Prostate cancer
Malignant tumors of the prostate gland. Prostate cancer is the most common non-skin form of cancer and the second-leading cause of deaths from cancer among men, with about 230,000 cases diagnosed and 30,000 deaths in the United States each year. The disease takes a mild course in many men who develop it and may exist in a chronic state for many years. In some men prostate cancer is very aggressive, requiring extensive therapeutic intervention. Prostate cancer typically produces few symptoms until it is fairly advanced; as with all cancers, the earlier that prostate cancer is detected, the more effective treatment is.
Symptoms and Diagnosis
Measurement of prostate specific antigen (PSA) and digital rectal examination (DRE) of the prostate gland for enlargement or palpable growths are the most common screening methods for prostate cancer, though neither is highly reliable. Prostatic enlargement, called benign prostatic hypertrophy (BPH), is normal as a man gets older; BPH and nonmalignant growths of the prostate gland cause increases in PSA. Doctors have mixed opinions about the clinical value of these methods as means of early detection, and researchers are searching for more reliable approaches. Biopsy with laboratory examination of prostate cells remains the only definitive diagnosis for prostate cancer.
Many men do not experience symptoms with prostate cancer, which is one reason there remains such high interest in developing reliable screening methods. When symptoms are present they are often vague and include lower pelvic pain, “start and stop” urination, urinary frequency, urinary incontinence, and occasionally pain in the lower back or upper thighs. A doctor should evaluate such symptoms, as they can suggest various medical conditions that are responsive to treatment.
Therapeutic approaches for prostate cancer
| Therapeutic Method | Course of Treatment | Detriments and Possible Complications | Benefits |
| Chemotherapy | Rotating cycles of administration and rest | Hair loss, tiredness, loss of libido during administration | Can eradicate cancer cells that have escaped from the prostate before they have opportunity to seed and grow elsewhere in the body |
| Cryotherapy (freezing of the tumor and tissue surrounding it) | Procedure takes about 2 hours, done under local anesthetic as an outpatient | Loss of erectile function if nerves are killed by the freezing | Fast recovery
Comparably effective to radiation therapy An option when surgery is impractical or for radiation failure |
| Hormone therapy | Alternating weeks on, weeks off
Continuous for advanced or aggressive cancers |
Loss of libido and erectile function
Loss of muscle mass and strength Enlarged breasts Hot flashes |
Suppresses testosterone, restricting ability of prostate cancer cells to reproduce
Temporary effects |
| Orchiectomy (surgical removal of the testicles) | 2 or 3 days in the hospital
Up to 8 weeks for full recovery |
Effects are permanent
Sterility Loss of libido and sexual function Loss of muscle mass and strength Enlargement of breasts Hot flashes |
Ends testosterone production |
| Prostatectomy | 5-7 days in the
Hospital Up to 1 2 weeks to full recovery following surgery |
Infection, excessive bleeding
Loss of erectile function due to nerve damage Sterility (seminal vesicles, which produce sperm, are also removed) Extended recovery period |
Removes site of the tumor and any cancer cells that have seeded into other areas of the prostate gland beyond the original tumor |
| Radiation therapy, brachytherapy (“seeds”) | About an hour to implant the seeds (done under anesthesia and placed into the prostate gland using ultrasound-guided injections) | May cause some damage to surrounding tissues
Man can emit radioactivity until seeds are no longer radioactive Urinary urgency |
Narrowly targets cancerous tissues or the cancer site, reducing damage to surrounding tissues
Can go about most of regular daily activities |
| Radiation therapy, external beam | 20-minute treatment sessions daily (week days) for 9 weeks | Tiredness, damage to surrounding tissue
Must go to radiation center for treatment |
Effective for killing cancer cells when all of tumor could not be removed or in lieu of surgery |
| Watchful waiting | Indefinite | Cancer may grow, become symptomatic, or metastasize | Noninvasive, no side effects |
Prostate cancer can take 10-20 years to develop after the first cancer cells appear; early diagnosis greatly improves treatment options and outlook.
Treatment
Treatment for prostate cancer depends on numerous variables, including the man’s age and general health at the time of diagnosis, the aggressiveness of the tumor, the presence of metastatic tumors, and what interference the tumor might be creating with urination (as the prostate gland surrounds the urethra). Watchful waiting may be the treatment of choice for slow-growing tumors that produce no symptoms in a man who is in his 70s or 80s, whereas surgery (prostatectomy), radiation therapy, chemotherapy, or hormone therapy (as individual or combined treatments) may be preferred for a man who is in his 50s or 60s and has a fast-growing or symptomatic cancer.
Lifestyle Measures
Diet appears to play a role in prostate cancer, with evidence suggesting that foods high in lycopenes (notably tomatoes and tomato products) and soy isoflavones (soybean-based foods and soy protein) have a protective effect on the prostate gland and are able to kill prostate cancer cells before they can form into tumors. Other foods that appear to have prostate cancer-fighting ability are the cruciferous vegetables (among them broccoli, Brussels sprouts, cabbage, cauliflower, horseradish, kale, kohlrabi, and rutabaga), which contain the antioxidants sulforaphane and isothiocyanate. Conversely, foods high in arachidonic acid and linoleic acid (such as meats) increase testosterone production and appear to fuel the growth of prostate cancer cells. Though clinical research studies are incomplete, many doctors recommend that men approaching middle age make changes in their eating habits to consume greater amounts of vegetables and fruits and begin replacing animal-based protein with soy-based protein to help preserve prostate health. Regular daily exercise also seems to correlate with slowed growth of prostate cancer cells, perhaps through effects that improve immune system function.
Outlook and Quality of Life
Men who live with prostate cancer have many concerns for how the disease, and perhaps even more so its treatment, will affect their lives. Though the prospect of prostate cancer frightens most men, its diagnosis is by no means a death sentence or a “living death” sentence. Four times as many men live with prostate cancer as die from it. The course of prostate cancer is highly individualized, and its difficulty depends as much on circumstances of support within a man’s life as the disease process itself. Most men who are diagnosed with prostate cancer are able to continue enjoying intimate, sexual relationships with full sexual function, as well as to continue enjoying other activities that are important in their lives. Open communication between partners, and sometimes redefining what is important, is a significant dimension of such enjoyment. Men who are younger may choose to retire from their jobs if that is an option, or to pursue other career interests.
Ongoing research produces a steady flow of new treatment options and approaches. Refined surgical procedures preserve bladder and sexual functions previously at risk with older surgical methods. Radiation therapy can precisely target prostate tumors, minimizing damage to surrounding tissues. At present doctors diagnose more than 80 percent of prostate cancers in their earliest and most treatable stages; the five-year survival rate (cancer’s milestone marker for treatment success) is nearly 100 percent for men diagnosed and treated when the tumor is small and localized to the prostate gland.