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Prostate Cancer

Prostate cancer occurs in the prostate of men. The prostate is a small gland the size of a walnut that makes one type of seminal fluid that transports the sperm. Prostate cancer is actually quite common and is one of the most common cancers seen in men. It generally is a slow growing cancer that does not progress as far as the border of the prostate. Other types of prostate cancer can be more aggressive and can spread to other body areas. In general, prostate cancer is easily treated, especially when found early enough to avoid metastases.

Early prostate cancer may not show any signs or symptoms. If the cancer causes enlargement of the prostate, it can result in difficulty urinating, slow stream, blood in the urine, swelling of the legs or blood in the semen. You can also have bony pain or pelvic discomfort.

Doctors do not know exactly why prostate cancer occurs. It is caused by mutations in the cells of the prostate gland. This results in a tumor of the prostate gland. It is more common as a person ages, especially if the man is over 65 years of age. Black men have a higher risk of the disease than whites and a family history of prostate cancer can increase your risk of developing the disease. Men who are obese are more likely to have advanced prostate cancer.

Doctors have different methods of screening for prostate cancer. These things include a digital rectal examination or DRE, which involves examining the posterior aspect of the prostate for nodularities or enlargement. One lobe of the prostate can be larger than the other lobe. The digital rectal exam can be combined with a PSA or prostate specific antigen test. This is a blood test that checks for the level of PSA in the blood. PSA is elevated with both prostatic enlargement and prostate cancer so the test alone doesn't make the diagnosis securely.

If prostate cancer is suspected, doctors can use a transrectal ultrasound to look for tumors in the prostate gland. A biopsy of the prostate gland can be done through the rectum using a needle biopsy. The prostate cancer is graded under the microscope to see how aggressive the tumor is. A scoring system know as the Gleason score rates prostate cancer from 2, which meets nonaggressive cancer, to 10, which means very aggressive cancer.

The spread of cancer can be determined through further testing. This testing can include an abdominal ultrasound to check for pelvic and abdominal involvement; a bone scan, which can check for bony involvement. A CT scan or MRI scan of the abdomen and pelvis can look for other metastatic disease.

The above testing allows the doctor to stage the cancer. There are four stages to prostate cancer:

• Stage I involves early cancer that is only identified by a microscope but cannot be felt during a DRE.
• Stage II cancer involves cancer that is felt by a doctor but is confined within the capsule of the prostate.
• Stage III cancer has spread to the seminal vesicles or to other tissue near the prostate gland.
• Stage IV cancer involves spread to lymph nodes or to other body areas, including pelvic structures, abdominal tissue, lung, or bone.

The treatment of prostate cancer depends on the stage and the grade of the cancer. Your overall health and age also play into whether or not the cancer is treated aggressively. Because prostate cancer grows relatively slowly in many cases, it may not be necessary to treat the cancer right away. Doctors will watch the cancer growth and only treat it if it seems to be spreading outside the confines of the prostate gland. If the prostate cancer appears to be progressive, you can have surgical management and/or radiation of the prostate tumor.

Radiation can come in the form of external beam radiation that comes from outside the body. It works well but can involve a great deal of secondary side effects, such as radiation enteritis. Another form of radiation therapy involves brachytherapy, which is radiation implanted in the form of radioactive seeds of radiation placed within the prostate tissue. It has fewer side effects than external radiation therapy. There are side effects to radiation, including pain on urination, urgency and frequency of urination and diarrhea or pain on having a bowel movement. Men can also have erectile dysfunction after radiation treatment for prostate cancer.

Another big treatment for prostate cancer involves the use of hormones that block testosterone. It is testosterone that makes prostate cancer grow. These include Lupron, gosrelin, histreline and degarelix. Medications are available, too, that block testosterone from getting into prostate cancer cells. These include Casodex and Nilandron. The testicles can be removed, which decreases the level of testosterone in the body. Side effects of having hormone therapy can include having hot flashes, erectile dysfunction, muscle loss, bone mass reduction, reduced sex drive and gain of weight. The incidence of heart disease rises when a person is placed on hormonal therapy for prostate cancer.

Surgery can be done to remove the prostate gland altogether. It can be done through and abdominal incision or through an incision in the perineum-the space between the anus and the scrotum. The procedure can even be done using a laparoscope, minimizing the size of the incision and the damage to nearby tissue.