About Prostate Cancer

According to the American Cancer Society, prostate cancer is one of the most common forms of cancer among American men, mainly affecting men over the age of 65. As men get older, the likelihood of developing prostate cancer increases, therefore, physicians usually recommend that prostate cancer screening begin at age 50. For African American men, or men with a family history of prostate cancer, physicians recommend screening beginning at age 40.

Diagnosis

There are currently 2 tests that are most commonly used in the diagnosis of prostate cancer, called the digital rectal exam (DRE) and the prostate-specific antigen (PSA) test. The DRE is a traditional diagnostic tool for the detection of prostate cancer and is sometimes given during regular "physicals." The doctor feels the prostate through the rectum, checking for irregularities that could indicate the presence of a tumor. Increasingly, doctors use the DRE in conjunction with the PSA test to diagnose prostate cancer. The PSA test is a blood test that searches for a substance called PSA, which may be elevated when there is even the smallest number of cancer-producing cells in the prostate.

If your doctor suspects that there are cancerous cells in your prostate, a biopsy may be recommended. Prostate tissue is removed with a needle and is examined under a microscope. If the biopsy indicates there are cancerous cells in the sample, further tests are done to help determine the level or severity of the cancer, and to aid in treatment decisions.

What a "Positive Biopsy" Means

If prostate cancer is detected early in the course of the disease, chances are that it is localized in the prostate, and is NOT life threatening. However, if it is discovered late, the cancer may have spread to other tissues in the body, outside of the prostate, and can eventually cause death. Approximately 40,000 men die every year from prostate cancer.

Treatment Options

There are many ways to treat prostate cancer, most of which are comparably effective. The choice of treatments options depends on different factors including:

• severity of the cancer, and whether or not it has spread outside of the prostate
• the age and general health of the patient
• what kind of side effects the patient can most easily tolerate.

When the cancer remains in the prostate, it’s considered “localized” and very curable. The treatment options for localized prostate cancer include:

• "Watchful waiting," which is a wait-and-see approach, assuming that the cancer will grow very slowly, and may never need active treatment. Watchful waiting is most often a seriously considered approach when the patient is older, has a small tumor with minimal or no symptoms, and whose body won't react well to more aggressive therapies like surgery.
• Removal of the entire prostate is the most traditional method. Though it virtually ensures that all of the cancer is removed from the body, and it won't come back, it carries serious side effects. These side effects include impotence and incontinence, though innovations in surgical techniques including "nerve sparing" technologies are reducing the incidence of these side effects.
• External beam radiation therapy (XBRT) delivers radiation to the prostate from OUTSIDE of the body. This therapy also carries side effects including an increased risk of impotence and incontinence, as well as mild burning in the treatment area.
• Brachytherapy involves INTERNAL radiation therapy, where the doctor puts radioactive seeds INSIDE of the prostate. It has been shown to be as effective as other treatments and has fewer side effects. Additional and more specific information about brachytherapy is available in the What Is Brachytherapy? section of the site.
• Combination therapy involves the use of BOTH XBRT and brachytherapy, and is usually used in the treatment of more aggressive tumors. When combined, XBRT and brachytherapy offer a very potent treatment option that is less invasive than surgery.
• Cryotherapy involves the insertion of a probe through the urethra to circulate liquid nitrogen through the prostate gland. The nitrogen freezes and kills all of the cells, cancerous and noncancerous.