Prostate Cancer

Many men have concerns about prostate cancer. Fortunately, prostate cancer can usually be treated successfully when it is detected early. In fact, the five-year survival rate for prostate cancer detected in early stages (when it is localized or regional) is almost 100%.

Early prostate cancer may not have any symptoms. For this reason is it important to have regular prostate exams once men reach age 50. The best way to beat prostate cancer is to detect it early.

If you have an unusual digital rectal exam or have high levels of prostate-specific antigen (PSA), it will also be important for you to have followup visits with your doctor.

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If you or someone you know has prostate cancer, it's important to get the facts about this disease and its treatment. Click here to receive a FREE copy of "Prostate Cancer: Facts & Fallacies."

Symptoms

It is important to remember that prostate cancer may not cause any symptoms. For this reason, it is important to have regular prostate exams if you are a man over 50 or if you are part of a high-risk group.

The following symptoms could be a sign that you have prostate cancer:

  • Urine flow is weak or interrupted
  • Frequent urination
  • Difficulty with urination
  • Inability to urinate
  • Pain or burning during urination
  • Blood in the urine or semen
  • Recurrent pain in the back, hips or pelvis
  • Difficulty having an erection

Please note: Symptoms such as these are not always an indication of prostate cancer. An enlarged prostate gland can obstruct the flow of urine or cause sexual dysfunction. This condition can be treated with surgery or medication to reduce symptoms.

Diagnosis

Early detection of prostate cancer is critical. The following diagnostic procedures will help your doctor determine if you have prostate cancer.

In all cases, the diagnosis of prostate cancer is confirmed by a biopsy.

Digital rectal examination (DRE)

Your doctor will use a lubricated finger to feel the prostate gland through the rectum. Men should typically begin having yearly DREs, beginning at age 50. High risk groups, such as African-Americans and those with family history of prostate disease, should ask their doctors about starting these exams at a younger age.

Prostate-Specific Antigen (PSA)

When a man has prostate cancer, he may also have higher levels of prostate-specific antigen. Through a blood test, your doctor can determine if your levels of PSA are high. A PSA test may be recommended by your doctor if you are a man over 50 or if you are in a high-risk group.

If a DRE or PSA test suggest you may have prostate cancer, your doctor may recommend one of the following tests for further diagnosis:

Transrectal Ultrasound/Biopsy

In this test, sound waves are used to create an image of your prostate gland. This image may also be used to guide a surgeon in performing a biopsy.

Computed Tomography (CT)

A CT scan uses x-rays to create highly detailed images of your prostate gland. In patients who have already been diagnosed, a CT scan may be used to determine the stage of the cancer.

Radionuclide Bone Scan

This nuclear imaging technology can show whether the disease has spread to bone cells.

Treatments for Prostate Cancer

Prostate cancer can be treated through surgery, radiation, hormone therapy and chemotherapy. Often, a combination of these treatments will be used.

Surgery

  • Radical prostatectomy is the removal of the prostate gland and other affected tissue through an incision in the abdomen or scrotum area.
  • Laparoscopic radical prostatectomy is a minimally invasive procedure that removes the prostate gland through a small incision. At URMC, this procedure is performed with the DaVinci robot surgical system.
  • Transurethral resection of the prostate
  • Cryosurgery involves freezing the affected cells, effectively killing the cancer.

Laparoscopic Prostatectomy

Prostatectomy is surgery to remove the prostate and seminal vesicles to control prostate cancer. Laparoscopic prostatectomy means we do the prostatectomy using the techniques and tools of minimally invasive surgery.

Radiation

  • External radiation means sending radiation directly into cancer cells with equipment that is outside your body.
  • Internal radiation, or implant therapy, involves sending radiation into affected cells through small radioactive "seeds" that are implanted directly into the prostate gland. View a video on Brachytherapy.

Side effects of external radiation may include diarrhea, colitis, problems with urination, impotence and fatigue.

Side effects of internal radiation may include slight bleeding, loss of seeds while urinating and irritation of the rectum.

Hormone therapy

  • Orchiectomy is the removal of the testicles to prevent the production of hormones responsible for the growth of prostate cancer.
  • LHRH analogs reduce the amount of testosterone produced, thereby slowing the growth of cancer cells.
  • Anti-androgens help prevent tumor growth by blocking the body from using testosterone.
  • LHRH antagonist is given by injection to help slow tumor growth.

Side effect of hormone therapy for prostate cancer may include impotence, decreased sexual desire, hot flashes and enlargement of breasts.

Chemotherapy

Chemotherapy is not generally used as the primary treatment for prostate cancer. It may be used in conjunction with other treatments, or if the cancer has spread beyond the prostate gland.

Staging

"Staging" means determining how advanced a cancer is. This is a critical step in planning the most appropriate treatment plan.

Stage I is the least advanced, when cancer cells are present in less than 5% of the prostate tissue and the cancer is not aggressive. Stage IV is the most advanced, when cancer cells have spread into other organs or structures.

Grading

Grading is another important step in the diagnostic process. It helps doctors determine how quickly a tumor is likely to grow or spread.

Cancer cells are removed through a biopsy and then examined in a lab to see how closely they resemble normal cells. Cells that look nearly normal are usually less aggressive, while those whose appearance is significantly different from normal cells are more likely to be aggressive.

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