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Prostate Cancer

By Hoyt A. “Tres” Childs, III, M.D., radiation oncologist at Alliance Cancer Care

What is prostate cancer?

Prostate cancer is a malignancy arising from the glands within the prostate itself.  The formal name is usually an adenocarcinoma.  There are others sometimes, but they are much rarer.

What are the risk factors for prostate cancer?

The risk factors of prostate cancer involve anything that can increase testosterone over a long period of time.  Because of this, it also occurs more in African American men and less often in Asian/American and Hispanic/Latino men.  Age is a huge factor.  Prostate cancer is rare in men younger than 40, and it starts to increase significantly after age 50.  Sixty percent of cases are found in men older than the age of 65.  Family history is also important; as are very rare, genetic mutations, such as Lynch syndrome, and mutations of BRCA1 or BRCA2 genes.

What are the symptoms of prostate cancer?

The symptoms of prostate cancer are rather vague.  You can have changes in the urine stream or sometimes blood in the urine or semen.  You could also have pain in the bones if the cancer has spread to other areas.

What testing is done to diagnose prostate cancer?

Because symptoms are so vague, the best testing to diagnose prostate cancer is to take a PSA. This is a protein that can be detected in the blood, made within the prostate itself, and increases to abnormally high values in the setting of prostate cancer.  Although there are many other reasons besides cancer that can make your PSA rise, if a PSA is elevated above 4.0, your doctor will probably want to do an evaluation and rule out cancer.

Other tests that can aid in the diagnosis include other PSA tests like a total PSA or a percent free PSA.  Digital rectal exams can help also.  Imaging like a CT scan or an MRI or an ultrasound can ensure that the cancer has not spread.  Finally, biopsies under ultrasound or MRI Guidance are required to confirm the diagnosis of prostate cancer.

What are treatment options for prostate cancer?

Treatment options are very wide-ranging.  Depending on the risk group of an individual’s prostate cancer, going from very low risk to very high risk, the recommended options of treatment may change.  With very low-risk disease, often observation is all that is recommended.  As you progress up the risk ladder, curative treatment options would include radical prostatectomy, with or without robotic assistance, different forms of radiation therapy; and hormonal therapy or chemotherapy can also be utilized.  There are also other forms of off-label treatments that can be utilized in specific cases, typically in research trials.

What are the side effects of treatment?

The side effects of treatments are greatly determined by the type of treatment that is recommended.  With surgery, the biggest short-term risk is temporary incontinence while the urethra heals.  With radiation, the largest side effects include irritation to the urethra, bladder, and rectum that gradually resolve after treatment.  With both forms of treatment, erectile dysfunction may be a risk.  These side effects are worth discussing in great detail with your doctor before choosing a treatment regimen for your cancer.

What kind of recovery is involved after treatment?

Recovery will be different depending on what kind of therapy is utilized for treatment.  With definitive surgery, a catheter is left in place for a few days while the urethra heals.  Urinary function improves as the sphincter muscles regain control, especially with Kegel exercises. With radiation, the irritation of the bladder, urethra, and rectum gradually increases over several weeks of treatment and then resolve over several weeks after treatment is over.

What happens after treatment?

After any kind of definitive treatment is given, the PSA is monitored every three or six months until stability is documented.  Once stability is documented, the interval is stretched out to 6 or 12 months.  Once several years have gone by and the physician is comfortable that the cancer is under control, then usually the PSA monitoring is once yearly.

What happens if the tumor spreads?

Unfortunately, prostate cancer can recur and spread to other organs.  The vast majority of the time it spreads to the bones.  This can present with either an elevated PSA or even bone pain.  If that occurs, physicians usually offer systemic therapy to treat the entire body.  Many times, the cancer can be held at bay for several years, offering good quality of life, often with nothing more than anti-testosterone hormones via either pills or shots.  If bone pain is significant, radiation therapy is often used to decrease pain and improve the quality of life.  There is also a radioactive treatment for patients with a widespread bony disease with prostate cancer.  Your doctor will discuss if this treatment is appropriate in your specific case.

Where can I find more information?

To find more information you can talk to your local oncologist, reference the American Cancer Society website, or reference multiple oncology centers of excellence at major academic institutions across the country.

If you were diagnosed with prostate cancer and would like to discuss treatment with one of our expert physicians, please contact our office at 256-319-5400 to schedule a consultation.