Prostate Cancer

What is it?

Prostate cancer is a disease that affects the cells of the prostate. The prostate gland is part of the male reproductive system. Normally, cells grow and divide in an orderly way. This is how the body grows and stays healthy. Sometimes this normal process of cell growth can go wrong. If the cells continue to divide when they're not supposed to, they can form a tumor. Cancerous prostate tumors display different behavior between individuals. If left untreated, they can block the flow of urine and spread to other parts of the body.

Who is at risk?

All men, of appropriate age should be counseled with regard to early detection for prostate cancer. Physicians are encouraged to offer prostate cancer testing to men to obtain a baseline at the age of 40. Further testing should be done based on overall health, family history, symptoms, and previous PSA values.

What are the early warning signs?

While often due to other non-cancerous causes, you should consult your physician if you are experiencing any of the following symptoms:

  • difficulty with urination;
  • frequent trips to the bathroom at night;
  • pelvic discomfort;
  • weight loss;
  • persistent back pain.

How do you test for it?

Early detection is the goal of testing. Treatment is most likely to be effective when finding the disease is its early stages. There are two widely used tests to aid in the early detection. They are:

PSA - This simple blood test measures the level of a protein called prostate-specific antigen (PSA). Normally, PSA is found in the blood at very low levels. Elevated PSA readings can be a sign of prostate cancer.

DRE - The digital rectal exam (DRE) involves the physician inserting a lubricated, gloved finger into the rectum to feel the prostate for signs of cancer. This test is simple, safe and only slightly uncomfortable.

Using both tests together will give your doctor the most accurate information.

Although an abnormal DRE or an elevated PSA may suggest the presence of prostate cancer, a diagnosis of cancer can only be confirmed by a prostate biopsy. A biopsy would be performed only after a thorough discussion with your urologist.

Biopsies are minimally invasive procedures. A small amount of prostate tissue is removed by a needle inserted through the rectum. An ultrasound probe is used to guide the needle. Usually this procedure is performed as an outpatient procedure without anesthesia.

The prostate tissue is then examined under a microscope by a pathologist. If a tumor is present, the biopsy report will give the tumor a "grade." The tumor grade indicates how quickly the tumor is likely to grow and spread. Once a cancer is diagnosed, you and your physician can discuss treatment options and choose the type of treatment that is best suited to your needs.

How is it treated?

There are a number of treatment options for managing prostate cancer including "watchful waiting" or active surveillance, surgery, radiation therapy and hormone therapy. In some cases, it is useful to combine more that one type of treatment.

Surveillance (also known as "watchful waiting") - In some men with slow-growing prostate tumors that are found at an early stage, it may not be necessary to start an active treatment. Your doctor will follow your progress closely and give you regular exams to check for cancer growth. The exams will indicate if and when active treatment should begin.

  • Surgery - The surgical procedure that removes the entire prostate and the surrounding tissue is called radical prostatectomy. It is done while the patient is under general anesthesia and may be recommended if the tumor is localized to the prostate.
  • Radiation Therapy - This is another type of local therapy used to attack cancer cells only in the treated area. For prostate cancer in its early stages, radiation therapy can be either used instead of surgery or it can be used following surgery to destroy cancer cells that may remain.
  • Hormone Therapy - Prostate cancer depends on male hormones, such as testosterone. Starving the cancer of hormones may slow or stop its growth. Hormone therapy is primarily used to halt or slow the spread of cancer. It does not cure cancer. There are several effective methods of blocking or reducing testosterone in the body. Hormone therapy is routinely used before radiation therapy to increase the effectiveness of radiation.
  • Cryosurgery - This option involves freezing the prostate tissue. The long-term effectiveness of this procedure is unknown.
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