Prostate cancer is the most common cancer in men. According to the American Cancer Society, 17 out 100 men (17 percent) age 50 and older will receive a prostate cancer diagnosis during their life.
Located in front of the rectum and just below the bladder, the prostate is a male reproductive gland about the size and shape of a walnut. Like all cancers, prostate cancer occurs when normal cells-in this case, cells in the prostate-become malignant and start to grow uncontrollably.
Prostate cancer may have no early symptoms. While the following signs may indicate prostate cancer, alone they may signal other medical problems, such as an infection or enlargement of the prostate. Any symptoms should be discussed with your primary care provider.
- Difficulty urinating
- An increase in frequency of urination, especially at night
- Blood in your urine
- Difficulty having or maintaining an erection
- Pain in your pelvic area
Although researchers still do not know what causes prostate cancer, they have identified certain risk factors that have consistently been associated with prostate cancer. The following groups of men are at a higher risk for prostate cancer:
- Older Men: As men age, their risk for prostate cancer increases. The chance of developing prostate cancer goes up significantly after age 50. Two-thirds (66 percent) of prostate cancer occur in men 65 and older.
- Family History: Men with a father or brother who has or had prostate cancer are at an increased risk for the disease. This is especially true if the family member developed prostate cancer before age 65.
- Race: While the reasons behind it are still unknown, African-American men are at an increased risk for prostate cancer. According to the Centers for Disease Control, African American men have about a 19 percent chance (1 in 5) of receiving a prostate cancer diagnosis.
- Diet: Men who eat a lot of fat (five or more servings per day of meat, dairy, eggs and butter) in their diet have a greater chance of developing prostate cancer. Men with a high-fat diet also tend to eat fewer fruits and vegetables and more dairy products (These other factors may be responsible for increased risk rather than the amount of fat itself).
While prostate cancer is a relatively common cancer among men, the good news is that, when caught in its early stages, it is a highly treatable disease. Because early-stage prostate cancer typically has no symptoms, annual prostate screenings are recommended.
Quick and easy prostate cancer screening at MedStar Health can keep you healthy and put you and your family at ease.
The good news about prostate cancer, which grows slowly and produces few symptoms, is that treatment is effective if detected early. Most doctors agree that healthy men over the age of 50 should consider prostate cancer screening, with the following tests.
Screening should occur earlier, at age 40, in those who are at a higher risk of prostate cancer, such as African-American men or those with a family history of prostate cancer. However, you and your MedStar Health doctor should discuss how and when testing can benefit you specifically.
- Prostate-Specific Antigen Blood Test (PSA): PSA is a protein found in semen and is produced by prostate cells. The function of these cells is to keep the semen liquid. If the prostate cells begin to break down or make more of the protein, they will escape into the blood. This causes the numbers to become elevated, signaling that there may be a problem with prostate function.
The PSA blood test measures the level of PSA in the blood; high level occur frequently in men with prostate cancer. However, some men may have high PSA in their blood and not have prostate cancer. That is why it is important to be seen by a urologic oncologist with experience in treating this form of cancer.
As a result of the prostate specific antigen (PSA) test in the last 10 years, men are being diagnosed with prostate cancer 10 years earlier, and the prostate cancer death rate has decreased by 30 percent.
- Digital Rectal Examination (DRE): Your doctor will perform this test in the office. While the patient is lying on his side or with his knees draw up to his chest, your doctor will insert a gloved finger into the rectum to examine the prostate gland. The size, shape, and any irregularities will be noted.
Diagnosis and Treatment
If you or someone you love is newly diagnosed with prostate cancer, you probably feel overwhelmed with a tremendous amount of information and questions. Of course, you have many questions as well. MedStar Health specialists can help you answer those questions and explain your options to you in a way that will make sense.
Once you have a prostate cancer diagnosis, your doctor will refer to the stage of the disease by either a number or a letter. These numbers and letters tell your doctor how big the tumor is and how far beyond the urinary system it has spread. All of these factors will determine your treatment route.
- Stage I (A): Cancer can't be detected by digital rectal examination and is confined to the prostate without evidence of spread outside the prostate.
- Stage II (B): The cancer can be detected by digital rectal examination or an elevated PSA but no evidence exists that the cancer has spread outside the prostate to other organs.
- Stage III (C): Cancer has extended through the capsule that encloses the prostate gland and may involve nearby tissues.
- Stage IV (D): Cancer invades structures adjacent to the prostate, has spread to the lymph nodes, or to other parts of the body such as the liver, bones, or lungs.
