Prostate Cancer
One of the most common cancers in men, prostate cancer can be treated successfully if caught early. Annual prostate screenings are your first defense against prostate cancer.
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Prostate cancer is rare in younger men, but your chance prostate cancer rises after age 50. About six in ten cases of prostate cancer are in men over the age of 65. Your physician will make recommendations based on your age, family history and ethnicity, since prostate cancer occurs more often in African-American men and Caribbean men.
Symptoms
There are usually no early signs of prostate cancer. If you do have symptoms, they are due to blockages caused by the tumor. Symptoms can also be caused by non-cancerous conditions, like BPH or an enlarged prostate, and include:
- Frequent urination, especially at night
- Difficulty starting or stopping your urine stream
- A weak urine stream
- Leaking urine when laughing or coughing
- Inability to urinate standing up
- A painful or burning sensation during urination or ejaculation
- Blood in your urine or semen
Symptoms of advanced prostate cancer may include:
- Pain or stiffness in the pelvis, lower back, chest or upper thighs
- Loss of weight and appetite
- Fatigue
- An upset stomach
- Swelling in the lower extremities
- Weakness or paralysis in the lower limbs, often with constipation
Diagnosis
Two tests are initially used to diagnose prostate cancer: a PSA blood test and a digital rectal exam.
A PSA exam tests for prostate-specific antigen, a substance in the prostate that doctors use to monitor prostate function. Doctors generally consider levels under 4 to be normal. Your physician will also take into account age, race, and family history, and will likely recommend additional testing.
During your digital rectal exam, your doctor inserts a finger into your rectum to feel for any lumps. If something is found, they will likely recommend additional testing.
Additional tests that your doctors may perform are:
- Prostate biopsy to check for cancer cells under a microscope.
- Cystoscopy, or cystourethroscopy, to allow your physician to see any blockage or abnormal growths.
- A CAT scan or MRI to let your physician see the prostate and nearby lymph nodes.
Treatment
There are several treatment options available for prostate cancer. Before making a decision, you should talk with your primary care physician or urologist about factors such as your age, the stage of the cancer, any other health conditions and treatment side effects to decide which course of treatment is best.
Early Stage Prostate Cancer
Since prostate cancer is often slow growing, for patients over 72, your doctor may recommend “expectant management” or just keeping an eye on the cancer. Research finds that older men with early stage prostate cancer are more likely to die from other causes.
Surgery or radiation therapy is often used to treat early stage prostate cancer. With general surgery, doctors remove the entire prostate and surrounding tissue. In a specialized procedure, your physician may decide cryosurgery is right for you. Cryosurgery freezes the cancer, but is generally not used as the first treatment option.
Radiation therapy is another treatment for early stage prostate cancer. It’s done either by external beam radiation or brachytherapy, commonly called tumor seed treatment. External beam radiation is delivered by a machine, usually five days a week for seven to nine weeks. Tumor seed treatment is the placement of anywhere from 40 to 100 radioactive seeds into the prostate. The seeds are the size of a grain of rice and deliver low doses of radiation for weeks to months. Seeds can be permanent or temporary.
Later Stage Prostate Cancer
If surgery or radiation alone aren’t options for treating your prostate cancer, you may receive hormone therapy. The goal is to reduce levels of male hormones, called androgens, in your body so that they stop feeding the prostate cancer cells. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time, but hormone therapy alone does not cure prostate cancer.
Chemotherapy, either administered orally or through an IV, is an option for prostate cancer that has spread to other organs. Treatment cycles generally last several weeks at a time.
Advances in technology have offered a new treatment for prostate cancer by using a vaccine known as Sipuleucel-T (Provenge®), which boosts the immune system to attack cancer cells. It’s used to treat advanced prostate cancer that is no longer responding to hormone therapy but that is causing few or no symptoms, and is made specifically for each man based on the makeup of his body.
Prostate cancer that has spread to the bones
If prostate cancer grows outside of the prostate, it is likely to go into nearby tissue, lymph nodes and most often the bones. Bone metastasis can be painful and can cause other problems, such as fractures or high blood calcium levels, which can be dangerous or even life threatening.
Once the cancer spreads, the major goal of treatment is preventing or slowing the spread of the cancer. Hormone therapy, chemotherapy and vaccines may help control the spread of the cancer, but other, more specific treatments are available when the cancer spreads to the bones.
Oral drugs and steroids can help relieve bone pain and to prevent fractures. Radiation and radioactive drugs can also help to reduce bone pain and shrink tumors in other parts of the body.
Prevention
Living a healthy lifestyle, keeping a healthy weight, eating right, not smoking, exercising and minimizing stress can greatly reduce your risk of cancer. Your risk of prostate cancer increases with age, family history, race, poor diet and some environmental factors.
Early Detection through Screenings
Early detection is the key to diagnosing prostate cancer in its early, and most treatable, stage.
African American men, and men with a father, brother, or son who was diagnosed with prostate cancer at an early age, should start screenings at age 40. Men at low risk can start screenings at age 50. Talk to your primary care physician about when you should start annual prostate checks.
