Prostate Cancer

Prostate Cancer‘Adenocarcinoma’ is the clinical term for a cancerous growth on the prostate gland is. A growing prostate cancer may spread to the interior of the prostate gland and tissues close to the gland, and even to distant parts of the man’s body. Untreated, the cancer can affect a man’s lungs, liver, bones and other parts of the body. When confined to the prostate gland, it can often be treated successfully so early detection through prostate exams are important.

About

Prostate cancer is the most common type of cancer in men.  Each year over 230,000 males will be diagnosed with prostate cancer and approximately 30,000 will die from the disease. However, prostate cancer can be cured if detected early.

Men at high risk (men with a family history of prostate cancer and African-American men) should begin yearly screening for prostate cancer at age 40 or earlier, all others at age 50.

FYI

RISK FACTORS 

Some factors that put you at risk of developing prostate cancer:

  • Age:  Men over age 50 are at a higher risk.
  • Family history: The risk is doubled if a father, brother or close male blood relative has had prostate cancer.
  • Race: African-Americans have the highest rate of prostate cancer.
  • Genes: Some common genetics have been linked to a higher risk of prostate cancer.
  • Nutrition: Eating a meal plan low in fiber and high in fat and red meat has been shown to increase the risk of prostate cancer.

CANCER STAGES

The stages of prostate cancer are described as I, II, III, or IV. Stage I is early-stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body.

The stage of the prostate cancer depends on:

  • If the tumor has spread to nearby tissue, such as the bladder or rectum
  • If prostate cancer cells have spread to lymph nodes, bones or other parts of the body
  • The Gleason score (grade) – A low Gleason score means the tumor is less likely to spread; a high Gleason score means the tumor is more likely to spread
  • The PSA level

Stage I – The cancer is only in the prostate. It might be too small to feel during a DRE (digital rectal exam).

Stage II – The tumor is more advanced, but doesn’t extend beyond the prostate.

Stage III – The tumor extends beyond the prostate and may have invaded a seminal vesicle, but has not spread to lymph nodes.

Stage IV – The tumor may have invaded the bladder or rectum, and may have spread to lymph nodes, bones, or other parts of the body. 

PROSTATE HEALTH & SEXUAL HEALTH

After prostate cancer treatment – prostatectomy, radiation therapy or hormone therapy – some patients may experience Erectile Dysfunction, or ED. Men with nerve damage from prostate cancer treatment might not respond as well to prescribed drugs as those with ED caused from other ailments. But some research suggests that men who use prescribed medications, starting within 6 months of prostate surgery, may have stronger erections over time in the absence of surgical nerve damage.

Information for women in dealing with the sensitive issues related to sexual health can be found here.

Symptoms

Early on, prostate cancer has no obvious symptoms. As the disease progresses you may feel the need to urinate more often, especially at night.

Once prostate cancer is advanced, symptoms include:

  • Blood in the urine
  • Trouble getting an erection
  • Chronic pain in the hips, thighs, or lower back.

The lack of early symptoms and the overlap of symptoms with non-cancerous conditions such as benign prostatic hyperplasia (BPH) make prostate cancer difficult to diagnose. That’s why it’s essential that you get screened regularly to find out what is causing bladder problems.

Prevention

Early prevention is essential to prostate health. Make sure and have your prostate checked yearly after age 50. If you are African American, have a family history or are a veteran exposed to Agent Orange, you may want to begin regular checkups beginning at age 40 as you may be at higher risk.

  • Eat a diet high in fiber, soy protein, fruits, and vegetables
  • Obesity may increase your risk of cancer
  • Exercise regularly
  • Don’t smoke
  • Limit alcohol and caffeine
  • Drink lots of water

Diagnosis

HOW DO I KNOW IF I HAVE PROSTATE CANCER?

Prostate cancer may be discovered during a checkup with a DRE (digital rectal exam) and/or PSA (prostate specific antigen).

DRE: The doctor probes the rectal area with a gloved, lubricated finger, feeling for bumps or hard areas on the prostate that could be an indicator of potential cancer.

PSA: A blood test searching for prostate cancer in men with or without symptoms.

