Prostate Cancer

Improved Outcomes

Prostate cancer is a disease in which malignant cells form in the tissues of the prostate, a small pelvic gland which sits between the bladder and the rectum. After skin cancer, prostate cancer is the most common cancer in males. The good news is that in the USA the outlook for men diagnosed with prostate cancer is better than ever because most of all prostate cancers are found early, while the tumor is still localized. In these patients the five-year survival rate is greater than 90 % if they are treated appropriately.

 

Enhanced Treatment Options

The treatment that will work best for you depends on several factors. These include: your overall health status, your age and the grade and stage of the prostate cancer when it is first diagnosed. It is essential for you to take the time to research your treatment options, ask questions and weigh the benefits of each treatment against its potential risk of complications and side effects, as well as its proven track record. The most common proven treatment options for prostate cancer are: surgery (radical prostatectomy, conventional or robotic), radical radiation therapy, hormone therapy and observation (watchful waiting).

Radiation is used as: 1) a curative alternative option instead of surgery; 2) if the cancer is not completely removed during surgery; and 3) if the tumor comes back (recurs) in the area after prostatectomy. Radiation is usually delivered with daily treatment sessions over several weeks using external beam radiation therapy (EBRT) with a Linear Accelerator (LINAC). Radiation therapy is non-invasive and painless. It is much like getting a regular x-ray, but for a longer time. Newer LINACS such as the ICI'S Varian EDGE™ unit allow for greater precision in treating the prostate cancer while reducing the radiation exposure to nearby healthy tissues. Actual treatment times are usually less than 2 minutes per session. These newer tools appear to offer better chances of increasing the success rate in curing prostate cancer and reducing the side effects of the treatment.

Radiosurgery

High-doses of radiation therapy are delivered to the prostate gland in a few minutes in 5 procedures in an outpatient basis, as effective as surgery without the need of anesthesia; while attacking the tumor and protecting healthy tissue.

 

Surgery

The most common curative operation for prostate cancer is called radical prostatectomy and involves removal of the entire prostate along with the adjacent glands called the seminal vesicles. Radical prostatectomy has a small but definite risk for subsequent urinary incontinence, and sexual impotence (ED: erectile dysfunction) even in the most experienced surgical hands.

Hormone Therapy

The goal of hormone therapy (also called androgen deprivation) is to lower the levels of the male hormones or androgens, such as testosterone. Androgens, which are made mostly in the testicles, induce prostate cancer cells to grow. Lowering androgen levels often makes prostate cancer shrink or grow more slowly. Hormone therapy can control, but will not cure prostate cancer. It is not a substitute for treatments aimed at a cure.

Observation (Watchful Waiting)

Because prostate cancer may grow very slowly, older men with low risk tumors can be followed using laboratory and imaging exams in a rather strict protocol with no treatment given. This approach is called watchful waiting. By definition, it involves close monitoring of the patient's condition without giving any treatment until symptoms appear or change. This is usually recommended in older men with less aggressive cancer or early-stage disease. It is less often a choice if you are younger, healthy, and have a fast-growing cancer.

Prostate Cancer FAQ's

What is the best treatment for prostate cancer?

You and your doctor will decide what is the best option for you. This will be dependent upon many factors including your type of tumor and its stage, your medical condition, and your wish to maintain sexual potency and urinary continence.

 

What is a PSA?

The Prostatic-Specific Antigen or PSA test, measures a substance in the bloodstream which is created only by the prostate gland. Abnormally high PSA levels may signal the presence of cancer. However, PSA levels are also higher in men with large prostate glands from benign prostatic hypertrophy (BPH) a very common benign condition among men older than 50 years of age.

In order to differentiate BPH from prostate cancer in patients with elevated blood PSA levels, doctors also use a test called PSA density, which relates PSA level to the size of the gland. A digital rectal exam, in which the doctor inserts a gloved lubricated finger into the rectum, is used to detect unusual bumps or hard areas on the prostate that might be cancer. If these tests raise concern, the next step is a prostate biopsy.

 

What is a Gleason Score?

The Gleason Score is an exam based on the pathologic examination of prostatic tissue obtained either from study of the prostate removed at surgery or more commonly from study of small core of tissue obtained from a needle biopsy of the prostate in a patient suspected of having prostate cancer. This biopsy is usually done in patients who have a palpable nodule on rectal exam or a high PSA level. Multiple samples of prostatic tissue are obtained using a core needle biopsy under local anesthesia via a Trans-Rectal approach with Ultrasound (US) guidance (TRUS).

 

Some of the results from this prostate biopsy are usually given in the form of a Gleason score. On the simplest level, this scoring system assigns a number from 2 to 10 to describe how abnormal the cells appear under a microscope. A score of 2 to 5 means the cells still look very much like normal cells and pose little danger of being malignant. A score of 6 is considered low risk prostate cancer, some of these patients may be observed depending on several factors including age, lifestyle and doctor and patients preferences. A score of 7 indicates intermediate risk prostate cancer and in general indicates need for treatment although the tumor still likely to be confined within the prostate. A score of 8 to 10 indicates that the tumor is very likely to be aggressive and may be already outside of the gland. These patients in general need to start treatment without delay.

 

The Gleason score is one of the best tests available to gauge the severity of the prostate cancer and guide its management, however, it is only one piece of information that you and your doctor will use. Biopsy reports also typically include the number of biopsy core samples that contain cancer, the percentage of cancer in each of the cores, and whether the cancer occurs on one side or both sides of the prostate. This information is key to guide treatment.

 

If there are no symptoms, how is prostate cancer detected?

Screening for prostate cancer can be performed in a physician's office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE).

 

How curable is prostate cancer?

In general, the earlier the cancer is caught, the more likely it is for the patient to be cured. Because approximately 90% of all prostate cancers in the USA are detected in the local stages, the cure rate is very high for patients with prostate cancer who are treated appropriately using radiation therapy or surgery.

 

What are the common side-effects of radiation treatment?

Radiation therapy to the pelvic region may cause:

  • Increased urinary frequency, pain or burning on urination
  • Diarrhea, constipation, rectal irritation and/or pain