The prostate gland is part of the male reproductive system and is responsible for the production of fluid to nourish and transport sperm. The prostate lies deep in the male pelvis between the bladder and the urethra (the tube that transports the urine and semen through the penis). Prostate Cancer develops when the cells of the gland mutate and undergo malignant changes. Cancer cells grow more rapidly than normal cells and refuse to die, and they also develop the ability to invade and destroy normal tissue. Over time, the spread of the malignant cells can result in the patient having symptoms, health problems and ultimately death.
Prostate Cancer is one of the most common male malignancies in the United States and it is expected that more than 241,740 men will be diagnosed with this condition annually. Men have a 1 in 6 lifetime chance of prostate cancer and it is the third leading cause for cancer death in men. The annual prostate cancer death rate has been declining recently which we think may be due to screening and early detection of the disease. Prostate cancer usually occurs later in life and grows slowly, but this is not always the case. While some types of prostate cancer may need minimal or no treatment, other types are aggressive and can spread quickly. If prostate cancer can be detected early while it is still confined to the prostate, the chance for successful treatment of disease is very good.
For most men, prostate cancer is first detected during a routine screening such as a Prostate Specific Antigen blood test (PSA) and/or a digital rectal exam (DRE), and since the cancer is usually detected much earlier with screening, there are often no associated symptoms. Later in its course, the cancer can cause compression on the urinary tract and this compression results in urinary symptoms such as decreased force of stream and stopping & starting of the urinary stream. Since these are the same symptoms associated with Benign Enlargement of the Prostate (BPH), it is important to be checked with the PSA and DRE to be sure that the symptoms are not due to Prostate Cancer. Later stages of Prostate Cancer can cause pelvic pain, bone pain or bone fractures, but because of routine screening, Prostate Cancer rarely presents with these advanced symptoms.
The main risk factors include:
Prostate cancer is more common as men get older
Race or Ethnicity –
For reasons that aren’t well understood; African American men have a higher risk of developing and dying of prostate cancer.
Family History –
If there is a family history of prostate cancer, the chances of getting it are higher. The closer the relative, the more relatives with this condition and the younger that it was found in the relative, all increase the risk of getting and dying of prostate cancer.
A high fat diet and obesity may increase the risk of prostate cancer.
When to seek medical advice
If you have difficulties with urination, contact your doctor. These symptoms are not always caused by prostate cancer, but screening for prostate cancer is advisable.
The American Cancer society and the American Urological Society recommend that the pros and cons of regular prostate cancer screening be discussed with the patient starting at age 40.
If the screening tests suggest prostate cancer (the Prostate Specific Antigen blood test and/or the Digital Rectal Exam), the pros and cons of a Prostate Biopsy will be discussed with the patient. This is an outpatient procedure using a small ultrasound probe in the rectum to visualize the prostate. Guided by images from the probe, numbing medication is injected around the prostate and using a fine, spring-propelled needle, samples of tissue are taken from the prostate to determine if cancer is present and how aggressive the cancer is. Using the current technique, most patients tolerate the procedure well and complications from the biopsy are rare.
The decision for treatment of prostate cancer depends on the age and health of the patient, the aggressiveness of the cancer and the extent of the cancer at the time of diagnosis. Virtually all treatments for prostate cancer except observation may have an effect on the quality of life with urinary control, erectile function and bowel function being the primary concerns. So, it is important to have a thorough discussion with your urologist about the benefits, risks, morbidity and side effects of the treatment options.
If the patient is older and has a slowly progressive prostate cancer, observation and treatment with palliative therapy at a later date is an option. Some younger patients with low volume non-aggressive cancer may be candidates for surveillance in which case the cancer is carefully watched by doing infrequent, repeated prostate biopsies and curative therapy is done if the cancer shows signs of progression.
