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Prostatitis
Prostate cancer is a malignant
tumor growth within the prostate gland. Prostate cancers are
classified or staged based on their aggressiveness and the
degree that they are different from the surrounding prostate
tissue (differentiation). There are several different ways
to stage tumors, however, most prostate cancers are staged
using the A-B-C-D staging system (also known as the
Whitmore-Jewett system). This staging system contains
several substages, but it basically categorizes tumors using
the following scale:
- A - tumor not
palpable (able to be felt) but detectable in microscopic
biopsy
- B - palpable tumor
confined to prostate
- C - extension of
tumor beyond prostate with no distant metastisis
- D - cancer has
spread to regional lymph nodes
Prostate cancers spreads by
extending into the seminal vesicles, bladder, and peritoneal
cavity. Prostate cancers typically metastasize to the lymph
nodes, bones, lungs, liver, and kidneys.
Risk
Factors
The cause is unknown,
although some studies have shown a relationship between high
dietary fat intake and increased testosterone levels. This
hormonal role has been suggested by observing that eunuchs
(men whose testicles have been destroyed or removed) do not
develop prostatic cancer, and prostate tumors regress after
surgical removal of the testicles (orchiectomy). There is no
known association with benign prostatic hyperplasia (BPH).
Prostatic cancer is the third most common cause of death
from cancer in men of all ages and is the most common cause
of death from cancer in men over 75 years old. Prostate
cancer is rarely found in men younger that 40 years of age.
The incidence is greatest in black men over 60 years old.
Increased incidence is also associated with farmers, tire
workers, painters, and men exposed to cadmium. The lowest
incidence occurs in Japanese men and vegetarians.
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Prevention
No preventive measures are
known. Adopting a vegetarian, low fat diet or one that
mimics the traditional Japanese diet may lower risk. Early
identification is now possible by YEARLY screening of men
over 40 or 50 years old through digital rectal examination (DRE)
and PSA (prostate specific antigen) blood test.
Additionally, a transrectal prostate ultrasound and biopsy
may be performed to evaluate suspicious areas.
Each year in September is Prostate Cancer Awareness Week.
Several urology clinics across the country hold free
prostate screening clinics which provide educational
materials as well as free rectal exams and PSA blood
testing. Contact a hospital or medical center in your area
for information on their program for Prostate Cancer
Awareness Week. Additionally information may be obtained by
contacting your local chapter of the American Cancer
Society.
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Symptoms
Symptoms of prostate cancer
include:
- urinary hesitancy (delayed
or slowed start of urinary stream)
- urinary dribbling,
especially immediately after urinating
- urinary retention
- pain with urination
- pain with ejaculation
- lower back pain
- pain with bowel movement
Additional symptoms that may be
associated with this disease:
- urination, excessive at
night
- urinary frequency/urgency,
increased
- sweating, excessive
- incontinence
- bone pain or tenderness
- abnormal urine color
- hematuria (blood in the
urine)
- abdominal pain
- anemia
- weight loss
- lethargy
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Treatment
Appropriate treatment for
prostate cancer is often controversial. Treatment options
vary based on the stage of the tumor. In the early stages,
surgical removal of the prostate (prostatectomy) and
radiation therapy may be used to eradicate the tumor.
Metastatic cancer of the prostate may be treated by hormonal
manipulation (reducing the levels of testosterone to prevent
further spread of the cancer) or chemotherapy.
MEDICATIONS:
- HORMONAL MANIPULATION:
Hormonal manipulation aims at lowering testosterone
levels. Since prostate tumors are dependent on
testosterone, reduction of the testosterone level is
often very effective in preventing further growth and
spread of the cancer. Hormonal manipulation may halt the
growth of advanced prostate cancer, or relieve symptoms
in people with metastatic disease.
A synthetic estrogen, DES (diethylstilbestrol), is often
used to reduce testosterone levels. This medication is
taken once a day. Possible side effects include
gynecomastia (development of breasts in males), nausea,
and vomiting.
Other medications used for hormonal therapy include
androgen blocking agents (such as flutamide) which
prevent testosterone from attaching to the prostate
cells. This medication must be taken three times a day
indefinitely. Possible side effects include gynecomastia,
erectile dysfunction, and diarrhea.
Synthetic drugs that mimic the function of LHRH (luteinizing
hormone releasing hormone) (lupron or zoladex) are being
used increasingly to treat advanced prostate cancer.
These medications suppress gonad (testicular)
stimulation of testosterone production. They must be
given by injection, on a monthly basis. Possible side
effects include nausea and vomiting, hot flashes, and
erectile dysfunction (impotence).
