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Prostate Cancer
Description
Prostate cancer is the second biggest killer of men. The reason for this is by the time it is detected, the cancer has often spread elsewhere in the body.
Nuclear-Medicine experts say they've found a new method that detects prostate cancer faster and more accureatly than current methods including MRI and CAT scans.
Known as prostascint, the new imaging technique relies on a radioactive isotope that is released into the body. This isotope attaches to cancer cells and can be scanned, providing a map that gives the size and location of the prostate cancer cells. An FDA committee recently recommended that the new technique be reviewed for approval.
Cancer of the prostate, a common form of cancer, is a disease in which cancer (malignant) cells are found in the prostate. The prostate is one of the male sex glands and is located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). The prostate is about the size of a walnut. It surrounds part of the urethra, the tube that carries urine from the bladder to the outside of the body. The prostate makes fluid that becomes part of the semen, the white fluid that contains sperm.
Cancer of the prostate is found mainly in older men. As you get older, your prostate may get bigger and block the urethra or bladder, which can cause you to have difficulty urinating or may interfere with sexual functions. This condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, you may need surgery to correct it. The symptoms of BPH or of other problems in the prostate may be similar to symptoms for prostate cancer.
You should see a doctor if you have any of the following symptoms: weak or interrupted flow of urine, urinating often (especially at night), difficulty urinating, pain or burning when you urinate, blood in the urine, or nagging pain in the back, hips, or pelvis. Often there are no symptoms of early cancer of the prostate. To examine you, usually your doctor will insert a gloved finger into the rectum (a rectal examination) to feel for lumps in the prostate. A special test called an ultrasound, which uses sound waves to make a picture of your bladder, may also be done.
If your doctor feels anything that is not normal, he or she may need to take cells from your prostate and look at them under a microscope. Your doctor will usually do this by putting a needle into the prostate to remove some cells. To get to your prostate, your doctor may put the needle through the rectum or through the space between the scrotum and the anus (the perineum). This is called a fine needle aspiration or a needle biopsy.
Your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the prostate or has spread to other places in the body) and your general health.
Stages Of Cancer Of The Prostate
Once cancer of the prostate has been found (diagnosed), more tests will be done to find out if cancer cells have spread from the prostate to tissues around it or to other parts of the body. This is called "staging." To plan treatment, your doctor needs to know the stage of your disease. The following stages are used for cancer of the prostate:
Stage I (A) Prostate cancer at this stage cannot be felt and causes no symptoms. The cancer is only in the prostate and usually is found accidentally when surgery is done for other reasons, such as for benign prostatic hyperplasia. It can also be found by a needle biopsy that is done because a blood test (called a prostate-specific antigen [PSA] test) showed an elevated PSA level. Cancer cells may be found in only one area of the prostate or they may be found in many areas of the prostate.
Stage II (B) The tumor may be found by a needle biopsy that is done because a blood test showed an elevated PSA level or it may be felt in the prostate during a rectal examination, even though the cancer cells are found only in the prostate gland.
Stage III (C) Cancer cells have spread outside the covering (capsule) of the prostate to tissues around the prostate. The glands that produce semen (the seminal vesicles) may have cancer in them.
Stage IV (D) Cancer cells have spread (metastasized) to lymph nodes (near or far from the prostate) or to organs and tissues far away from the prostate such as the bone, liver, or lungs.
Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the prostate or in another part of the body.
Prostate staging can also be described by using T (tumor size), N (extent of spread to lymph nodes), and M (extent of spread to other parts of the body
How Cancer Of The Prostate Is Treated
There are treatments for all patients with cancer of the prostate. Four kinds of treatment are commonly used: surgery (taking out the cancer) radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) hormone therapy (using hormones to stop cancer cells from growing) biological therapy (using your body's immune system to fight cancer).
Surgery is a common treatment for cancer of the prostate. Your doctor may take out the cancer using one of the following operations.
Radical prostatectomy is the removal of the prostate and some of the tissue around it. Your doctor may do the surgery by cutting into the space between the scrotum and the anus (the perineum) in an operation called a perineal prostatectomy or by cutting into the lower abdomen in an operation called a retropubic prostatectomy. Radical prostatectomy is done only if the cancer has not spread outside the prostate. Often before the prostatectomy is done, your doctor will do surgery to take out lymph nodes in the pelvis to see if they contain cancer. This is called a pelvic lymph node dissection. If the lymph nodes contain cancer, usually your doctor will not do a prostatectomy and may or may not recommend other therapy at this time. Impotence and leakage of urine from the bladder can occur in men treated with surgery.
Transurethral resection is a procedure in which the cancer is cut from the prostate using a tool with a small wire loop on the end that is put into the prostate through the urethra. This operation is sometimes done to relieve symptoms caused by the tumor before other treatment or in men who cannot have a radical prostatectomy because of age or other illness.
Cryosurgery is a type of surgery that kills the cancer by freezing it.
Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). Impotence may occur in men treated with radiation therapy.
Hormone therapy is the use of hormones to stop cancer cells from growing. Hormone therapy for prostate cancer can take several forms. Male hormones (especially testosterone) can help prostate cancer grow. To stop the cancer from growing, female hormones or drugs called LHRH agonists that decrease the amount of male hormones made may be given. Sometimes an operation to remove the testicles (orchiectomy) is done to stop the testicles from making testosterone. This treatment is usually used in men with advanced prostate cancer. Growth of breast tissue is a common side effect of therapy with female hormones (estrogens). Other side effects that can occur after orchiectomy and other hormone therapies include hot flashes, impaired sexual function, and loss of desire for sex.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the prostate. To date, chemotherapy has not had significant value in treating prostate cancer, but clinical trials are in progress to find more effective drugs.