- Recurrent/Relapsed: The prostate cancer has been detected or returned (recurred/relapsed) following an initial treatment with surgery and radiation or hormonal therapy.
While common, prostate cancer is a complex and sometimes hard-to-navigate cancer. Treatment options are varied, depend on a variety of factors (such as age, general health and preferences) and all come with both benefits and risks. It is important to discuss different treatments with your doctor and decide which approach is right for you.
Surgery is often the cornerstone of any cancer treatment plan. The goal of surgical oncology (surgery for cancer) is to remove the entire tumor, or as much of it as possible. You may have other treatments following the surgery to destroy remaining cancer cells and prevent it from returning. Sometimes, you have a treatment such as chemotherapy or radiation before your surgery, so the tumor is easier to remove.
Surgical options will depend on the size and stage of the tumor, including:
- Transurethral resection of the prostate (TURP): During this procedure, your surgeon removes tissue from your prostate. This can often help relieve symptoms caused by the cancer.
Surgery to treat prostate cancer may result in impotence and leaking urine or stool. Talk to your doctor about nerve-sparing surgery, which spares the nerves that control erection. Depending on the size and location of your tumor, this may be an option for you.
Cancer specialists at MedStar Health may use medicines to adjust the levels of testosterone. This is called hormonal manipulation. Since prostate tumors require testosterone in order to grow, reducing the testosterone level often works very well in preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. Hormone manipulation may also be done by surgically removing the testes.
The drugs Lupron and Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, it is reversible, unlike surgery. The drugs must be given by injection, usually every 3 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and erectile dysfunction (impotence).
Other medications used for hormonal therapy include androgen-blocking agents (such as flutamide), which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
MedStar Health cancer specialist use prostate seed implementation to treat prostate cancer. It is one of the latest forms of brachytherapy, a mode of treatment in which radioactive material is implanted directly into the organ containing the tumor.
Prostate seeds are tiny titanium metal capsules about the thickness of a toothpick. They contain either radioactive iodine (I-125) or Palladium (Pd-103). Each seed produces a high level of radiation, but only to an area about the size of marble. Seeds are implanted in the prostate through thin tubes, and when tubes are retracted, the radioactive seeds become permanent implants.
This minimally invasive procedure is popular among men with prostate cancer. It is performed in the operating room under spinal anesthesia, and the radiation oncologist uses computer software programs, CAT scans, and transrectal ultrasound to determine the total amount of radioactivity, as well as the number of seeds and seed distribution required within the prostate. Symmetrical distribution of the seeds and correct dosage are essential to the effectiveness of treatment.
Your team of specialists will likely recommend one of the following radiation treatments for prostate cancer:
- Intensity-Modulated Radiation Therapy (IMRT) uses devices that allow the radiation beams to move and change intensity, depending on what kind of tissue they are targeting. This flexibility allows different areas of a tumor to receive different amounts of radiation and protect surrounding healthy tissue from unnecessary radiation exposure.
- Image-Guided Radiation Therapy (IGRT) uses high-quality imaging technology to create images of targeted areas of a tumor during the radiation procedure. Using these images, your radiation oncology team carefully adjusts radiation beams and doses during your treatment session to best fit the size, shape, and location of the tumor while sparing normal tissues. This delivers high doses of radiation to the prostate gland for cancer cure and reduces the dose to normal structures such as the bladder and rectum to lower the risk of side effects.
- 3D Conformal Radiotherapy is a radiation therapy technique that sculpts radiation beams to the shape of a tumor. This is ideal for tumors that have irregular shapes or for those that are close to healthy tissues and organs. We view a tumor in three dimensions with the help of advanced imaging and then deliver radiation beams from several directions.
- CyberKnife Radiation: The prostate is a moving target—it moves when urine fills and then empties from the bladder and when air moves into the rectum. This movement makes accessing the prostate—during either surgery or conventional radiation—without affecting surrounding healthy tissue a challenge. But CyberKnife, with an advanced combination of computer and imaging technology, identifies the exact location of the tumor, coordinates with the Synchrony® Respiratory Tracking System (which follows the tumor's movement as you breathe), and accurately focuses radiation on the tumor without affecting surrounding healthy tissue.
You will be closely watched to make sure the cancer does not spread. This involves routine doctor's checkups. Monitoring will include:
- Serial PSA blood test (usually every 3 months to 1 year)
- Bone scan or CT scan to check for spreading of the cancers
- Complete blood count (CBC) to monitor for signs and symptoms of anemia
- Monitoring for other signs and symptoms, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness