What is it?

A widespread disease in the western world, prostate cancer is showing no signs of decreasing. About 10% of men will get prostate cancer and approximately 4% die as a result. The disease develops more commonly with men over the age of 50. Studies of autopsies, however, show that half of men over age 70 have some signs of prostate cancer.

Nobody knows what causes prostate cancer, but family history, environmental and dietary factors appear to be important. Prostate cancer in Asia is significantly lower than in Europe, America and Australia. Small doses of vitamin E (leafy, green vegetables), lycopene (tomatoes) and omega-3 fatty acids (salmon) help to significantly reduce the risk of prostate cancer.

Signs & Symptoms:

The early symptoms are usually gone undetected. There are no obvious symptoms. Advanced prostate cancer can cause symptoms such as:

- Slow urine flow

- Need to urinate more often

- Painful urination and ejaculation

- Incomplete bladder emptying

- Blood in urine or semen

- Pain in groin, hips and lower back area

Prostate cancer may spread to other parts of the body without any immediate symptoms ("metastasis disease") it usually first appears in the pelvic lymph nodes. After the lymph nodes the next most common site for the cancer to attack are bone tissues. Typically, patients experienced pain in the pelvis or lower back bone.

The most common way prostate cancer is detected is in association with benign enlargement of the prostate. With the latter you may experience a range of lower urinary tract symptoms, and prostate cancer may be diagnosed when you see a doctor about other problems with your urinary tract than the above described symptoms.

Arguments for Screening:

10% of men will get clinical prostate cancer in their lifetime, and 2-4% dies from it. Screening for prostate cancer is relatively simple to do, with an annual prostate examination and PSA test. Most patients who discover prostate cancer early will have a relatively higher chance of being cured.

Arguments against Screening:

Screening is expensive if instituted nationwide. Potentially patients with relatively small, slow-growing tumors may be over-treated, and suffer dangerous side effects including the possibility of dying from the treatment itself. People who oppose screening also argue that there have not been any studies done that prove prostate cancer screening are effective. Some indirect evidence that screening is effective is starting to appear in some geographical areas of the United States where screening is popular, and death from prostate cancer is slowly decreasing.

Treatment:

Hormonal treatment, regardless of the stage of the tumor is usually effective in bringing about remission of prostate cancer, often for several years. When prostate cancer has spread, it becomes metastasis. The most effective treatment in this case is hormonal treatment. This either involves orchidectomy, which is basically a surgical removal of the testes, or medication specifically designed to block the effects of testosterone.

The treatment for prostate cancer depends on the stage of the disease and the age and fitness level of the patient. Prostate cancer has a wide range of behavior, in some men it may be a very slow-growing tumor, but in others the tumors are relatively aggressive and can grow rapidly. Prostate cancers can be graded using a prostate biopsy with reasonable accuracy.

If you are deemed to have a 10-15 year life expectancy, radical treatment is generally indicated. This usually consists of radical prostatectomy, a surgical removal of the prostate and seminal vesicles. This can either be done through an abdominal or perinea incision. If diagnosed early, for 80-90% of patient's prolonged remissions or a "cure" can be expected. The disadvantages of surgery include a temporary loss of continence, which can last several weeks or months post-op. Small percentages (2-20%) of patients have longer term impaired continence. Erectile dysfunction occurs in at least 50% of patients.

Surgical Alternatives:

The alternative to surgery is radical radiotherapy, most commonly external beam radiotherapy. This normally involves a daily treatment for 6 weeks, and has short-term side effects which include frequent urination, occasional bloody urine, as well as frequent bowel movement. Most of these side effects are short term, but a small percentage of patients can have ongoing radiation damage to their bladder and bowels. Similar to radical prostatectomy, erectile dysfunction affects 30-50% of men who have radical radiotherapy.

An alternative radiotherapy treatment is brachytherapy, where radioactive seeds are placed directly in the prostate, with the potential advantage of reducing the radiotherapy dose to the nearby bowel and bladder. Initial results with brachytherapy are encouraging, but it remains a relatively new treatment, so there isn't much long-term data to assess results.

PSA:

Prostate Specific Antigen or PSA is used to test for the presence of prostate cancer. PSA is a tumor marker which has been helpful both as a screening tool in the detection of prostate cancer, for the staging of cancer, and also for measuring the response of treatment. In large scale screening 5-10% of a population will have an abnormal PSA. In addition to a PSA blood test, prostate examination should be done regularly, as digital rectal examination can detect about 20% of tumors missed by PSA alone.

Prostate Biopsy:

If the PSA is elevated or the prostate examination is abnormal, a transrectal ultrasound and prostate biopsy may be required. This procedure is performed with a transrectal ultrasound probe, which is placed up the rectum, and several needle samples are obtained from each side of the prostate. The procedure is uncomfortable for most patients, but a general anesthetic is not usually required.