The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It surrounds the urethra and produces a substance that contributes to semen, the fluid that carries sperm from the testicles. When cancer starts in the prostate, it is called prostate cancer. The prostate is a part of the male reproductive system.
The prostate has various functions, including:
● producing the fluid that nourishes and transports sperm
● secreting prostate-specific antigen (PSA), a protein that helps semen retain its liquid state
● helping aid urine control
Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.
People who are at high risk include:
• African American men, who are also more likely to develop this cancer at every age
• Men above age 60 years
• Men who have a father or brother with prostate cancer
Other people at risk include:
• Men who have been around Agent Orange
• Men who eat a diet high in fat, especially animal fat
• Obese men
Prostate cancer is less common in people who do not eat meat (vegetarians).
A common problem in almost all men as they grow older is an enlarged prostate. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk of prostate cancer. But, it can increase your prostate-specific antigen (PSA) blood test result.
Different people have different symptoms of prostate cancer. Some men do not have symptoms at all.
● Difficulty starting urination.
● The weak or interrupted flow of urine.
● Frequent urination, especially at night.
● Difficulty emptying the bladder.
● Pain or burning during urination.
● Blood in the urine or semen.
● Pain in the back, hips, or pelvis that doesn’t go away.
● Painful ejaculation.
These symptoms may be caused by conditions other than prostate cancer.
Different types of treatment are available for prostate cancer.
Some common treatments are:
Active surveillance is often used to mean monitoring cancer closely. Usually, this includes a doctor visit with a prostate-specific antigen (PSA) blood test about every 6 months and a digital rectal exam (DRE) at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well. If the test results change, the doctor would then talk to you about treatment options to try and cure cancer.
In general, active surveillance may be an option for patients whose prostate cancer is:
● Not causing symptoms
● Expected to grow slowly
● Small and contained within the prostate
The potential side effects of chemotherapy may include nausea and vomiting, hair loss, and mouth sores. The care team will use multiple measures to help reduce or moderate chemotherapy-related symptoms.
Before receiving chemotherapy for prostate cancer, you may receive pre-medications to help make symptoms more tolerable.
Hormone therapy is a form of systemic therapy—a way of administering drugs so they travel throughout the body, rather than being delivered directly to cancer—that works to add, block or remove hormones from the body to slow or stop the growth of cancer cells.
Hormone therapy for prostate cancer deprives cancer cells of the male hormones they need to grow. Prostate cancer hormone therapy is often used in combination with radiation and other therapies. We may use hormone therapy to shrink advanced prostate cancer tumors, so they can be treated with radiation.
Immunotherapy is a promising treatment for prostate cancer, including advanced or recurrent forms of the disease. A variety of immune-based strategies is used to kill a prostate cancer tumor and prevent its recurrence.
This treatment method may be used alone or in conjunction with other treatments, such as radiation therapy and hormone therapy.
Radiation therapy uses targeted energy (e.g., X-rays, radioactive substances) to destroy cancer cells, shrink tumors, and/or alleviate certain cancer-related symptoms.
It may be used:
● As a primary treatment to destroy cancer cells
● In combination with other treatments to stop the growth of cancer cells
● Before another treatment to shrink a tumor
● After another treatment to stop the growth of any remaining cancer cells
● To relieve symptoms of advanced cancer
Radiation therapy is an important part of treatment
With advanced radiation therapy delivery systems, radiation oncologists can target difficult-to-reach tumors in the prostate. Also, radiation oncologists may direct higher radiation doses at prostate cancer cells, while reducing exposure to normal, healthy tissue.
Two primary types of radiation therapy for the treatment of prostate cancer:
External beam radiation therapy (EBRT): Delivers high doses of radiation to prostate cancer cells from outside the body, using a variety of machine-based technologies
High-dose-rate brachytherapy (internal radiation): Delivers high doses of radiation from implants placed close to, or inside, the tumor(s) in the body
Some prostate cancer patients may also undergo stereotactic body radiosurgery, which uses innovative imaging technologies to deliver high doses of radiation to tumors in the prostate. Despite its name, stereotactic body radiosurgery is not a surgical procedure, but a form of radiation therapy. Because the dose rate is high, fewer treatments are used.