For many patients, curative therapy is the best choice and there are basically 4 options:
- Surgical removal of the prostate
- Radioactive Seed Implants
- External Beam Radiation therapy (EBRT)
- Cryosurgery (freezing of the prostate)
If the cancer is very aggressive or more extensive than usual, a combination with hormone therapy (shots to remove male hormone) or a combination of surgery followed by EBRT or Radioactive Seeds plus EBRT may give the best chance for cure. When surgical removal of the prostate is indicated, we are fortunate to have well qualified, experienced robotic surgeons at Urology Centers of Alabama, and we feel that the robotic technology offers less morbidity & side effects and excellent cancer control.
Hormone therapy involves stopping your body from producing the male sex hormone testosterone which stimulates the growth of prostate cancer cells. Another type of this therapy can block testosterone from getting into the cancer cells. Sometimes a combination of two drugs is used to achieve both effects. Hormone therapy is occasionally used to stop the growth of the cancer when needed curative therapy cannot be given in a timely manner, sometimes it is used as adjunctive therapy to improve the cure rate of Surgery and External Beam Radiation Therapy (EBRT) and often, it is used as palliative therapy to stop the progression of widespread, incurable cancer. It is a very effective and useful treatment for prostate cancer but does have some side effects. Side effects of hormone therapy can include:
- Breast enlargement (gynecomastia)
- Reduced sex drive
- Erectile dysfunction
- Hot flashes
- Weight gain
High-Intensity Focused Ultrasound (HIFU)
High-Intensity Focused Ultrasound (HIFU) is a newly FDA cleared, minimally invasive treatment designed to provide men with a surgery-free option for prostate cancer. The treatment uses high-intensity sound waves to heat and destroy cancer cells. This allows the cancer to be targeted rather than removing the prostate entirely.
The benefits of this treatment include:
- Shorter hospital stay
- Lower risk of erectile dysfunction
- Decreased probability of incontinence
Although side effects may be less likely with HIFU, there’s still a chance that you may have some. For example, you may have erection problems after the procedure. Some men have problems with urination and are more likely to have bladder infections, after the procedure.
Drs. Andrew Strang and Bryant Poole are the certified physicians at Urology Centers of Alabama that will be performing this procedure.
This treatment is not suitable for all cases of prostate cancer. Potential candidates for this procedure are men who have low-volume, previously untreated prostate cancer. Talk with your urologist to determine the best treatment option for you.
Reduction in muscle and bone mass
Recent reports have shown that men who undergo hormone therapy for prostate cancer may have a higher risk of having a heart attack in the first year or two after starting hormone therapy. So you doctor should carefully monitor your heart condition and aggressively treat any other conditions that may predispose you to a heart attack, such as high blood pressure, high cholesterol or smoking.
Surgery to remove the testicles, which produces most of the testosterone is as effective as other forms of hormonal therapy. Many men are not comfortable with the idea of losing their testicles, so they opt for shots or medication to control the testosterone. However, removing the testicles has the advantage of not having to have an injection every 3 to 6 months and can be less expensive. The surgery to remove the testicles is done on an outpatient basis.
Prostate Cancer Prevention
Prostate cancer may not be preventable in some people but you can take measures to reduce your risk or possibly slow the disease’s development. This includes the following:
High-fat diets and obesity have been linked to prostate cancer as well as a number of other health problems. Limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods and supplements containing lycopene (an ingredient in cooked tomatoes), selenium, soy, vitamin D and Vitamin E may also be of help.
Get regular exercise.
Regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren’t as clear cut, but studies do indicate that regular exercise may reduce your cancer risk. Exercise has been shown to strengthen your immune system, improve circulation and speed digestion – all of which may play a role in cancer prevention. Regular exercise may also minimize you risk of prostate gland enlargement or benign prostatic hypertrophy (BPH).
The important thing to remember is that what is prostate healthy is heart healthy, cancer healthy and healthy for your vascular system. In addition, healthy living helps to prevent obesity and diabetes and it improves your quality of life.