Prostate cancer
Prostate cancer is a common type of cancer among men. Treatment for prostate cancer works best when the disease is found early.
Diagnosis
Early prostate cancer does not usually cause symptoms. As the cancer grows, it may cause trouble urinating, and the need to urinate often, especially at night. Other symptoms can be pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.
To figure out if these symptoms are caused by prostate cancer, the doctor will ask the patient questions about past medical problems, and will perform a physical exam, putting a gloved finger into the rectum to feel the prostate through the wall. Hard or lumpy areas may be a sign of cancer.
The doctor may also do a test to check the prostate-specific antigen (PSA) level in the blood. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer.
It may also need to have an ultrasound exam. In this procedure, a probe that produces sound waves is put into the rectum. Sound waves bounce off the tissues, and a computer uses the echoes to make a picture of the prostate.
A biopsy is almost always needed to diagnose prostate cancer for sure. This exam takes out tiny pieces of the prostate and sends them to a laboratory to be checked for cancer cells under a microscope.
Treatment
The choice of treatment depends on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other parts of the body). It also depends on the patient age and general health. The following are three standard treatment choices for cancer that has not spread beyond the prostate:
Watchful waiting. If the cancer is growing slowly and not causing problems, is possible to decide not to have treatment right away. Instead, the doctor will check regularly for changes in the patient condition. Older men with other medical problems often choose this option.
Surgery. The most common type of surgery is a radical prostatectomy. The surgeon takes out the whole prostate and some nearby tissues. Side effects may include loss of sexual function (impotence) or problems holding urine (incontinence), which can go away within a year of surgery. But some men continue to have problems and have to wear a pad. An operation called nerve-sparing surgery gives some men a better chance of keeping their sexual function.
Radiation therapy. This treatment uses high-energy x-rays to kill cancer cells and shrink tumors. There are two kinds of radiation therapy. External radiation therapy is beamed into the prostate from a machine outside the body. Internal radiation therapy uses radioactive “seeds” that are placed in the prostate, into or near the tumor itself. Like surgery, radiation therapy can cause problems with impotence, not as likely to cause urinary incontinence as surgery. But it can cause rectal problems such as pain and soreness, rectal urgency, and trouble controlling bowel movements.
In addition, after radiation therapy, some men are treated with hormone therapy. This is used when chances are high that the cancer will come back. Hormone therapy is also used for prostate cancer that has spread beyond the prostate. Side effects of hormone treatments include hot flashes, loss of sexual function, and loss of desire for sex.
Screening
Some doctors think that men should have regular prostate specific antigen (PSA) tests, and others do not. The reason is even knowing that this test can catch a cancer before it causes symptoms, it is not sure that PSA tests save lives. Also, PSA tests find small cancers that would never grow or spread. When that happens, a man may have surgery or other heavy treatments that are not needed. Researchers are studying ways to improve the PSA test so that it catches only cancers that need treatment.