Prostate Cancer

Nine out of 10 men who are diagnosed with early stage prostate cancer can go on to live a healthy life after proper treatment. That is great news, considering prostate cancer is the most common cancer among men and the third leading cause of cancer deaths in men. Despite these excellent odds, more than 33,720 men still die each year from cancer of the prostate gland. Prostate cancer is rarely found in men younger than 40.

Prostate cancer involves a malignant tumor growth within the prostate gland. The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels.

Men at higher risk include African-America men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).

Prostate cancers are grouped according to tumor size, any spreading outside the prostate (and how far), and how different tumor cells are from normal tissue. This is called staging. Identifying the correct stage may help the doctor determine which treatment is best.

Prostate Cancer Symptoms

Often prostate cancer will have no symptoms at all. With testing, it can be detected long before any of these prostate cancer symptoms appear.

• Painful or burning urination
• Inability to urinate or difficulty in starting urine stream
• Inability to empty bladder
• Blood in urine
• Continual pain in the lower back, pelvis or upper thighs
• Frequent, urgent need to urinate

Prostate Check-Up Guidelines

Men over the age of 65 are most likely to develop prostate cancer. There are some check-up guidelines, however, that men can follow to detect prostate cancer early.

Click here for Cancer Screening Guidelines for Men.

Prostate Cancer Treatment

Prostate cancer treatments may vary based on the stage of the cancer. Depending on the stage, cancer treatments may include medications, surgery, radiation therapy or lifestyle changes. Treatment options vary based on the stage of the tumor. In the early stages, talk to your doctor about several options, including surgery, radiation therapy or, in older patients, monitoring the cancer without active treatment.

Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes or chemotherapy.

Surgery, radiation therapy and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.

Surgery

Surgery is usually only recommended after thorough evaluation and discussion of all treatment options. A man considering surgery should be aware of the benefits and risks of the procedure.

Removal of prostate gland (radical prostatectomy) is often recommended for treatment of stage A and B prostate cancers. This is a lengthy procedure, usually done using general or spinal anesthesia. A surgical cut is made through the abdomen or perineal area. You may remain in the hospital for 5 - 7 days. Possible complications include impotence and urinary incontinence, although nerve-sparing procedures may reduce the risk of these complications. This surgery should be done by a urologist with extensive experience doing this specific procedure.
Orchiectomy alters hormone production and may be recommended for metastatic cancer. There may be some bruising and swelling initially after surgery, but this will gradually go away. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass. 

Radiation Therapy

 
Radiation therapy is used primarily to treat prostate cancers classified as stages A, B, or C. Whether radiation is as good as prostate removal is a debatable topic, and the decision about which to choose can be difficult. In patients whose health makes the risk of surgery unacceptably high, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:

External beam radiation therapy is done in a radiation oncology center by specially trained radiation oncologists, usually on an outpatient basis. Prior to treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that resembles a normal x-ray machine. The treatment itself is generally painless. Side effects may include loss of appetite, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, cystitis (inflamed bladder), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.
Internal radiation therapy places radioactive seeds inside you, directly in or near the tumor. This is called brachytherapy. A surgeon makes a small cut in the area to inject the seeds. They are so small, you don't feel them. The seeds can be temporary or permanent. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues surrounding the prostate. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea. Radiation is sometimes used for pain relief when cancer has spread to the bone.

In addition, CyberKnife stereotactic radiosurgery may be an option. UT Medical Center is home to CyberKnife, a revolutionary technology that enables treatment of tumors throughout the body at greater convenience and comfort to the patient than other radiosurgery systems such as Gamma Knife.

CyberKnife, a non-invasive, image guided, high-energy radiation treatment, often is used for tumors and is capable of treatment throughout the entire body. CyberKnife delivers precise beams of radiation from many angles outside the body without requiring the use of a metal head frame. The accuracy is so precise, in fact, that radiation can be matched to the shape of small complex tumors—even those close to critical organs. This technology is able to treat conditions such as prostate cancer, even tumors that are considered inoperable or untreatable with surgery or other options.

For additional information on your prostate cancer treatment, please contact the CyberKnife Center at 865.305.6889.

Medications

Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Since prostate tumors require testosterone 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.

Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs. After the first round of chemotherapy, most men receive further doses on an outpatient basis at a clinic or physician's office. Side effects depend on the drug given and how often and how long you take it.

Monitoring

You will be closely watched to make sure the cancer does not spread. This involves routine doctor's check ups. Monitoring will include the following. 

• 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

 Early detection is your best defense against prostate cancer.

Call 865.305.6970 to request an appointment today!

For more information, visit the American Cancer Society or National Cancer Institute.