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Prostate Cancer

Overview

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Prostate cancer is the most common cancer, excluding skin cancer, in American men.  The American Cancer Society estimates that more than 200,000 men are affected by this disease annually, and more 25,000 will die from prostate cancer.
Among men diagnosed with prostate cancer, nearly 100% survive at least 5 years, 93% survive at least 10 years and 77% survive at least 15 years.
Modern methods of detection and treatment mean that prostate cancers are detected earlier and treated more effectively, which has led to a yearly drop in death rate of about 3.5% in recent years.

Our urologist are experts in Prostate Cancer, schedule an appointment with one of our urologist today, we have conveniently located urology offices in Bonita Springs, Fort Myers, Cape Coral, Lehigh and Punta Gorda

Symptoms

Prostate cancer usually doesn’t produce any noticeable symptoms in its early stages, so many cases of prostate cancer aren’t detected until the cancer has spread beyond the prostate.  For most men, prostate cancer is first detected during a routine screening such as a prostate-specific anitigen (PSA) test or a digital rectal exam (DRE).
When signs and symptoms do occur, they depend on how advanced the cancer is and how far the cancer has spread.
Early signs and symptoms of prostate cancer can include urinary problems, caused when the prostate tumor presses on the bladder or the tube that carries urine from the bladder (urethra).  However, urinary symptoms are much more commonly caused by benign prostate problems, such as an enlarged prostate (benign prostatic hyperplasia) or prostate infections.  Less than 5 percent of cases of prostate cancer have urinary problems as the initial symptom.  When urinary signs and symptoms do occur, they can include:

Cancer in your prostate or the area around the prostate can cause:

Prostate cancer that has spread to the lymph nodes in your pelvis may cause:

Advanced prostate cancer that has spread to your bones can cause:

Causes

Cancer is a group of abnormal cells that grow more rapidly than normal cells and that refuse to die.  Cancer cells also have the ability to invade and destroy normal tissues, either by growing directly into surrounding structures or after traveling to another part of your body through your bloodstream or lymph system (metastasize).  Microscopic cancer cells develop into small clusters that continue to grow, becoming more densely packed and hard.
What causes prostate cancer and why some types behave differently are unknown.  Research suggests that a combination of factors may play a role, including heredity, ethnicity, hormones, diet and the environment.

Diagnosis

Beginning at age 50, the American Cancer Society recommends having yearly screening tests for prostate cancer.  If you’re black or have a family history of the disease, you may want to begin at a younger age.  Yearly screenings can help detect prostate cancer early, when it’s easier to treat.
Prostate cancer may not cause any symptoms at first.  The first indication of a problem may come during a routine screening test, such as:

Determining how far the cancer has spread
Once a cancer diagnosis has been made, you may need further tests to help determine if or how far the cancer has spread.  Many men don’t require additional studies and can directly proceed with treatment based on the characteristics of their tumors and the results of their pre-biopsy PSA tests.

Grading
When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is.  The tissue samples are studied, and the cancer cells are compared with healthy prostate cells.  The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly.
Cancer cells may vary in shape and size.  Some cells may be aggressive, while others are not.  The pathologist identifies the two most aggressive types of cancer cells when assigning a grade.  The most common scale used to evaluate prostate cancer cells is called a Gleason score.  Based on microscopic appearance of cells, individual ratings from 1 to 5 are assigned to the two most common cancer patterns identified.  These two numbers are then added together to determine your overall score.  Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).

Staging
Afterr the level of aggressiveness of your prostate cancer is known, the next step, callled staging, determines if or how far the cancer has spread.  Your cancer is assigned one of four stages, based on how far it has spread:

Complications
Complications from prostate cancer are related to both the disease and its treatment.  One of the biggest fears of many men who have prostate cancer is that treatment may leave them incontinent or unable to maintain an erection firm enough for sex (erectile dysfunction).  Fortunately, therapies exist to help cope with or treat  these conditions.
The typical complications of prostate cancer and its treatments include:

Treatments

There’s more than one way to treat prostate cancer.  For some men a combination of treatments — such as surgery followed by radiation or radiation paired with hormone therapy — works best.  The treatment that’s best for each man depends on several factors.  These include how fast your cancer is growing, how much it has spread, your age and life expectancy, as well as the benefits and the potential side effects of the treatment.  The most common treatments for prostate cancer include the following:

External beam radiation therapy – External beam radiation treatment uses high-powered x-rays to kill cancer cells.  This type of radiation is effective at destroying cancerous cells, but it can also scar adjacent healthy tissue.
The first step in radiation therapy is to map the precise area of your body that needs to receive radiation.  Computer-imaging software helps your doctor find the best angles to aim the beams of radiation.  Precisely focused radiation kills cancer in your prostate while minimizing harm to surrounding tissue.
Treatments are generally given five days a week for about eight weeks.  You do not need anesthesia because the treatment isn’t painful.  You will be asked to arrive with a full bladder.  This will push most of your bladder out of the path of the radiation beam.  A body supporter holds you in the same position for each treatment.  Ink marks on your skin help guide the radiation beam, and small gold markers may be placed in your prostate to ensure the radiation hits the same target each time.  Custom designed shields help protect nearby normal tissue, such as your bladder, erectile tissues, anus and rectal wall.

