and nearby lymph nodes. In many cases, surgeons can remove the gland without cutting nerves that control penile erection or bladder function, making such complications as impotence or incontinence much less common than in the past. Depending on the man's age and the amount of surgery needed to remove all the cancer, nerve-sparing techniques allow about 40%-65% of men who were able to get erections before surgery to be able to do so after surgery without a need for any additional E.D. treatments.

After surgery, most men experience some degree of incontinence but usually regain complete urinary control. Impotence can be treated in a variety of ways -- including with medications such as Levitra, Cialis or Viagra. If severe or prolonged, incontinence can be managed with special disposable underwear, exercises, condom catheters, biofeedback or penile clamps; in rare cases that don't resolve on their own, incontinence can be eliminated altogether with surgically inserted sphincter implants around the urethra or a urethral sling.

Radiation therapy can very effective as the primary treatment for localized prostate cancer. It may also be given as follow-up to surgery for cancer that has not spread. If cancer has spread to adjacent tissue, radiation is the preferred treatment; it is also used in advanced cases to relieve pain from the spread of cancer to bones. Incontinence and impotence also occur with radiation, and some studies have shown similar results to surgery. New forms of radiation such as IMRT (Intensity Modulated Radiation Therapy) are proving even more effective with fewer side effects.

Permanent radioactive seed implants (brachytherapy) allow for delivery of a high dose of radiation to the prostate with limited damage to surrounding tissues. During the procedure, tiny radioactive seeds are implanted into the prostate gland using ultrasound guidance. The implants remain in place permanently and become inactive after many months.

Even advanced cases that cannot be cured may be controlled for many years with hormone therapy, sometimes supplemented by other treatments. Hormone therapy slows the cancer's growth by cutting off the testosterone supply, although the treatment's effectiveness may decrease over time. Testosterone can be removed from the bloodstream by surgically removing the testicles (orchiectomy) or by administering female hormones such as estrogen or other drugs that block testosterone production. Men generally prefer the testosterone-blocking drug treatment because it is effective, less invasive, and causes fewer side effects than surgery or female hormone drugs. If the testicles are removed, the scrotum can be left intact with testicular implants put in place.

Chemotherapy and vaccine therapies are proving to be effective for some men with advanced prostate cancer.

The goal of prostate cancer treatment is a cure, and is likely in men diagnosed with early prostate cancer. All prostate cancer survivors should be examined regularly and have their PSA levels monitored closely.

As with other types of cancer, new treatments are being developed for advanced prostate cancer. Researchers are using radiation and hormone therapy in innovative ways and are testing the effectiveness of chemotherapy on patients who do not respond to other treatments.