Surgical treatments for prostate cancer may be an option for men who qualify based on their overall health and other factors. Surgery is designed to remove cancer through an open (traditional) operation or with robotic equipment. One example of surgery for prostate cancer is the removal of the prostate, called a prostatectomy. One of the preferred options for treating organ-confined prostate cancer is a radical prostatectomy.
Some advantages of surgery for prostate cancer may include:
● Patients with localized cancer may need no further treatment.
● A simultaneous biopsy allows for more accurate staging.
● Post-surgical PSA levels reliably predict the recurrence of cancer.
● Fewer bowel or rectal side effects than with radiation treatments
● Lower risk of urinary urgency and frequency than with radiation treatments
Some disadvantages may include:
● It comes with the possibility of surgery-related risks, including side effects from general anesthesia.
● It requires overnight hospitalization.
● A catheter is required for one or two weeks.
● Long-term sexual changes, including dry orgasms, pain during orgasm and shortened penis, may result
Metastatic prostate cancer
Metastasis is the spread of cancer cells to new areas of the body, often by way of the lymph system or bloodstream. Metastatic cancer, or metastatic tumor, is one that has spread from the primary site of origin, or where it started, into different areas of the body.
It is rare for prostate cancer to metastasize, or spread to other parts of the body. In about 90 percent of all cases, prostate cancer is diagnosed in its early stages, when the disease is confined to the prostate. Most of the time, when the disease metastasizes, prostate cancer cells spread to the brain, bones, lungs, and liver. Metastatic prostate cancer cells may also be found in lymph nodes outside the pelvis.
Treatment for metastatic prostate cancer may depend on where in the body the disease has been detected.
Treatment options include:
● Hormone therapy
● Radiation therapy
In some cases, these treatments may be considered palliative, used to relieve symptoms and improve quality of life.
Exams and Tests
An abnormal digital rectal exam may be the only sign of prostate cancer.
A biopsy is needed to tell if you have prostate cancer. A biopsy is a procedure to remove a sample of tissue from the prostate. The sample is sent to a lab for examination. It will be done in your doctor’s office.
Your doctor may recommend a biopsy if:
• You have a high PSA level
• A digital rectal exam reveals a hard or uneven surface
The biopsy result is reported using what is called a Gleason grade and a Gleason score.
The Gleason grade tells you how fast cancer might spread. It grades tumors on a scale of 1 through 5. You may have different grades of cancer in one biopsy sample. The two most common grades are added together. This gives you the Gleason score.
The higher your Gleason score, the more likely cancer can spread beyond the prostate:
• Scores 2 through 6: Low-grade prostate cancer.
• Score 7: Intermediate- (or in the middle) grade cancer. Most prostate cancers fall into this group.
• Scores 8 through 10: High-grade cancer.
Another grading system, the 5 Grade Group System does a better job of describing how cancer will behave and respond to treatment:
• Grade group 1: Gleason score 6 or lower (low-grade cancer)
• Grade group 2: Gleason score 3 + 4 = 7 (medium-grade cancer)
• Grade group 3: Gleason score 4 + 3 = 7 (medium-grade cancer)
• Grade group 4: Gleason score 8 (high-grade cancer)
• Grade group 5: Gleason score 9 to 10 (high-grade cancer)
A lower group indicates a better chance for successful treatment than a higher group. A higher group means that more of the cancer cells look different from normal cells. A higher group also means that it is more likely that the tumor will spread aggressively.
The following tests may be done to determine whether cancer has spread:
• CT scan
• Bone scan
• MRI scan
The PSA blood test will also be used to monitor your cancer after treatment.