Prostate Cancer

Prostate Cancer & Treatment Options

Prostate cancer is the most common cancer (excluding certain types of skin cancer) in men in the United States affecting approximately 186,320 men in 2008. It is the second leading cause of death with more than 28,600 men expected to die of prostate cancer this year. African-American men and those with a strong family history of prostate cancer are at particular risk and should discuss their specific possibility with their doctor or health care provider.

Risk Factors

Although it is not known why many men develop prostate cancer, certain risk factors lead to a higher incidence. Among them are:

  • Age: the chance of developing prostate cancer increases after age 50
  • Race: there is a higher incidence among the African-American population
  • Family history: having a father and/or brother diagnosed with prostate cancer, especially at an early age, increases the risk

 

Diagnosis

Prostate cancer is usually diagnosed through a blood test measuring the amount of prostate specific antigens (PSA) in the body, but sometimes signs and symptoms can occur. These may include:

  • Frequent urination, especially at night
  • Difficulty starting or holding back urination
  • Weak or interrupted flow of urine
  • Painful urination
  • Blood in urine or semen

Other conditions can also cause these symptoms, so it is important to check with your doctor or health care provider.

If your doctor or health care provider suspects an abnormality in your prostate he/she may order a variety of tests including:

  • Prostate Specific Antigen (PSA)*: a blood test that is a valuable marker for prostate cancer. This test should be performed annually in men over the age of 45 (earlier for men at high risk for prostate cancer).

*A normal range is 0-4, but a PSA above 2.0 in men younger than 60 may be considered abnormal. Infection or other inflammatory processes of the prostate can also cause a rise in this level, so it is important to undergo additional testing to determine the reason for the elevation.

  • Core Needle Biopsy: using a transrectal ultrasound machine (TRUS) for guidance, your doctor inserts a narrow needle through the rectal wall into the prostate gland. Small pieces of tissue are removed from different areas of the prostate and reviewed under the microscope.

 

Treatment

After a diagnosis of prostate cancer has been established, it is important to discuss your treatment options with a radiation oncologist and urologist. They may include one or a combination of the following choices:

Surgery

Surgery to remove the prostate gland (radical prostatectomy) is an option for some individuals with early stage prostate cancer.

Chemotherapy

The use of chemotherapy to treat prostate cancer is currently under review. It may be recommended in specialized circumstances or through participation in a clinical trial.

Hormone Therapy

Often hormone therapy will be used in addition to other treatment.  It may consist of a combination of injections and oral tablets and may be recommended for between three months and several years depending on the circumstances.

Radiation Therapy

Radiation therapy plays a major role in the treatment of prostate cancer. There are several methods by which the radiation therapy treatments can be given: External beam radiationor Brachytherapy.

  • External beam radiation therapy involves a series of painless, daily (Monday through Friday) outpatient treatments delivered over approximately seven to ten weeks. It works by focusing a beam of ionizing radiation to the prostate while sparing the surrounding tissue. The two main techniques for delivering external beam radiation are:
    • 3-dimensional conformal therapy (3-D conformal) refers to a method of treatment delivery that incorporates 3-dimensional computer planning and treatment systems to produce a high-dose area of radiation that conforms to the shape of the area to be treated. This technique allows the delivery of precise doses of radiation to the targeted area through multiple treatment fields while sparing surrounding tissues such as the bladder or rectum.
    • Intensity modulated radiation therapy (IMRT) which utilizes a more sophisticated system of shields within the machine allowing a higher dose of radiation to be delivered to the prostate from multiple angles, while minimizing the effects on surrounding tissue. This form of 3-D conformal radiotherapy allows a precise adjustment of radiation beams to the tissue within the target area.

While both types of external beam radiation therapy are acceptable treatment, IMRT is the preferred technique for most prostate cancer patients.

  • Brachytherapy refers to the technique of implanting radioactive sources directly into the prostate gland. This procedure takes place under anesthesia, usually in the operating room. There are two methods of delivering this type of radiation to prostate cancer:
    • Permanent seed implants are radioactive seeds inserted directly into the prostate gland under ultrasound guidance and are left in the tissue where the radiation decays over time.
    • High-dose rate brachytherapy (HDR) involves the placement of several hollow tubes in and around the prostate. After these tubes are in place, a small amount of radioactive material is passed through these catheters by a special machine allowing a high dose of radiation to be delivered to the prostate gland while sparing surrounding normal tissue, including the bladder and rectum.  The radiation catheters are removed at the end of each treatment.  This procedure may be performed several times following the completion of your external beam radiation therapy.

In certain situations both external beam radiation therapy and high-dose rate brachytherapy (HDR) may be recommended.

 

Treatment Side Effects

The type and extent of side effects may vary by individual and depend on the type of treatment received. These may include fatigue, increased urinary frequency, burning or difficulty holding your urine. A burning sensation in the rectum and loose stools can also occur. Most of these effects resolve within a few weeks of completing treatment.

Impotence is also a potential side effect of some treatments for prostate cancer, however many individuals who receive radiation therapy for prostate cancer are able to maintain sexual function.