Side effects of External Beam Radiation can include:

Radioactive seed implants – Radioactive seeds implanted into the prostate have gained popularity in recent years as treatment for prostate cancer.  The implants, also known as brachytherapy, deliver a higher dose of radiation than do external beams, but over a substantially longer period of time.  The therapy is generally used in men with smaller or moderate-sized prostates with small and lower grade cancers.
During the procedure, between 40 and 100 rice-sized radioactive seeds are placed in your prostate through ultrasound-guided needles.  The implant procedure typically lasts one to two hours and is done under general anesthesia — which means you won’t be awake.  Most men can go home the day of the procedure.  Sometimes, hormone therapy is used for a few months to shrink the size of the prostate before seeds are implanted.  The seeds may contain one of several radioactive isotopes — including iodine and palladium.  These seeds don’t have to be removed after they stop emitting radiation.  Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location.  This type of radiation isn’t likely to escape your body in significant doses.  However, doctors recommend that for the first few months, you stay at least six feet away from children and pregnant women, who are especially sensitive to radiation.  All radiation inside the pellets is generally exhausted within a year.

Side effects of radioactive seed implants can include:

Hormone therapy – Hormone therapy involves trying to stop your body from producing the male sex hormone teststerone, which can stimulate the growth of cancer cells. This type of therapy can also block hormones from getting into cancer cells.  Sometimes doctors use a combination of drugs to achieve both.  In most men with advanced prostate cancer, this form of treatment is effective in helping both shrink the cancer and slow the growth of tumors.  Sometimes doctors use hormone hormone therapy in early-stage cancers to shrink large tumors so that surgery or radiation can remove or destroy them more easily.  In some cases, hormone therapy is used in combination with radiation therapy or surgey.  After these treatments, the drugs can slow the growth of any stray cancer cells left behind.
Some drugs used in hormone therapy decrease your body’s production of testosterone.  The hormones, known as luteinizing hormone-releasing hormone (LHRH) agonists, can set up a chemical blockade.  This blockade prevents the testicles from receiving messages to make testosterone.  Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard) and goserelin (Zoladex).  They’re injected into a muscle once every three or six months.  You can receive them for a few months, a few years or the rest of your life, depending on your situation.
Other drugs used in hormone therapy block your body’s ability to use testosterone.  A small amount of testosterone comes from the adrenal glands and is not suppressed by LHRH agonists.  Certain medications, known as anti-androgens, can prevent testosterone from reaching your cancer cells.
Simply depriving prostate cancer of testosterone usually doesn’t kill all of the cancer cells.  Within a few years, the cancer often learns to thrive without trestosterone.  Once this happens, hormone therapy is less likely to be effective.  However, several treatment options still exist.  To avoid such resistence, intermittent hormone therapy programs have been developed.  During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady.  You will need to resume taking the drugs if your PSA level rises again.

Side effects of hormone therapy can include:

Certain hormmone therapy medications can also cause:

Recent reports have shown that men who undergo hormone therapy for prostate cancer may have a higher risk of having a heart attack in the first year or two after starting hormone therapy.  So your doctor should carefully monitor your heart condition and aggressively treat any other conditions that may predispose you to a heart attack, such as high blood pressure, high cholesterol or smoking.
Surgery to remove the testicles, which produce most of your testosterone, is as effective as other forms of hormonal therapy.  Many men are not comfortable with the idea of losing their testicles, so they opt for the above-noted methods of lowering testosterone in the body.  However, removing the testicles has the advantage of not having to have an injection every three or six months and can be less expensive.  The surgery can be done on an outpatient basis using a local anesthetic.

Radical prostatectomy – Surgical removal of your prostate gland, called radical prostatectomy, is used to treat cancer that’s confined to the prostate gland.  During this procedure, your surgeon uses special techniques to completely remove your prostate and nearby lymph nodes.  This surgery can affect muscles and nerves that control urination and sexual function.  Two surgical approaches are available for a prostatectomy — retropubic surgery and perineal surgery.

During either type of operation, a catheter is inserted into your bladder through your penis to drain urine from the bladder during your recovery.  The catheter will likely remain in place for one to two weeks after the operation while the urinary tract heals.