Prostate cancer

Prostate cancer is the most common cancer found only in men. Despite increased screening and a steady decline in the number of prostate cancer deaths over the years, prostate cancer still is the second leading cause of cancer deaths among men.

The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It surrounds the urethra and produces a substance that contributes to semen, the fluid that carries sperm from the testicles. Most cases of prostate cancer—99 percent—are adenocarcinomas, which develop when gland cells mutate and grow out of control, forming a tumor.

Who gets prostate cancer?

Prostate cancer is rarely diagnosed in men younger than 40. Still, by age 50, it is common for men to experience changes in the size and shape of the cells in the prostate. Understanding whether these changes are signs of a prostate tumor and knowing your risk for developing prostate cancer are important steps in protecting your health.

The average age of a man diagnosed with prostate cancer is 66.

The average age of a man who dies from prostate cancer is 80.

Men whose father or brother has or had prostate cancer are twice as likely to develop the disease. Also, men who have inherited mutations in their BRCA or BRCA2 genes are at a higher risk for developing a prostate tumor.

Types of prostate cancer

Almost all prostate cancers—more than 99 percent—are adenocarcinomas.

 

Prostate cancer symptoms

In early stages, prostate cancer may not produce symptoms. However, the disease may be discovered early with regular digital rectal exams or prostate specific antigen tests. Warning signs of prostate cancer include:

Difficulty urinating, frequent urinations, incontinence, burning during urination or blood in the urine

Erectile disfunction, blood in the semen or painful ejaculation

Learn more about the risk factors for prostate cancer

 

Prostate cancer screening and diagnosis

Prostate cancer is typically treatable if caught early. Routine Serum PSA screening has improved the diagnosis of prostate cancer in recent years. More than 90 percent of prostate cancers are found when the disease is in an early stage, confined to the prostate and nearby organs. Men, especially middle-aged men and those with a family history of prostate cancer should talk to their doctor about an appropriate screening regimen.

 

Treating prostate cancer

In most men, prostate cancer is diagnosed before the disease has spread outside the prostate. In those cases, because prostate cancer often grows slowly, active surveillance may be an option.

Active surveillance

Localized prostate cancer has not spread outside the prostate and generally does not cause symptoms. Because prostate cancer often grows slowly, active surveillance may be the preferred treatment option for some men, with the oncologist closely monitoring the disease with tests and holding off on treatment until a later date.

Older men are more likely to be candidates for active surveillance because treating them with surgery or radiation has not been shown to help them live longer. The decision to monitor prostate cancer instead of treating is made between a patient and his doctor.

In general, active surveillance may be an option for patients whose prostate cancer is:

  • Not causing symptoms
  • Expected to grow slowly
  • Small and contained within the prostate.

Hormone therapy

Hormone therapy for prostate cancer deprives cancer cells of the male hormones they need to grow. Prostate cancer hormone therapy is often used in combination with radiation and other therapies. We may use hormone therapy to shrink advanced prostate cancer tumors, so they can be treated with radiation.

A common regimen for prostate cancer therapy uses a combination of two or more drugs to lower the level of testosterone and other hormones that can fuel the disease. In some cases, hormone therapy may be given intermittently to help reduce treatment-related side effects. We anticipate side effects by focusing on prevention, and managing them with a variety of approaches if they do occur.

Radiation therapy

With advanced radiation therapy delivery systems, our radiation oncologists are able to target difficult-to-reach tumors in the prostate. Also, our radiation oncologists may direct higher radiation doses at prostate cancer cells, while reducing exposure to normal, healthy tissue.

We offer two primary types of radiation therapy for the treatment of prostate cancer:

External beam radiation therapy (EBRT): Delivers high doses of radiation to prostate cancer cells from outside the body, using a variety of machine-based technologies

High-dose rate brachytherapy (internal radiation): Delivers high doses of radiation from implants placed close to, or inside, the tumor(s) in the body

Some prostate cancer patients may also undergo stereotactic body radiosurgery, which uses innovative imaging technologies to deliver high doses of radiation to tumors in the prostate. Despite its name, stereotactic body radiosurgery is not a surgical procedure, but a form of radiation therapy. Because the dose rate is high, fewer treatments are used.

Surgery

Surgical treatments for prostate cancer may be an option for men who qualify based on their overall health and other factors. Surgery is designed to remove the cancer through an open (traditional) operation or with robotic equipment. One example of surgery for prostate cancer is removal of the prostate, called a prostatectomy. One of the preferred options for treating organ-confined prostate cancer is radical prostatectomy. The da Vinci® Surgical System allows the surgeon to offer this procedure using a minimally invasive approach.

Some advantages of surgery for prostate cancer may include:

  • Patients with localized cancer may need no further treatment.
  • Simultaneous biopsy allows for more accurate staging.
  • Post-surgical PSA levels reliably predict recurrence of cancer.
  • Fewer bowel or rectal side effects than with radiation treatments
  • Lower risk of urinary urgency and frequency than with radiation treatments

Some disadvantages may include:

  • It comes with the possibility for surgery-related risks, including side effects from general anesthesia.
  • It requires an overnight hospitalization.
  • A catheter is required for one or two weeks.
Long-term sexual changes, including dry orgasms, pain during orgasm and shortened penis, may result

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