Prostate cancer is the second most common type of cancer among American men. The National Cancer Institute estimates there are almost 200,000 newly diagnosed cases of prostate cancer in the United States annually. Prostate cancer is the second leading cause of cancer death in men in the United States with approximately 28,000 men dying of it each year.
The prostate is a walnut-sized gland found in the male reproductive system in front of the rectum just below the bladder. It surrounds the urethra, the tube that carries urine from the bladder through the tip of the penis. In addition, the nerves responsible for erections are located on either side of the prostate. The main purpose of the prostate is to produce seminal fluid, which transports sperm during the male orgasm. The normal prostate gland is quite small and weighs only about an ounce.
Prostate cancer occurs when a malignant tumor is formed in the prostate gland. If left untreated, the cancer can grow and spread beyond the prostate into the surrounding tissues and lymph nodes, as well as to distant parts of the body such as the bones, lungs and liver.
- Age (most patients are over 65)
- Family history
- African-American men are more likely to get this type of cancer
- Diets heavy in red meat and high-fat dairy products, and low in vegetables and fruit
- Physical inactivity
- Frequent urination, particularly at night
- Difficulty starting or holding back urination
- Weak or unable to urinate
- Painful urination
- Painful ejaculation
- Difficulty having an erection
- Blood in semen or urine
- Pain in lower back, hips or upper thighs
Podcast: What the New Prostate Screening Guidelines Mean for Men’s Health
Learn about the newly updated prostate screening guidelines in this health education podcast. The guidelines advise a shared decision making process between patients and their providers.
Detection and Diagnosis
If a patient has a number of symptoms or risk factors, the following tests can diagnose prostate cancer.
- PSA (Prostate Specific Antigen): PSA has been employed as an indicator of early, potentially curable prostate cancer. It can identify patients with prostate cancers not detectable by digital rectal examination with the aid of a blood test.
- CT Scan and MRI: Computed tomography scan (CT Scan) is a series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Magnetic resonance imaging (MRI) is a procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These two tests are used to evaluate whether the tumor has extended outside the confines of the prostate gland or into the lymph nodes that are located around the prostate.
- Evaluation of Pelvic Lymph Nodes
- Radionuclide Bone Scan: A test that is used to see if prostate cancer has spread to the bones. This test is used to rule out metastasis in the bony structure of the body.
- Monoclonal Antibody Scan (ProstaScint): A new test that uses a compound that recognizes a protein on prostate tissue may be useful to detect spread of prostate cancer outside the prostate area. This scan is similar to the bone scan where a solution containing very small radioactive particles is injected in the vein and then followed at various times as it goes through the body.
Many factors affect choosing a treatment or treatments, such as stage of the cancer, age of the patient and overall health.
Traditional surgery is the most common treatment, particularly in early-stage prostate cancers. By making an incision in the abdomen (radical retropubic prostatectomy) or between the scrotum and anus (radical perineal prostatectomy) the surgeon can remove the entire prostate, including surrounding lymph nodes. Or, in a transurethral resection of the prostate (TURP), the surgeon uses electricity generated at the end of a small instrument to remove only the cancerous portion of the prostate. Loss of bladder control and impotence are frequent side effects of prostate surgery.
Robotic Prostatectomy a minimally invasive method of removing the prostate gland through advancements in robotics and computer technology. Using the the da Vinci robot, surgeons have more precision which lowers the risk of incontinence and impotence for patients when compared to standard prostate cancer surgery. More prostate cancer surgeries, using the da Vinci robot, are performed at The George Washington University Hospital than at any other hospital in the region.
If cancer has spread to nearby lymph nodes, surgery may not be a practical option.
External Beam Radiation therapy kills cancer cells with intense x-rays aimed only at the cancerous growth. With advances in technology, particular medical equipment can emit radiation from outside the patient's body, or radioactive materials can be placed internally to the targeted area. Patients may receive one or both forms of radiotherapy, depending on the size of the cancer.
Brachytherapy is the most advanced method of radioactive seed implantation. This method uses the latest advances in computer calculation of internal seed placement for maximal effect and minimal side effects. The dose of each seed is customized at the time of surgery to conform to the size of the individual prostate gland. In general, side effects of radiation therapy include extreme fatigue, though physicians recommend staying active throughout treatment. Patients may also experience painful or frequent urination, diarrhea or impotence. External beam radiation often causes hair loss and skin irritations in the area of treatment. Internal radiation, meanwhile, is less likely to affect erectile functioning but slightly more likely to cause temporary incontinence.
Hormone therapy can prevent prostate cancer cells from getting the male hormones they need to grow, even if they have spread to other parts of the body. Although it won't cure prostate cancer, hormone therapy can control it.
In Cryotherapy, the prostate is frozen rapidly to kill cancer cells. This procedure is performed by placing probes into the prostate while the patient is under anesthesia. Survival data suggests that cryotherapy for localized prostate cancer is at least equal to radiation therapy with either seed implantation or external beam.
Surveillance for a disease process is an accepted alternative for those who want to avoid or defer the side effects of other forms of therapy. Good candidates for surveillance have a relatively short life expectancy as calculated from age and coexisting medical conditions.The disadvantage to surveillance is the risk of subsequent, possibly incurable, disease progression. Furthermore, surveillance places the patient at risk for complications from disease progression such as pain, urinary obstruction, pathological fractures, obstruction of the ureters and spinal cord compression. Therefore, the option of surveillance must be weighed against the potential disadvantages of withholding treatment.
GW Hospital Research
GW Hospital is at the forefront of developing new diagnostic techniques for both benign (non cancerous) and malignant (cancerous) conditions of the prostate. These include the use of immunotherapy, which uses a patient's own immune system, for detecting cancer outside of the prostate and the use of various advances in technology to treat noncancerous prostatic enlargement.