What Is a Prostate?
The prostate is a gland found only in males which sits between the bladder and the rectum and wraps around the urethra, the tube that carries urine and semen out of the penis. The prostate gland’s function is to make up the fluid that mixes with the semen to form the ejaculate. It also turns the hormone testosterone into dihydrotestosterone, which effects male sexual characteristics. The prostate gland is about the size of a chestnut and grows until you reach 20 years old. In most people the gland stops growing at that point. However, in some men the prostate can grow larger. This can happen in two ways: either benign hypertrophy (increase in glandular tissue) or by cancerous growth.
Who’s At Risk?
Risk factors for prostate cancer include:
Sex: Males only are at risk (obviously). In the U.S., it is the most common male cancer and the second leading cause of cancer deaths in men. Lung cancer is #1.
Age: Prostate cancer almost always occurs over the age of 40, with the risk increasing with age.
Ethnicity: African Americans have the highest risk of prostate cancer in the world, with a 50% higher risk than white males.
Family History: The risk for a man increases if his brother or father had prostate cancer, or his mother or sister had breast or ovarian cancer.
Sexual Activity: There has been no data to prove that sexual activity increases the risk of prostate cancer. Persons with a history of sexually transmitted disease may actually have a slightly decreased risk of developing this cancer. The reason for this is unclear.
What Are The Symptoms?
In the earliest stages prostate cancer usually has no symptoms. Many elderly people have localized prostate cancer for years without even feeling sick or showing any signs of disease. As the cancer spreads, it can cause the urethra to constrict and cause problems with urination. Symptoms include frequent urination, pain or burning on urination, difficulty starting a stream or maintaining a strong flow and blood in the urine. Bone pain can be a sign of spread of the cancer to the bones.
I Was Told I Have A Large Prostate. Does That Mean I Have Cancer?
Another disease of the prostate called Benign Prostatic Hypertrophy (BPH) has similar symptoms, however, it is completely benign and not cancerous. The mechanism of developing BPH and the location where it occurs in the prostate are completely different than in prostate cancer. BPH is very common in elderly males and the symptoms often can be treated with medication. In some instances surgical resection of the prostate is recommended. Many studies suggest that patients with BPH are not at an increased risk for developing prostate cancer.
I Have Prostate Cancer. So What Happens Next?
The first thing to remember is that all cancers are different. Prostate cancer is a very slow growing and treatable cancer. Urologists (prostate specialists) have many tools now that can treat the disease and relieve the symptoms. Prostate cancer is initially checked for on physical exam and a blood test called a PSA test (Prostate Specific Antigen). The physical exam usually involves the doctor placing a gloved finger in the rectum and palpating the prostate gland in order to assess its size, consistency and determine if any nodules or lumps are present. An ultrasound can also be performed and this is felt to represent a more sensitive study of the gland than the digital rectal exam. Cancerous or benign tissue can be diagnosed with a biopsy of the prostate gland. At this point the cancer can be staged as either localized or having spread to adjacent or distant tissue. The tissue will also be graded as to how invasive the cells are. Localized prostate cancer can be either treated with radiation, surgery or watchful waiting. Cancer that has spread to other tissues can be treated using radiation, surgery, or hormonal therapy.
If I Have Localized Prostate Cancer…How Do I Choose The Treatment?
There is no single or most effective choice for the treatment of prostate cancer which is recommended by all physicians. These three options have been shown in many studies to be equally effective in patients for a period of up to 15 years. The decision should be made based on many factors and should be carefully discussed with family members and the physician. Physicians specializing in urology, radiation therapy and oncology should all be involved in helping the patient make an informed decision.
Watchful Waiting: This type of treatment is usually more favorable in elderly males with multiple medical problems and a relatively short life expectancy. These patients are usually not ideal candidates for surgery or radiation therapy. During the waiting period the patient’s prostate size is monitored and they are given other medications to control symptoms and progression of the disease.
Radiation Therapy: This option is most likely to benefit a patient with a relatively long life expectancy, no significant risk factors for radiation toxicity, and a preference for radiation therapy. Advantages include potential for cure and little side effects. Potential risks include radiation cystitis, proctitis, impotence, and progression of the disease.
Surgery: Surgery would most likely benefit the patient with a relatively long life expectancy, no significant surgical risk factors and a preference to undergo surgery. Advantages include potential cure, and complete removal of the cancer. Disadvantages include incomplete removal of the prostate cancer, incontinence, and erectile dysfunction.