Prostate cancer facts
Cancer of the prostate occurs in men, rarely before the age of 50 and very often after the age of 80. It has been estimated that if all men over the age of 80 were tested, as many as 70% would be found to have prostate cancer. The cancer that occurs in the 80 plus year old man seems to be a less aggressive cancer than those in the younger men. Because of this fact, urologists feel that if the cancers that occur in the younger men can be found early enough, then a good chance of cure can be offered. The incidence of cancer of the prostate is about 1 in 10 or 11 men. If a man has a grandfather, father, or brother who had cancer of the prostate, then the incidence doubles to about 1 in 5 or 6 men.
All men in the 50 - 55 age group should go for a PSA and rectal exam by their urologist or family physician, and then have the testing yearly. Black men and men with a family history of cancer of the prostate should have their testing starting as early as 40 years of age, continuing thereafter on a yearly basis.
How accurate is the PSA test?
The PSA is very specific for prostate disease. We do not recommend that the PSA be done as a screening test alone. A rectal exam of the prostate is necessary also, for the most accurate assessment of the gland and any problems which may be present. The "split PSA" method is now being done in those cases where the PSA is between 4 and 10 with no nodule or irregularity on the prostate exam.
What causes prostate cancer
There is no known specific cause of cancer of the prostate. Several theories exist, from excessive smoking to excessive fat in the diet. The most likely reason is some changing hormonal pattern or some genetic influence in the aging male.
What are the symptoms?
Very early cancer of the prostate has no symptoms. Although not specific, certain symptoms may include: Frequent urination, weak urinary stream, painful urination, pain in the prostate area just before or just after climax, blood in the urine or semen, persistent pain in the low back or hips, loss of sex drive.
Some of these symptoms are indications of late cancer of the prostate, or can be symptoms of other problems. I stress once again the importance of the yearly PSA and rectal examination, and visiting a physician if you have any of the above symptoms.
The diagnosis is made by examining tissue taken from the prostate by either a needle biopsy of the prostate or through an operating type cystoscope. The urologist will most likely perform a transrectal ultrasound of the prostate, this procedure is usually done in the office. It is uncomfortable but is usually not painful. Certain instructions will be given to you prior to and after the ultrasound exam.
Once the diagnosis is made, the urologist will probably order some other testing, usually a bone scan and CT scans or in some cases a MRI scan. Sometimes, testing of the bone marrow is indicated.
What factors determine a treatment plan?
Factors include: Age of the patient, health of the patient, PSA result, stage of the cancer, grade of the cancer, bone scan, CT, MRI etc results, lymph node or bone marrow results, desires of the patient and his family.
How do we start treatment?
As a general rule, men 70 years of age or younger, in good health, with low to medium grade cancer confined to the prostate gland, are best treated with surgical removal of the prostate. Other factors play a part in the decision, and each patient must be treated individually. A good conversation between the patient and his family, and his urologist, is the best way to start to try to understand the problem and what will be best for each person.
What treatment plans are available?
1. Close observation with treatment later when troublesome
2. Total surgical removal of the prostate and seminal vesicals
3. Radiation treatment: Brachytherapy (placement of internal seed)
External beam radiation.
4. Cryoablation of the prostate (freezing)
5. Hormone therapy
What are the chances of cure with prostate cancer?
If one has low grade, low stage cancer of the prostate, according to the latest results of several centers in the United States, the following can be stated:
1. Surgery: A 93% 10 year disease specific survival
2. Close observation: Usually recommended for patients who are older or have other serious medical problems. A 70-75% 8-10 year survival. Bear in mind that left untreated, cancer of the prostate will probably spread within 3-5 years. At that time hormone therapy can put the cancer in remission for another 3-5 years. Most patients who select observation as their form of treatment die with the cancer, not of it.
3. Radiation: External beam irradiation seems to give about a 60% 10 year, disease specific survival. This may have improved with conformal treatment. The newer applications of using Iodine-131 and Paladium-203 seeds into the prostate are showing results of 73% to 83% 10 year survival without cancer.
4. Cryoablation (freezing) : The treatment results are being followed very closely, but the most recent data indicates that it will be better than external beam radiation therapy alone and as good as or better than the seed implantation, interpreted (85-88% 7 year survival without recurrence).
What to do if you find out you have prostate cancer
Of course, consult with the urologist who made the diagnosis. One of the best things one can do is to get a second opinion. This second opinion may be the best time and money you will every spend. Nothing may change in your mind about the proposed treatment, but you will at least be exposed to a second approach and to a second personality.