Prostate Cancer


Prostate cancer forms in the tissues of the prostate. Except for skin cancer, cancer of the prostate is the most common malignancy among American men. In most men with prostate cancer, the disease grows very slowly. The majority of men with low-grade, early prostate cancer, in which cancer cells have been found only in the prostate, live a long time after their diagnosis. More than 70 percent of men diagnosed with this disease are over the age of 65. African American men have a substantially higher risk of prostate cancer than Caucasian men and Hispanic men. Genetic factors also appear to play a role, particularly for families in which the diagnosis is made in men under age 60. The risk of prostate cancer rises with the number of close relatives who have the disease.

Prostate cancer often does not cause symptoms for many years but when symptoms do occur, they may include urinary problems such as:

  • Not being able to urinate
  • Having a hard time starting or stopping the urine flow
  • Needing to urinate often, especially at night
  • Weak flow of urine
  • Urine flow that starts and stops
  • Pain or burning during urination

Other symptoms may include:

  • Difficulty having an erection
  • Blood in the urine or semen
  • Frequent pain in the lower back, hips or upper thighs

These can be symptoms of cancer, but more often they are symptoms of non-cancerous conditions. It is important to check with a physician or the Good Samaritan cancer team.

Digital Rectal Exam and Prostate-Specific Antigen Tests
Two tests can be used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE) in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate-specific antigen (PSA). Together, these tests can detect many prostate cancers that have not caused symptoms. Due to the widespread use of PSA testing in the United States, approximately 90% of all prostate cancers are currently diagnosed at an early stage, enabling men to survive longer after diagnosis.

Neither of the screening tests for prostate cancer are perfect. Most men with mildly elevated PSA levels do not have prostate cancer and many men with prostate cancer have normal levels of PSA. Also, the DRE can miss many prostate cancers. Therefore, DRE and PSA tests together are more accurate than either test alone.

Biopsy
The diagnosis of prostate cancer can be confirmed only by a biopsy. During a biopsy, a Good Samaritan urologist removes tissue samples, usually with a needle. This is generally done in the doctor’s office with local anesthesia. Then a skilled hospital pathologist checks for cancer cells.

Prostate cancer is described by both grade and stage:

Gradedescribes how closely the tumor resembles normal prostate tissue. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10.  The higher the Gleason score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.

Stagerefers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland and may be in the seminal vesicles. Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to other tissues or organs.

Three treatment options are generally accepted for men with localized prostate cancer—radical prostatectomy, radiation therapy (with or without hormonal therapy), and surveillance (also called watchful waiting).

Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes the cancer team will also recommend that lymph nodes in the pelvic area are also removed. Radical prostatectomy may be performed without causing damage to the nerves needed for an erection. However, nerve-sparing surgery is not always possible. Possible side effects of surgery can include incontinence (inability to control urination) and impotence (inability to achieve erection). 

Radiation therapy involves the delivery of radiation to the prostate through the Varian TrueBeam system, using an external beam of radiation. The energy can also be delivered in a technique known as brachytherapy, which involves implanting radioactive seeds in the prostate using a needle. Patients with high-risk prostate cancer are candidates for adding hormonal therapy to standard radiation therapy. Treatment is painless, though some men experience diarrhea, urinary symptoms and skin irritation.

Active surveillance (watchful waiting) may be an option recommended for patients with early-stage prostate cancer, particularly those who have low-grade tumors with only a small amount of cancer seen in the biopsy specimen. These patients have regular examinations, PSA testing, and sometimes scheduled biopsies. If there is evidence of cancer growth, active treatment may be recommended. Older patients and those with serious medical problems may also be good candidates for active surveillance.
Choosing a treatment option involves the patient, his family, and one or more doctors. They will need to consider the grade and stage of the cancer, the man’s age and health, and his values and feelings about the potential benefits and risks of each treatment option. Often it is useful to seek additional opinions from physicians on the cancer team such as a urologist, radiation oncologist, internist, family practitioner or a medical oncologist. Because there are several reasonable options, patients may hear different opinions and recommendations, making the decision difficult. However, it is important to get as much information as possible and allow enough time to make an informed decision.