Dr. M.J. Bazos, MD.
Prostate cancer is the most common cancer among
men in the United States. Nearly 300,000 new cases are diagnosed each year. It
is estimated that 1 in 5 men has a diagnosis of prostate cancer in his lifetime.
The cause of prostate cancer is unknown. Abnormal findings during a digital
rectal examination or an abnormal prostate-specific antigen (PSA) blood test
usually leads the physician to ordering transrectal ultrasonography (TRUS). A
biopsy of the prostate is performed to confirm the diagnosis of prostate cancer.
The PSA blood test can lead to early detection of prostate cancer even before
there are any symptoms. This accounts for the high number of new cases diagnosed
each year but also has led to controversy regarding therapy for early localized
prostate cancer. The reason for the controversy is that prostate cancer
generally is slow growing; some reports show that 80% of patients live 10 years
without treatment. The decision is whether patients should undergo treatment,
which places them at risk for complications, or undergo observation and be
treated only when symptoms occur (watchful waiting), knowing that prostate
cancer is curable if treated at an early
Living With Your
Typical symptoms are
difficulty starting the urine stream, waking up frequently at night to urinate,
dribbling at the end of urination, blood in the urine, urinary urgency, and pain
with urination. If the prostate cancer has spread (usually to bone), you may
have back or hip
the diagnosis is made, staging is performed to determine whether the cancer is
localized or has spread, or “metastasized” (Fig 1). Computed
tomography (CT) of the abdomen and pelvis and a bone scan usually are ordered.
If the tumor is confined to the prostate, the treatment options include the
1. Surgical removal of the
prostate. The main complications are impotence (inability to have an erection)
and urinary incontinence (leaking).
Radiation therapy. The main complications are diarrhea, blood-streaked stools
and rectal and urinary urgency, frequency, and
3. Radiation seed implants.
Complications are similar to those of radiation therapy. If the tumor has
spread, treatment is focused on elimination of the male hormone testosterone,
which increases prostate tissue growth. Removal of all testosterone stimulation
has been shown to cause remission. The testes produce 95% of the testosterone in
the body; the other 5% comes from the adrenal gland. Therefore, treatment of
advanced prostate cancer includes the
1. Surgical removal of both
testes (orchiectomy). Complications are impotence, hot flashes, and loss of
libido (sexual drive).
2. Use of medicines,
including hormones, that inhibit formation of testosterone, such as estrogens,
leuprolide, and flutamide. Complications are similar to those of
• Be aware of the controversy
about PSA screening. Some authorities recommend an annual PSA blood test with
digital rectal examination for all men older than 50 years or sooner for men who
have a family member in his 40s or 50s with prostate cancer. There is no answer
to what age to stop checking PSA level. This becomes a judgment and discussion
between you and your physician. Most prostate cancers are slow growing and
produce no clinical symptoms for as long as 10
• Ask yourself the following
questions and have an active role in making decisions about your treatment: Do
you believe your life expectancy is more than 10 years? A 50-year-old man would
say yes, but an 80-year-old would think twice. What about a 70-year-old man? Do
you want to find out if you have prostate cancer by undergoing a biopsy? Do you
want to go through surgical treatment or radiation therapy and its
• Do not forget your
options if you have localized prostate cancer. They are watchful waiting,
surgical treatment, or radiation
• Do not be afraid to ask
for second opinions. You can ask opinions from an oncologist (cancer
specialist), urologist (specialist who deals with diseases of the urinary and
genital tract), and your primary care
When to Call Your
• If you have blood in the
• If you have difficulty
initiating the urine stream or cannot
• If you have urinary
frequency, urgency, or pain.
• If you
have prostate cancer and new onset of back, hip, or bone pain.