Prostate Cancer

by Andrew Seibert, MD

 

What Is Prostate Cancer?

Prostate cancer develops in a man's prostate, the walnut-sized gland just below the bladder that produces some of the fluid in semen. It's the most common cancer in men after skin cancer. Prostate cancer often grows very slowly and may not cause significant harm. But some types are more aggressive and can spread quickly without treatment.

Symptoms of Prostate Cancer

In the early stages, men may have no symptoms. Later, symptoms can include:

• Frequent urination, especially at night
• Difficulty starting or stopping urination
• Weak or interrupted urinary stream
• Painful or burning sensation during urination or ejaculation
• Blood in urine or semen

Advanced cancer can cause deep pain in the lower back, hips, or upper thighs.

Enlarged Prostate or Prostate Cancer?

The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia (BPH). It's not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis. This inflammation or infection may also cause a fever and in many cases is treated with medicine.

Risk Factors You Can Control

Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. The reason for this link is unclear. Dietary fat, particularly animal fat from red meat, may boost male hormone levels. And this may fuel the growth of cancerous prostate cells. A diet too low in fruits and vegetables may also play a role.

Screening: DRE and PSA

Your doctor may initially do a digital rectal exam (DRE) to feel for bumps or hard spots on the prostate. After a discussion with your doctor, a blood test can be used to measure prostate-specific antigen (PSA), a protein produced by prostate cells. An elevated level may indicate a higher chance that you have cancer, but you can have a high level and still be cancer-free. It is also possible to have a normal PSA and have prostate cancer.

Prostate Cancer Imaging

Some men may need additional tests to see if the cancer has spread beyond the prostate. These can include ultrasound, a CT scan, or an MRI scan (seen here). A radionuclide bone scan traces an injection of low-level radioactive material to help detect cancer that has spread to the bone.

In the MRI scan shown here, the tumor is the green, kidney-shaped mass in the center, next to the prostate gland (in pink).

Prostate Cancer Staging

Staging is used to describe how far prostate cancer has spread (metastasized) and to help determine the best treatment.

• Stage I: Cancer is small and still within the prostate.
• Stage II: Cancer is more advanced, but still confined to the prostate.
• Stage III: Cancer has spread to the outer part of the prostate and nearby seminal vesicles.
• Stage IV: Cancer has spread to lymph nodes, nearby organs or tissues such as bladder or rectum, or distant organs such as bones or lungs.

Prostate Cancer Survival Rates

The good news about prostate cancer is that it usually grows slowly. And 9 out of 10 cases are found in the early stages. Overall, the 5-year relative survival rate is 100% for men with disease confined to the prostate or nearby tissues, and many men live much longer. When the disease has spread to distant areas, that figure drops to 31%. But these numbers are based on men diagnosed at least 5 years ago. The outlook may be better for men diagnosed and treated today.

Treatment: Radiation Therapy

External beam radiation to kill cancer cells can be used as a first treatment or after prostate cancer surgery. It can also help relieve bone pain from the spread of cancer. In brachytherapy, tiny radioactive pellets about the size of a grain of rice are inserted into the prostate. Both methods can impair erectile function. Fatigue, urinary problems, and diarrhea are other possible side effects.

Treatment: Surgery

Removing the prostate, or radical prostatectomy, is used to eliminate the cancer when it is confined to the prostate. New techniques use smaller incisions and seek to avoid damaging nearby nerves. If lymph nodes are also cancerous, prostatectomy may not be the best option. Surgery may impair urinary and sexual function, but both can improve over time.

Treatment: Hormone Therapy

Hormone therapy may shrink or slow the growth of your cancer, but unless it is used with another therapy it will not eliminate the cancer. Drugs or hormones block or stop the production of testosterone and other male hormones, called androgens. Side effects can include hot flashes, growth of breast tissue, weight gain, and impotence.

Treatment: Chemotherapy

Chemotherapy kills cancer cells throughout the body, including those outside the prostate, so it is used to treat more advanced cancer and cancer that did not respond to hormone therapy. Treatment is usually intravenous and is given in cycles lasting 3-6 months. Because the chemotherapy kills other fast-growing cells in the body, you may have hair loss and mouth sores. Other side effects include nausea, vomiting, and fatigue.

Treatment: Cryotherapy

Cryotherapy freezes and kills cancerous cells within the prostate (like the highly magnified cells shown here.) It is not as widely used because little is known about its long-term effectiveness. It's less invasive than surgery, with a shorter recovery time. Because the freezing damages nerves, as many as 80% of men become impotent after cryosurgery. There can be temporary pain and burning sensations in the bladder and bowel.

Treatment: Prostate Cancer Vaccine

This vaccine is designed to treat, not prevent, prostate cancer by spurring your body's immune system to attack prostate cancer cells. Immune cells are removed from your blood, activated to fight cancer, and infused back into your blood. Three cycles occur in one month. It's used for advanced prostate cancer that no longer responds to hormone therapy. Mild side-effects can occur such as fatigue, nausea, and fever.

Food for Health

A cancer-conscious diet may be the best choice for survivors who want to bolster their health and those hoping to lower their risk. That means:

• Five or more fruits and veggies a day
• Whole grains instead of white flour or white rice
• Limit high-fat meat
• Limit or eliminate processed meat (hot dogs, cold cuts, bacon)
• Limit alcohol to 1-2 drinks per day (if you drink)

Foods high in folate may have some action against prostate cancer (spinach, orange juice, lentils). Studies found mixed results on lycopene, an antioxidant found in tomatoes.