Biological therapy tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy or immunotherapy.
Treatment By Stage
Treatment of cancer of the prostate depends on the stage of your disease, your age, and your overall health. Your doctor may choose to follow your condition more closely rather than starting treatment immediately. This decision depends on whether you have symptoms of the disease, are elderly, have another more serious illness, or have only slightly abnormal tumor cells.
STAGE I (A) PROSTATE CANCER
Your treatment depends on whether your cancer cells are found in one or more areas of the prostate.
If your cancer cells are found in only one area of the prostate and you are older, your doctor may follow your condition closely without any treatment. Your doctor may choose this option for you because your cancer is not causing any symptoms or other problems and may be growing slowly. If you are younger, you may have surgery to remove the prostate and the tissue around it (radical prostatectomy) or external radiation therapy.
If your cancer cells are found in more than one area of the prostate, your treatment may be one of the following: 1. If you are older or have another more serious illness, your doctor may follow your condition closely without treatment. 2. External radiation therapy. 3. Surgery to remove the prostate and the tissue around it (radical prostatectomy), with or without new techniques to preserve the nerves necessary for an erection as well as preventing leakage of urine from the bladder (nerve sparing technique). Any surgery may cause some leakage. Usually some of the lymph nodes in the pelvis are also removed (pelvic lymph node dissection). Radiation therapy may be given after surgery in some cases. 4. A clinical trial of internal radiation therapy, often in addition to pelvic lymph node dissection. 5. A clinical trial of external radiation therapy using new techniques to protect your normal tissues from radiation. 6. Other clinical trials.
STAGE II (B) PROSTATE CANCER
Your treatment may be one of the following: 1. Surgery to remove the prostate and the tissue around it (radical prostatectomy), with or without techniques to preserve the nerves necessary for an erection as well as preventing leakage of urine from the bladder (nerve sparing technique). Any surgery may cause some leakage. Usually some of the lymph nodes in the pelvis are also removed (pelvic lymph node dissection). Radiation therapy may be given following surgery. 2. External radiation therapy. Clinical trials are testing new types of radiation. 3. If you are older or have another more serious illness, your doctor may follow your condition closely without treatment. Your doctor may choose this option for you because your cancer is not causing any symptoms or other problems and may be growing slowly. 4. A clinical trial of internal radiation therapy, often in addition to pelvic lymph node dissection. 5. A clinical trial of external radiation therapy using new techniques to protect your normal tissues from the radiation. 6. A clinical trial of cryosurgery. 7. Other clinical trials.
STAGE III (C) PROSTATE CANCER
Your treatment may be one of the following: 1. External radiation therapy. Clinical trials are testing new types of radiation. 2. Surgery to remove the prostate and the tissue around it (radical prostatectomy). Usually some of the lymph nodes in the pelvis are also removed (pelvic lymph node dissection). Radiation therapy may be given following surgery. 3. If you are older or have another more serious illness, your doctor may follow your condition closely without treatment. Your doctor may choose this option for you because your cancer is not causing any symptoms or other problems and may be growing slowly. 4. Clinical trials of internal radiation therapy, often in addition to pelvic lymph node dissection. 5. Clinical trials of other forms of radiation therapy. 6. Clinical trials of cryosurgery. 7. Other clinical trials.
If you are unable to have surgery or radiation therapy to cure you of the disease, your doctor may give you palliative treatments (treatments to relieve the symptoms of the disease, such as problems urinating). In this case, your treatment may be one of the following: 1. Radiation therapy to relieve symptoms. 2. Hormone therapy. 3. Surgery to cut the cancer from the prostate using a tool with a small wire loop on the end that is put into the prostate through the urethra (transurethral resection).
STAGE IV (D) PROSTATE CANCER
Your treatment may be one of the following: 1. Hormone therapy. 2. External radiation therapy. Clinical trials are testing new forms of radiation. Hormone therapy may be given in addition to radiation. 3. Radiation therapy to relieve symptoms. 4. Surgery to relieve symptoms. 5. If you are older or have another more serious illness, your doctor may follow your condition closely without treatment. Your doctor may choose this option for you because your cancer is not causing any symptoms or other problems and may be growing slowly. 6. Other types of radiotherapy. 7. Clinical trials of surgery to remove the prostate and the tissue around it (radical prostatectomy) and surgery to remove the testicles (orchiectomy). 8. A clinical trial of chemotherapy. 9. A clinical trial of more than one hormone therapy.
RECURRENT PROSTATE CANCER
Your treatment depends on many things, including what treatment you had before. If you had surgery to remove the prostate (prostatectomy) and the cancer comes back in only a small area, you may receive radiation therapy. If the disease has spread to other parts of the body, you will probably receive hormone therapy. Radiation therapy may be given to relieve symptoms, such as bone pain. You may also choose to take part in a clinical trial of chemotherapy or biological therapy.
Upper Limit of a normal PSA level for Asians, blacks, and whites in 4 age ranges.
| Age Range | Asian PSA | Black PSA | White PSA |
| 40'S | 2.0 | 2.0 | 2.5 |
| 50,S | 3.0 | 4.0 | 3.5 |
| 60,S | 4.0 | 4.5 | 4.5 |
| 70'S | 5.0 | 5.5 | 6.5 |