Prostate Cancer

The Prostate

The prostate is a walnut shaped muscular gland surrounding portion of the urethra (tube transporting urine and sperm out of your body). The function of the prostate is to produce semen, the fluid containing sperm. Your prostate is positioned beneath the bladder right in front of the rectum. Since the upper portion of the urethra passes the prostate, obstruction of urine and semen can occur if the prostate becomes enlarged.

 
What is Prostate Cancer?
Prostate cancer is the most common nondermatologic cancer in men over age 50 in the US. There are about about 219,000 new cases and about 27,000 estimated deaths that occur each year. Incidence of prostate cancer increases with each decade of life; autopsy studies reveal prostate cancer in 15 to 60% of men age 60 to 90 yr, with incidence increasing with age. The lifetime risk of being diagnosed with prostate cancer is 1 in 6. Median age at diagnosis is 72, and greater than 75% of prostate cancers are diagnosed in men over age 65. Risk is highest for black men.
Prostate cancer symptoms are rare and usually go undetected until urethral obstruction occurs. The cancer is a malignant growth usually beginning in the outer portion of the prostate. Early stage prostate cancer is localized within the prostate gland itself, and majority of patients survive for years with no problems.
 
  • Prognosis

    • Prognosis for most patients diagnosed with prostate cancer, when it is localized or regional, is very good. The life expectancy for elderly men with prostate cancer may only differ little from age-matched men without the disease, depending on their age and comorbidities. For many patients, long-term local control, or even cure, is possible. Potential for prostate cancer cure, when clinically localized, depends on the tumor’s grade and stage. Without early treatment, patients with high-grade, poorly differentiated cancer have a poor prognosis.
 
  • Prostate Cancer Symptoms

    • The disease usually progresses slowly causing no symptoms until advanced. As the cancer becomes advanced, hematuria and symptoms of bladder outlet obstruction (eg, straining, hesitancy, weak or intermittent urine stream, a sense of incomplete emptying, terminal dribbling) may appear. Patients may experience the need to urinate more frequently, especially during the night. Other symptoms may include lower back, hip and extremity stiffness.
 
  • Detection of Prostate Cancer
The most effective detection process includes:
  • Digital rectal examination and prostate-serum specific antigen tests (PSA)
  • Assessment of abnormalities by transrectal needle biopsy (removal of tiny pieces of prostate tissue). Doctors are able to confirm/rule out prostate cancer hence determine if the cancer has spread to other organs.
  • Grading by histology
  • Staging by CT and bone scan
        
  • Treatment

    • Your doctor will tailor your prostate cancer treatment plan, taking into account the type of cancer, the age of the patient, degree to which the cancer has spread and the health condition of the patient. Treatment is guided by PSA level, grade and stage of tumor, patient age, coexisting disorders, and life expectancy.
    • When the cancer is localized within the prostate, surgery or radiation therapy may be appropriate.
    • For cancer outside of the prostate, palliation with hormonal therapy, radiation therapy, or chemotherapy·         For some men who have low-risk cancers, active surveillance without treatment
    • Active surveillance (referred to as watchful waiting when used for elderly patients)
    • This may be appropriate for many asymptomatic patients over the age of 70 with low-risk, or possibly even intermediate-risk, localized prostate cancer or underlying life-limiting disorders coexist; in these patients, risk of death due to other causes is greater than that due to prostate cancer.
  • Treatment Options
    • Laparoscopic radical prostatectomy: This is a minimally invasive procedure whereby the prostate gland is laparascopically removed.  Incisions are made on the patient’s abdomen. Through these incisions, a surgeon uses a laparoscope—a tiny camera—and surgical instruments to conduct the operation and remove the prostate.
       
    • Robotic radical prostatectomy: Robotic prostate cancer surgery is only offered at some institutions. This procedure involves the use robotic arms to guide the laparoscope through small abdominal incisions to remove the cancerous prostate and affected tissue.
       
    • Open radical prostatectomy: This procedure removes the entire prostate with an incision in the lower abdomen. Since the prostate wraps around the urethra, once it is removed the surgeon must reconnect the bladder with the urethra. Radical prostatectomy (removal of prostate with seminal vesicles and regional lymph nodes) is probably best suited for patients under 70 with a tumor confined to the prostate. Prostatectomy is appropriate for some elderly patients, based on life expectancy, coexisting disorders, and ability to tolerate surgery and anesthesia. Prostatectomy is done through an incision in the lower abdomen.
       
    • Radiation therapy: Utilizes high energy x-rays to kill the cancer cells and reduce tumor size. Radiation can be administered from an external machine outside the body (external radiation) or by introducing materials that produce radiation (radioisotopes) through thin plastic tubes directly where the cancer cells are situated (internal radiation).
       
    • Cryotherapy: This minimally invasive procedure uses tiny needle probes. The probes are inserted into the prostate, freezing the gland to temperatures lethal to the prostate cancer. The procedure is incision-free and performed either on an outpatient basis or with a one-night hospital admission. Patients recover y is short and usually experience minimal after effects.
       
    • Chemotherapy: Is a process administering the use of drugs to kill cancer cells. Chemotherapy may be taken orally or injected into a vein. Chemotherapy is usually a systemic treatment, which means that the drugs are administered through the bloodstream, travel through the body and can destroy cancer cells anywhere in the body, including the prostate.