Prostate Cancer Symptoms and Treatment at Newyorkurologic.com

About Prostate Cancer

Cancer of the prostate is most common in men over 60 years of age. The prostate is an organ in the male reproductive tract that lies below the bladder and in front of the rectum.  Nearly 200,000 new cases of Prostate Cancer are reported annually in the United States.  It is more common in African American men and least common among Asians and Native Americans.  There appears to be a genetic predisposition to the disease since it is more commonly diagnosed in men whose fathers also had prostate cancer.  Men who follow low-fat diets rich in fruits and vegetables may also be at lower risk of developing prostate cancer.

Prostate Cancer Symptoms

While many men with Prostate cancer do not demonstrate any symptoms early on, the most common symptoms reported include frequent or painful urination, a weak flow of urine, blood in the urine, difficulty obtaining an erection, and pain in the lower back or upper thighs.  It is important to note that a majority of men who report these symptoms are not diagnosed with prostate cancer.

Prostate Cancer Diagnosis

As with all cancers, early detection is of the utmost importance.  Doctors can now screen for prostate cancer before men show any symptoms.  The two step screening process for prostate cancer includes the digital rectal exam and the PSA blood test.  During the digital rectal exam, a trained physician examines the prostate with a gloved finger to determine if any hard spots or lumps are present.  A PSA or prostate specific antigen is a protein that is produced by prostate gland cells and excreted into the semen.  Some of this PSA also escapes into the circulating blood stream.  Thus, doctors can measure the level of circulating PSA in the blood with the PSA blood test to see if PSA levels are elevated beyond the norm.  But it is important to note that both an inflamed prostate and prostate cancer can lead to elevated levels of PSA which has escaped into the blood stream.  As with many medical procedures, these tests are not definitive and further testing and procedures must take place to determine if cancer or other medical conditions are present.  Tests used to help make this determination include a prostate biopsy, where a sample of the prostate is analyzed for abnormal cells.  However, while a prostate biopsy is a very accurate tool in making a prostate cancer diagnosis, there is 15-20% chance that the technique may miss the cancerous cells in the specimen. Therefore, a patient may sometimes need to undergo more than one prostate biopsy.  Other diagnostic tests include a cystoscopy, where a small camera is inserted to examine the urethra and bladder, while urodynamic exams use a variety of methods to examine the functioning of the lower urinary tract. 
   
After discussing your test results and/or symptoms with your doctor, you may choose to have a biopsy performed.  But you should also be sure that you are well-informed about the risks involved, any potential pain or discomfort after during and after the procedure, recovery time from the biopsy, how long it will take to learn the results, and the next course of action should the biopsy indicates that cancer is present.  If no cancer is found, many patients opt for a trans-urethral resection of the prostate, or TURP, or other advanced treatment options such as Greanlight PVP laser, Microwave thermodilation (TUMTD), or TUNA to ease the pressure the enlarged prostate places on the bladder.

Gleason Scale

If cancer is indeed found, a pathologist will score the tumor on a scale from G1 to G4, or on a different scale called the Gleason Scale, which ranges from 2 to 10 and is the sum of two numerical scored attributes of the tumor.  In addition, you may undergo a CT scan, a Bone Scan and possibly an MRI to determine if the cancer has spread.  Staging for prostate cancer ranges from stage 1 where the tumor cannot be felt by a digital exam and is usually discovered incidentally, to stage 4 where it has spread to local tissues and organs, and may have metastasized to the lymph nodes. Stage 4 also includes cases of recurring prostate cancer, which may have returned after a period in remission. 

Prostate Cancer Treatment

There are many treatment choices for prostate cancer today, and most patients will opt for one of four choices. 

1. Radical Prostatectomy

One option is a radical prostatectomy where the prostate gland is completely removed.  This may be done via the gold standard of the open surgical technique or a robotic assisted laparoscopic prostatectomy.  A robotic Prostatectomy allows for the complete removal of the cancerous prostate by a highly specialized machine in a minimally invasive procedure with less surgical pain and faster recovery time than a traditional open prostatectomy surgery.  The most widely used robotic machine for this procedure is the da Vinci model, which has seen a dramatic rise in popularity in recent years. 

2. Radiation Therapy

Another widely accepted treatment option is radiation therapy.  Intensity Modulated Radiation Therapy, or IMRT radiation therapy, uses a precise, high-powered radiation dose that is controlled by a computer in order to deliver a potent quantity of radiation specifically to the tumor cells.  Radioactive seed therapy, orbrachytherapy, treats the cancerous cells by inserting radioactive “seeds” directly into the cancerous tissue.  Radiation therapy is generally used in patients who are not good candidates for surgery or elderly patients with very minimal disease.  The Radiation option is also recommended for those with locally advanced disease where the cancer has spread beyond the prostate capsule, classified as stage 3 prostate cancer.

3. Cryosurgery

A third treatment option is cryosurgery, which utilizes a tool that freezes and kills the tumor cells.  This is an extremely effective curative means of therapy for patients with prostate cancer and is in fact the most accepted option for patients with a recurrence of prostate cancer after initial radiation treatment.  Today, Cryosurgery is being widely used as an initial therapy or even as a focal therapy for patients who were diagnosed very early and with a small zone of cancerous cells in their prostate that otherwise would not benefit from very aggressive therapies such as a prostatectomy. 

4. “Watch and wait” approach

The fourth treatment option is watching and waiting or active surveillance. Because prostate cancer is a very slow growing cancer it can be a difficult choice for the patient and the care provider to determine if the disease is severe enough for some of the more aggressive treatment options.  Thus, some patients and their doctors prefer to take the “watch and wait” approach.  This way, the tumor’s size and growth rate as well as the patient’s PSA levels can be monitored. This is important because a slowly growing tumor will be treated differently than a more aggressive tumor.  In fact, some men with very small and slowly-growing tumors have the same life expectancy as men without prostate cancer.  Thus, the risks of some treatments may outweigh the benefits for these patients.

5. Hormone Therapy

Though not a curative treatment option, hormone therapy is sometimes used. Androgen, a hormone synthesized and secreted by the testicles can cause prostate cancer cells to grow faster.  By blocking this hormone, doctors can sometimes slow the growth of the tumor for a few years. The hormonal therapy is not a curative option, but rather, it is used either in conjunction with other treatments, such as radiation therapy or cryosurgery, or as a palliative measure for tumors that have spread beyond the prostate gland to other organs.



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