- CHEMOTHERAPY:
Chemotherapy is often used as a palliative (relieve
symptoms without curing disease) treatment of prostate
cancers that are resistant to hormonal treatments. You
will usually be hospitalized for the first few doses of
chemotherapy to monitor for possible side effects. Most
people receive their chemotherapy (after the initial
dose) on an outpatient basis at a clinic or physician's
office. Possible side effects are numerous and specific
to a given chemotherapy drug.
SURGERY:
Surgical treatment is usually only recommended after
thorough evaluation and discussion of the treatment options.
A man considering surgery should be aware of the expected
benefit of the procedure as well as its potential risks.
- RADICAL PROSTATECTOMY
Radical prostatectomy is often recommended for treatment
of localized stage A and B prostate cancers. This
procedure is a lengthy procedure, especially if a lymph
node dissection (removal) is performed at the same time,
which is usually performed using general or spinal
anesthesia. An incision is made through the abdomen or
perineal area. You will remain in the hospital for 7 to
10 days. Possible complications include impotence and
urinary incontinence, although nerve sparing procedures
can reduce the risk of these complications.
- ORCHIECTOMY
Metastatic cancer of the prostate may be treated by
hormonal manipulation through bilateral orchiectomy
(removal of the testicles, castration). The resulting
lower levels of testosterone prevents further spread of
the cancer. Orchiectomy is performed under general
anesthesia as a same day surgical procedure with an
overnight stay. A small incision is made in the groin
area to remove the testicle. There may be some bruising
and swelling initially after surgery, but this will
gradually subside.
- OTHER SURGICAL OPTIONS
Physicians are currently evaluating the long term
effects of an investigational surgical procedure called
cryosurgical ablation of the prostate. Cryosurgery
ablation is a method of destroying the tumor by freezing
the entire prostate gland. The procedure is performed
using general anesthesia. A series of cryoprobes are
inserted through the perineum to freeze the prostate
gland. You will stay in the hospital 2 to 3 days after
the procedure to monitor you for potential
complications, including bleeding, infection, tissue
injury, and inability to urinate. You should be able to
resume normal activities within one week after surgery.
Cryosurgery ablation is now considered an alternative to
radiation therapy for people with small, localized tumor
since this procedure is associated with less risk of
bleeding, incontinence, and impotence when compared to
standard treatments.
RADIATION THERAPY:
Radiation therapy is used primarily to treat Stage B and C
prostate cancers, or for people with localized tumors who
are not candidates for surgery for health or personal
reasons. Radiation therapy to the prostate gland may be
performed in a number of ways.
External beam radiation therapy, is performed in the
hospital, usually on an outpatient basis, by specially
trained radiation therapists. Prior to treatment, a
therapist will mark the location that is to be radiated with
a special semi-permanent marking pen. The radiation is
delivered to the prostate gland and regional lymph nodes
using a device that resembles a normal x-ray machine. The
treatment itself is generally painless, however, there are
several side effects associated with radiation therapy.
Possible side effects include loss of appetite, fatigue,
skin reactions such as redness and irritation, rectal
burning or injury, cystitis (inflamed bladder), and
hematuria (blood in urine). External beam radiation therapy
is usually performed five days a week for six to eight
weeks.
Another method of administering radiation therapy to the
prostate consists of implanting radioactive iodine, gold, or
iridium in the form of small pellets or seeds directly into
the prostate tissue through a small incision. The advantage
of this form of radiation therapy is that the radiation is
directed at the prostate with less damage to the surrounding
tissues. Because of the amount of radiation involved is
small, you are not considered radioactive.
LIFESTYLE CHANGES:
Surgery, radiation therapy, and hormonal manipulation all
have the potential to disrupt sexual desire and/or
performance. Discuss your concerns with your health care
provider as some of these dysfunctions may be temporary.
Additionally, there are several options available for
managing the sexual dysfunctions related to prostate cancer
treatments.
MONITORING:
You will be closely monitored for progression of the disease
regardless of the type of prostate cancer treatment you
receive. Monitoring will include:
- Serial prostatic-specific
antigen (PSA) blood test (usually every 6 months to 1
year)
- Bone scan and/or CT scan
to evaluate for metastasis
- Complete blood count (CBC)
to monitor for signs and symptoms of anemia indicating
disease progression
- Post void residual (PVR)
to monitor for urinary retention indicating possible
disease progression
- Monitor for other signs
and symptoms indicating disease progression, such as
fatigue, weight loss, increased pain, decreased bowel
and bladder function, and weakness
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