Prostate Cancer Health Center

Each year in the United States, over 200,000 men will be diagnosed with prostate cancer. Unfortunately, 32,000 of them will succumb to the disease, making it the third most common cause of death from cancer in men of all ages and the most common cause of death from cancer in men over age 75. However, due to improved detection and treatment, there are over 2 million men in the United States who are currently prostate cancer survivors.

The prostate is a small, walnut sized organ in men that sits below the bladder and is responsible for making seminal fluid, which is necessary for ejaculation and fertility. Symptoms of prostate cancer closely resemble those of benign prostatic hypertrophy, with delayed or slowed initiation of urination, dribbling and leaking of urine, a slow urinary stream, and incomplete emptying of the bladder. Blood may be present in the urine or semen as well. Pain in the bones of the lower back and pelvis may be a sign that prostate cancer has spread.

The biggest risk factors for prostate cancer are advancing age and prostate cancer in a first degree relative, such as a father or brother. African-American men are at greater risk as well. Other risk factors include alcohol abuse, a diet high in animal fat, and environmental exposures to Agent Orange, cadmium, paint fumes, farm work.

Because most of the symptoms of prostate cancer are clinically indistinguishable from BPH, further testing is often needed. In some cases, during a rectal exam, a doctor may be able to feel a hard, easily identifiable tumor through the rectum which aids diagnosis. In other cases, a rectal exam may not be able to differentiate between cancer and BPH. Concrete diagnosis is made by prostate biopsy, and the tissue is graded by a Gleason grade (1-5) to determine how abnormal the cancer is. Two different grades are often present in one biopsy, and the two samples are added together for a Gleason score (2-10) which further classifies how aggressive the cancer is. Prostate specific antigen (PSA), a protein found in the blood, may be elevated in some men that would prompt a doctor to check for prostate cancer, but it is usually not used as a sole screening method. It is better utilized as a marker of the return of cancer after treatment. The best thing a man can do to detect prostate cancer when it's in early stages and highly treatable is to have yearly rectal exams beginning at age 50, and age 40 if they have a diagnosed first degree relative.

Treatment methods are variable depending on how aggressive the cancer is and if it has spread. Early cancer contained within the walls of the prostate will usually be surgically removed by a radical prostatectomy. There is some risk of incontinence and erectile dysfunction as a result. Radiation therapy is also available for early stage cancer, in the form of implanted radioactive seeds or a focused beam. When prostate cancer has spread outside of the prostate, there is a wide array of chemotherapeutic and hormone therapy options. Prostate cancer is fueled by testosterone, so many hormonal treatments block the release of or prevent the action of it. Hormone therapy is mainly used when cancer has spread to help relieve symptoms, and there are two types. Luteinizing hormone-releasing hormone (LH-RH) agonists block the body from making testosterone. They are injected usually every 3 - 6 months and include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix. Androgen-blocking drugs are often given along with the above drugs and include flutamide, bicalutamide, and nilutamide.