Digital rectal examination (DRE):
In this test a gloved finger is inserted in the rectum. The physician feels for the size, shape and texture of the prostate. Cancer feels hard. However, more tests will be needed to make sure that cancer is present.
PSA test:
This is a blood test that measures the levels of prostate specific antigen (PSA). PSA is a protein found in the blood and produced by the prostate. PSA levels rise in the presence of prostate cancer. Although the test is not 100% accurate, PSAs have become an important step in diagnosing prostate cancer and following the course of disease.
Transrectal ultrasonography (TRUS):
With a probe inserted in the rectum, TRUS shows sound waves bouncing off the prostate and other parts of the body. It is sometimes used along with PSAs and DREs to diagnose prostate cancer. It may also be used to help the biopsy process.
Biopsy:
This a surgical procedure in which a few cells are removed for microscopic examination. Biopsies are usually done using a local anesthetic. The biopsy allows for an accurate assessment of the presence and types of cancer cells within the prostate.
Be on the lookout
The highest risk groups for prostate cancer are African-American men and men with a family history of the disease. However, every man aged 40 and older is at risk. Therefore, the American Cancer Society recommends that:
- All men aged 40 and older should get a digital rectal exam (DRE) as part of their regular, annual physical checkup.
- All men aged 50 and older should get a PSA test as part of their annual physical, in addition to a DRE.
- If the DRE or PSA test is suspicious, a transrectal ultrasound should be performed.
Remember, prostate cancer often occurs without any symptoms. Regular testing can lead to life-saving therapy.
Stages of prostate cancer
Doctors characterize the extent of prostate cancer with what is called staging. Either of two staging systems are used.
A-through-D system:
In the early stages (A and B), only a few cells of the prostate are cancerous and are confined to the prostate. Over time, the cancer takes over more of the prostate. In the advanced stages, the cancer spreads to surrounding tissues (C), then to lymph nodes, other organs and the bones (D).
TNM system:
In this system, T stands for tumor size, N for lymph node involvement and M for degree of metastases. All designations are included in staging. For example, T3c,Nl,M0 means that the tumor has extended into the seminal vesicles (T3c), one lymph node is cancerous (N 1) and there is no sign of cancer in other areas of the body (MO). The TNM system corresponds closely to the A-through-D system but not exactly.
Grading
In addition to staging, physicians rate how life-threatening the tumor is by using the Gleason system. The biopsied tumor is put under a microscope, and the cells are assigned a grade according to how closely they resemble normal cells. Tumors with a Gleason score of 2 to 4 contain more normal looking cells and are generally slow growing. Tumors rated S to 10 are the most aggressive types.
Treating Prostate Cancer
How can you treat prostate cancer?
How prostate cancer is treated depends on the stage of the cancer, the aggressive nature of the cancer, the age of the patient, the patient's overall health, and the side effects of the different treatments. Because so many treatment options exist, your treatment should be a carefully weighed decision involving you, your family, and your doctor.
One of the treatment options is watchful waiting. Because prostate cancer usually grows so slowly, symptoms may not appear for years, and men generally develop the disease late in life, a period of observation is one of your choices. Watchful waiting avoids the side effects and discomfort caused by any treatment. However, as the disease progresses, more active treatments may seem appropriate.
Treatment depends on the stage of prostate cancer. In early stages, getting rid of the cancer or destroying tumor cells is the primary objective. If the cancer has reached an advanced stage, there is too much tumor to eradicate. Therefore, the goal becomes slowing the cancer's growth.
Prostate cancer grows with male hormones such as testosterone, which is primarily made in the testicles. Treating advanced prostate cancer depends on stopping the male hormones from "feeding" the tumor cells. This strategy is called hormonal therapy. Recently, studies have shown that hormonal therapy can also provide benefits in the early stages of prostate cancer.
How do you treat the early stages of prostate cancer?
In the beginning stages, when prostate cancer is localized (confined to the prostate), treatment options generally include:
Prostatectomy:
This is the surgical removal of the prostate. The objective is to stop the growth of the tumor by removing the prostate. Side effects may include impotence and difficulty controlling urination.
Radiation therapy:
This treatment shrinks tumors that are still in the prostate either by 1) directing radiation (x-rays) at the tumor from outside the body, or 2) implanting tiny radioactive seeds directly into the prostate. Radiation can cause impotence, diarrhea, cramps, rectal irritation, and difficulty with urination.
The benefits of radiation therapy can be improved with complete hormonal therapy (CHT). Recent studies have shown that patients given CHT in conjunction with radiation therapy remained cancer-free for an average of 21 months longer than patients given only radiation therapy. CHT is the combination of two drugs, EULEXIN® (flutamide) and an LHRH agonist (Lupron®* or Zoladex®t). The two drugs work together to stop male hormones from "feeding" cancer cells. CHT does not add substantial side effects to radiation therapy alone.
*Lupron® (leoprolide) is a registered trademark of TAP Pharmaceuticals Inc.
Zoladex® (goserelin acetate) is a registered trademark of Zeneca Pharmaceuticals.
How do you treat advanced prostate cancer?
Symptoms may not be present even in advanced prostate cancer. The goal of treating advanced prostate cancer is to slow further growth of the disease, even before symptoms begin. Slowing the growth will delay the onset of symptoms or drastically reduce their severity. Hormonal therapy is usually used for slowing the spread of prostate cancer.