If your PSA or DRE test is abnormal, your healthcare provider may do more testing using one of the following methods:

  • Biopsy: Taking a number of small pieces of prostate tissue following local anesthesia and examining them under a microscope.
  • Urinalysis: Often used to rule out BPH or prostatitis.
  • Imaging: Ultrasound uses sound waves to produce an image of the prostate. MRI and CT scans use computers to produce images. Also, bone scanning can look for prostate cancer that might have spread to the skeletal system.
  • Transrectal ultrasound (TRUS). A test using sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions.
  • Lymph node biopsy: Examination of small samples from the lymph nodes can determine whether the prostate cancer has spread to other parts of the body

New tests are being developed, so when consulting with your healthcare provider ask if other tests are available.

It’s important that you speak to your healthcare provider to learn more about screening for prostate cancer to help you decide if it is right for you.

Questions to Ask Your Health Care Provider

You should become proactive with your healthcare to get the best treatment available. Ask your healthcare provider these questions:

  • What type of prostate cancer do I have?
  • Will I feel pain if I have it?
  • Am I more likely to get prostate cancer than anyone else?
  • Do you think I should have screening? If so, what are the available tests?
  • What are the pros and cons of the PSA blood test?
  • What is my PSA (prostate-specific antigen) level? What does this mean?
  • What is the cancer’s clinical stage and grade (Gleason score)? What does this mean?
  • What are the chances that the cancer has spread to other parts of my body?
  • What treatment options do you recommend and why? What are the benefits and side effects of each?
  • Is watchful waiting (active surveillance) an option for me? Why or why not?
  • What would we do if the treatment doesn’t work or if the cancer come back?

Treatments

Your healthcare provider decides the best treatment for your case, and may choose one or a combination of the following options:

  • Active surveillance – delaying treatment until test results show that your prostate cancer is growing or changing
  • Surgery
  • Radiation therapy
  • Hormone therapy
  • Chemotherapy
  • Vaccine treatment
  • Cryosurgery (cryotherapy)

Ask your healthcare provider which treatment is best for you depending on:

  • Your age at diagnosis
  • How severe your cancer is
  • Whether or not you have other health conditions
  • Whether or not you and your healthcare provider feel it’s necessary to treat the cancer
  • The likelihood that each type of treatment will cure your cancer (or provide some other measure of benefit)
  • The possible side effects from each treatment

Second Opinion:

If you feel uncertain as to what your treatment options are, you may wish to seek a second opinion from another healthcare provider. You can talk to several different healthcare providers, such as urologists, radiation oncologists, and medical oncologist, about treatment options, side effects, and possible results.

TREATMENT AFFECT ON SEXUAL HEALTH

Prostate cancer is not a cause of Erectile Dysfunction. However, treatments for the disease can cause ED.

Surgery. Some operations cause more sex problems than others.  Men who had strong erections before cancer surgery are more likely to maintain them than men who had problems with erections prior to surgery. Surgery can cause loss of blood flow in some arteries, potentially restricting blood flow to the penis.

Radiation.  Radiation treatments to the lower abdomen can cause problems with erections because of the attack to the vessels that carry blood to the penis. As the treated area heals, scar tissue can form inside causing a difficulty with blood flow. Radiation may also harm the nerves that control erection, and some men may produce less testosterone after radiation treatment. However,  testosterone levels usually go back up within 6 months after radiation. Male hormones may cause prostate cancer cells to grow faster.

Chemotherapy. Most men getting chemo can still have normal erections. However, it is normal for erections and desire often drop right after getting chemo but return shortly thereafter. In some cases, testosterone treatment may be prescribed to regain normal desire and erections.

Hormone Treatment. Treatment for metastasized prostate cancer may include adjusting hormone balance. Hormone treatment starves the cancer cells of testosterone slowing cancer’s growth. Blocking testosterone can be done by:

  • Using drugs to keep the man from making testosterone
  • Using drugs that block the body from using testosterone
  • Removing the testicles (called orchiectomy)

Men with nerve damage from prostate cancer treatment might not respond as well to these drugs as those with Erectile Dysfunction from other physical causes. But some research suggests that men who use one of these drugs fairly often, starting within 6 months of prostate surgery, might have better erections over time (as long as there is no nerve damage).

Information for women for dealing with the sensitive issues related to sexual health can be found here.

Last modified: September 25, 2015