Prostate Cancer – The Facts

What is prostate cancer?

Prostate cancer is a malignant (cancerous) tumour (growth) that consists of cells from the prostate gland. The tumour usually grows slowly and remains confined to the gland for many years. As the cancer advances, it spreads beyond the prostate. The cancer can metastasize (spread) to other areas of the body.

Why is testing for prostate cancer important?

Prostate cancer is the most common malignancy in Jamaican men. It is the second leading cause of deaths from cancer. It is recommended that beginning at age 40 all men should be tested.

What causes prostate cancer?

The cause of prostate cancer is not known. The risk factors include advancing age, genetics, hormonal and environmental.

What are the symptoms of prostate cancer?

In the early stages, prostate cancer often causes no symptom. As the cancer enlarges the flow of urine diminishes, urination becomes more difficult resulting in complete obstruction to urine flow. There is burning with urination or blood in the urine.

In the later stages, the cancer spreads to surrounding tissues and to distant sites such as the spine, hips, liver and lungs causing: bone pain, loss of appetite, weakness due to anaemia, jaundice and shortness of breath.

What are the screening tests for prostate cancer?

Digital rectal examination- the doctor feels the prostate gland with a gloved index finger passed into the rectum. A blood test called the prostate specific antigen (PSA). The PSA is a protein released from the prostate gland into the blood and is usually higher in men with prostate cancer.

How is prostate cancer diagnosed?

Prostate cancer is diagnosed from the results of a biopsy. This is done from the rectum or through the perineum. A small piece of prostate is removed which is then examined under a microscope for signs of cancer. Once diagnosed, the pathologist will grade the tissue from 2 to 10 called Gleason score. Gleason score can be helpful in guiding treatment and predicting the risk of death from prostate cancer.

How is the staging of prostate cancer done?

Staging refers to determining the extent of the disease using the following test: Abdominal ultrasound, radionuclide bone scans, Cat scans and MRI. Staging helps to predict the expected course of the disease and determine the choice of treatment.

What are the treatment options for prostate cancer?

Prostate cancer is categorized as organ confined, locally advanced or metastatic. Treatment options for organ-confined prostate or locally advanced prostate cancer include surgery, radiation therapy, hormonal therapy, cryotherapy, combinations of some of these and watchful waiting. A cure for metastatic prostate cancer is not possible at this time. Treatments are considered palliative. Palliation aims to slow the growth and relieve the symptoms of the patient. Other factors considered in choosing treatment include: age, general health, preference of the patient, PSA, Gleason score, stage of the cancer.

What about surgery for prostate cancer?

Radical or total prostatectomy

Most common treatment for prostate cancer with a cure rate estimated at 90% for organ confined disease. Potential complications include risks of anaesthesia, local bleeding, erectile dysfunction, urinary incontinence and urinary obstruction.

Advances in dealing with complications:

• Anaesthesia-employment of well-trained anaesthetist with good track record.

• Bleeding is decreased by following good surgical technique.

• Blood must be made available

• Erectile dysfunction: the introduction of nerve-spearing technique, use of tablets such as Viagra, levitra and Cialis, injections into the penis, vacuum device, penile implant.

What about radiation therapy for prostate cancer?

Radiation kills cancer cells thus stopping their growth. Complications of radiotherapy include: erectile dysfunction, incontinence, proctitis.

Radiation therapy can be given as:

• External beam radiation over 6 or 7 weeks

• Implant of radioactive seeds (brachytherapy) directly into the prostate.

 What about hormonal treatment for prostate cancer?

The male hormone testosterone stimulates the growth of cancerous prostate cells. The idea of hormonal treatment is to decrease testosterone either surgically or medically. Hormonal treatment is reserved for patients with advanced cancer. Complications of hormonal therapy include: enlarged breast (gynaecomastia), flushing (like hot flashes),erectile dysfunction.

What is cryotherapy for prostate cancer?

This treatment kills the cancer cells by freezing them. Effectiveness has not been proven.

What is chemotherapy for prostate cancer?

These are anti-cancer drugs used for palliation in patients with advanced prostate cancer.

Common side effects include: weakness, nausea, hair loss, anaemia and infection.

 What about herbal or alternative medicine treatments for prostate cancer?

This includes such non-traditional treatments as herbs, dietary supplements and acupuncture. A major problem with most herbal treatments is that their composition is not standardized.

What is watchful waiting?

This is observing a patient while no treatment is given. If there is cancer progression watchful waiting is discontinued and treatment is recommended.

Can prostate cancer be prevented?

No specific measures are known. Early detection with an attempt to cure the disease should prevent progression. Digital rectal examination and PSA testing of men over 40 are essential. Certain dietary measures have been suggested to prevent progression of prostate cancer such as: low fat diet, avoidance of red meat, soybean products, lycopenes from tomato, selenium and vitamin e.

Article by Dr. Keith Wedderburn. He is a Consultant Urologist and founding member of the Jamaica Urological Society