Partial Hormonal Therapy
Most testosterone is made in the testes. With partial hormonal therapy, testes stop producing testosterone. Examples of partial hormonal therapy include the following:
Estrogen:
Estrogen (DES) is a female hormone that is used occasionally in the treatment of prostate cancer. When men take estrogen their testosterone levels fall. However, the use of estrogens is limited due to their many side effects. Taken as a pill once a day, estrogen can cause nausea, vomiting, breast tenderness or enlargement, serious heart or blood vessel problems (such as stroke, clots, fluid retention), and lower sex drive.
Orchiectomy:
Orchiectomy is also known as surgical castration, which is the removal of the testicles by surgery. Without testicles, the main source of male hormones is absent, which slows the growth of the tumor. Side effects usually include impotence and hot flashes. The surgery can be performed without an overnight hospital stay.
Medical Castration:
The ability of the testicles to make testosterone can also be stopped without surgery. Medical castration shuts off the supply of testosterone by the testicles and achieves the same result as surgical castration. Medical castration involves injections of Lupron®* (leuprolide) or Zoladex®t (goserelin) once a month or once every three months. These medications are also referred to as LHRH agonists. An LHRH agonist helps reduce the amount of testosterone similar to the surgical procedure. Side effects usually include hot flashes, impotence, breast enlargement and tenderness, loss of sex drive, and nausea.
*Lupron® (leuprolide) is a registered trademark of TAP Pharmaceuticals Inc.
Zoladex® (goserelin acetate) is a registered trademark of Zeneca Pharmaceuticals.
Complete hormonal therapy
While the regular injections of LHRH agonist stop the testicles from making testosterone, they do not eliminate all testosterone in the body. A medicine called EULEXIN® (flutamide) prevents the remaining testosterone from reaching prostate cancer cells.
The combination of LHRH agonists (Lupron® or Zoladex®) plus EULEXIN is called complete hormonal therapy. Complete hormonal therapy virtually shuts off the body's supply of male hormones and slows the growth of the tumor.
Prostate cancer support groups
Prostate cancer treatments can help you physically. Staying active and talking about your feelings can help you feel good mentally. To keep a positive attitude, joining a support group may help.
In a support group you can talk with prostate cancer patients who know exactly what you and your family are going through. In addition, support groups teach various coping mechanisms for stress, depression and anxiety. Many prostate cancer patients have greatly benefitted from support groups.
The organizations listed below provide support for men with prostate cancer and their families. You can call them for details about their organization.
US-TOO
930 North York Road, Suite 50
Hinsdale, IL 60521-2993
Tel: 800.80-USTOO
Patient Advocates for Advanced Cancer Treatments (PAACT)
1143 Parmelee, NW
Grand Rapids, MI 49504
Tel: 616.453.1477
American Cancer Society, Inc.
1599 Clifton Road, NE
Atlanta, GA 30329-4521
Tel: 800.ACS.2345
Local chapters of the ACS provide literature, counseling, and guidance for cancer patients and their families. The ACS sponsors a number of programs, including:
CanSurmount, which brings together patients or families with trained volunteers who can provide one-on-one help.
I Can Cope, an 8-week course that addresses practical and emotional needs of people with cancer.
American Foundation for Urologic Disease
300 W. Pratt St.
Baltimore, MD 21201
800.242.2383
[ back to top ]
Prostate Surgery and Sex
Many men worry about whether surgery for benign prostate hyperplasia (BPH) will affect their ability to enjoy sex. Some sources state that sexual function is rarely affected, while others claim that it can cause problems in up to 30 percent of all cases.
However, most doctors say that even though it takes awhile for sexual function to return fully, with time, most men are able to enjoy sex again.
Complete recovery of sexual function may take up to one year, lagging behind a person's general recovery. The exact length of time depends on how long BPH surgery was postponed despite symptoms and on the type of surgery that was done.
Here is a summary of how surgery may affect the following aspects of sexual function, according to the National Institutes of Health.
- Erections: Most doctors agree that if an individual was potent (able to maintain an erection) shortly before surgery, he will probably be able to have erections afterward. Surgery rarely causes a loss of potency. However, surgery cannot usually restore potency that was lost before the operation.
- Ejaculation: Although most men are able to continue having erections after surgery, a prostatectomy frequently makes them sterile (unable to father children) by causing a condition called "retrograde ejaculation" or "dry climax."
During sexual activity, sperm from the testicles enters the urethra near the opening of the bladder. Normally, a muscle blocks off the entrance to the bladder, and the semen is expelled through the penis. However, the coring action of prostate surgery cuts this muscle as it widens the neck of the bladder.
Following surgery, the semen takes the path of least resistance and enters the wider opening to the bladder rather than being expelled through the penis. Later it is harmlessly flushed out with urine.
- Orgasm: Most men find little or no difference in the sensation of orgasm, or sexual climax, before and after surgery. Although it may take some time to get used to retrograde ejaculation, men should eventually find sex as pleasurable after surgery as before.
Many people have found that concerns about sexual function can interfere with sex as much as the operation itself. Understanding the surgical procedure and talking over any worries with the doctor before surgery often help men regain sexual function earlier. Many men also find it helpful to talk to a counselor during the adjustment period after surgery.
[ back to top ]
Prostate Questionnaire
You can view and/or print the Prostate Questionnaire by following these easy instructions. In order to view and/or print the questionnaire, you must have the Adobe Acrobat Reader, which you probably already have on your computer. If not, you can easily and quickly download a free version of Adobe Acrobat Reader by going to their website Download Reader.
When viewing the questionnaire in Adobe Acrobat Reader, the text might appear somewhat fuzzy; this is normal (the questionnaire will print out clearly). To print, just click on the printer icon in the Adobe Reader toolbar above the document.
Once you have the Adobe Acrobat Reader installed, click on the link below.
Prostate Questionnaire
[ back to top ]
