Prostate Cancer: Cancer of the Prostate

Definition: Prostate cancer is a disease in which cancer cells grow in the prostate gland. The prostate is a walnut-sized gland in men that surrounds the urethra. The prostate produces a fluid that is part of semen.

Cancer occurs when cells in the body (in this case prostate cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissues and can spread to other parts of the body. A benign tumor is unable to invade or spread.

Causes: The cause of prostate cancer is unknown. However, research shows that certain risk factors are associated with the disease.

Risk Factors: A risk factor is something that increases your chance of getting a disease or condition.

• Age: 55 or older 

• Race: Black 

• Family history of prostate cancer, especially father or brother 

• Family history of prostate cancer diagnosed at a young age Diets high in fat

Symptoms: Although early prostate cancer may cause no symptoms, prostate cancer may cause the following symptoms:

• A need to urinate frequently, especially at night 

• Difficulty starting urination or holding back urine 

• Inability to urinate 

• Weak or interrupted flow of urine 

• Painful or burning urination 

• Difficulty having an erection 

• Painful ejaculation 

• Blood in urine or semen 

• Frequent pain or stiffness in the lower back, hips, or upper thighs

Note: These symptoms may also be caused by other, less serious health conditions, such as benign prostatic hyperplasia (BPH) or an infection. A man experiencing these symptoms should see a doctor.

Diagnosis: Your doctor will ask about symptoms and medical history, and perform a physical exam. Tests may include:

• Digital rectal exam - examination of the rectum with the doctor's gloved finger inserted into your rectum Urine test to check for blood or infection Blood test to measure prostate specific antigen (PSA) Blood test to measure prostatic acid phosphatase (PAP)

• Other tests to learn more about the cause of your symptoms may include:

• Transrectal Ultrasonography - a test that uses sound waves and a probe inserted into the rectum to find tumors

• Intravenous Pyelogram - series of x-rays of the organs of the urinary tract

• Cystoscopy - a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube

• Biopsy - removal of a sample of prostate tissue to test for cancer cells

Treatment: Once prostate cancer is found, tests are performed to find out if the cancer has spread and, if so, to what extent. Treatment depends on the extent of the cancer.

Treatments include:

• Watchful Waiting - no treatment, but your doctor tests periodically to see if the cancer is growing. Suggested for:

• Early stage prostate cancer that seems to be growing slowly 

• Older prostate cancer patients or those with serious medical problems that may make the risks of treatment outweigh the possible benefits

• Surgery - surgical removal of a cancerous tumor and nearby tissues, and possibly nearby lymph nodes. Types of prostate cancer surgery include:

• Radical Retropubic Prostatectomy - removal of the entire prostate and nearby lymph nodes through an incision in the abdomen

• Radical Perineal Prostatectomy - removal of the entire prostate through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.

• Transurethral Resection of the Prostate (TURP) - removal of part of the prostate with an instrument inserted through the urethra. A TURP is not a cancer surgery, but can be used to relieve the symptoms of obstruction when a patient either has prostate cancer or an enlarged gland due to other reasons.

• Radiation Therapy (Radiotherapy) - the use of radiation to kill cancer cells and shrink tumors. Radiation may be: External Radiation Therapy - radiation directed at the tumor from a source outside the body Internal Radiation Therapy - radioactive materials placed into the body in or near the cancer cells

• Chemotherapy - the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Chemotherapy use in the treatment of prostate cancer is still investigational; that is, chemotherapy has not been shown to prolong survival or reliably and durably reduce PSA levels in men with prostate cancer. Many studies are currently ongoing to evaluate the potential role of chemotherapy in prostate cancer.

• Biological Therapy - the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. Also called biological response modifier (BRM) therapy. Biologic therapy is not standardly used in the management of prostate cancer.

• Hormone Therapy - often used for patients whose prostate cancer has spread beyond the prostate or has recurred after treatment. The goal of hormone therapy is to lower levels of the male hormones, also known as androgens. The main androgen is testosterone. Lowering androgen levels can make prostate cancers shrink or grow more slowly, but does not cure the cancer. Methods of hormone therapy include:

• Orchiectomy -Although it is a surgical treatment, orchiectomy is considered hormonal therapy because it works by removing the testicles, the main source of male hormones. By lowering androgen levels, orchiectomy is able to shrink or slow the growth of most prostate cancers.

• Luteinizing Hormone-Releasing Hormone (LHRH) Analogs -These drugs can decrease the amount of testosterone produced by the testicles. LHRH analogs are given by injection.

• Anti-androgens -Even after orchiectomy or during treatment with LHRH analogs, a small amount of androgen is still produced by the adrenal glands. Antiandrogens block the body's ability to use androgens. Drugs of this type are taken as pills. Antiandrogens are often used in combination with orchiectomy or LHRH analogs. This combination is called total androgen blockade.

• Other Hormonal Drugs -Other hormonal drugs are sometimes used if "first-line" hormonal treatments lose effectiveness.

Prevention: Beginning at age 50, men should be offered a digital rectal exam and the PSA blood test to screen for prostate cancer. Many, but not all professional organizations, recommend yearly a PSA blood test for men over age 50 to screen for prostate cancer. Black men and men with close family members who have had prostate cancer diagnosed at a young age should begin testing at age 45. All men should discuss the pros and cons of PSA testing with their physician.

(American Cancer Society & National Cancer Institute)