Prostate cancer is the most prevalent malignancy among the males in the United States. The American Cancer Society estimates 186,320 new cases for men in the United States in 2008 and 28,660 deaths from the disease. The risk of prostate cancer increases with age. African-American males and older males with family of cancer are at a greater risk for developing the disease.

Prostate cancer develops in the prostate gland, a walnut shaped organ that surrounds the urethra and is located immediately under the bladder. The gland produces secretions that form part of the seminal fluid during ejaculation. Around the age of 20, it reaches the adult weight of about 20 grams. In most men it begins to enlarge further after the age 50. This enlargement, called benign prostate hypertrophy (BPH) may interfere with urination by compressing the urethra. Cancer of the prostate may cause symptoms similar to those that occur with BPH.

Most prostate cancers develop in the region of prostate closest to the rectum, where they lie in a dormant stage for years. Once the growth begins it will spread to nearby lymph nodes, bones, liver, or lungs. Therefore, early diagnosis and treatment is absolutely essential for normal life expectancy.

Symptoms of prostate cancer
At the early stages, prostate cancer may not cause symptoms. When symptoms develop they are often similar to those of BPH and include:

1. Frequent urination, especially at night

2. Weak urine flow with interruptions

3. Difficulty in starting and stopping urination

4. Burning or painful urination

5. Blood in the urine

6. Constant pain in the lower back, pelvis, or upper thighs

7. Loss of appetite and weight

Detection and diagnosis of prostate cancer
The American Cancer Society and Urological Association recommends a prostate screening exam for all men over age 50 at least once a year.

1. Digital Rectal Exam (DRE) - This exam allows a physician to determine by touch whether the prostate gland has changed in size, texture, or lumps. This test is not sufficient for diagnosis, because small tumors cannot be detected by this exam.

2. Blood test for Prostate Specific Antigen (PSA) - Normally, a small amount of PSA is found in the blood (values are less than 4.0 ng per ml). These values are increased during the pathologic conditions of the prostate, such as inflammation of the prostate and trauma. The most common cause of PSA elevation is benign prostatic hyperplasia (BPH). Around 25% of males with elevated PSA are found to have prostate cancer.

3. Free PSA Blood Test - The FDA approved a new type of prostate cancer screening test in March of 1998 which detects "free" PSA in the blood that is not attached to proteins. In the case of prostate cancer, PSA is likely to bind to other blood proteins, therefore a very low "free" PSA value as compared to the total PSA could be a sign of prostate cancer. This test may detect 95% of prostate cancers and will reduce some unnecessary biopsies.

4. Transrectal Ultrasonography - This is proved to be nonspecific for general screening, but it is used to direct prostate biopsies.

5. Prostate Biopsy - When prostate cancer is suspected because of either an elevated level of PSA or an abnormality detected by DRE, a prostate biopsy is performed. Under local anesthesia, the tissue specimen is removed for microscopic and biochemical examination. This procedure helps determine whether the cancer is an aggressive type (one that is likely to spread quickly) or the type that tends to grow and spread slowly. Additional tests may be necessary to determine if the cancer has spread to other parts of the body. Tests for this include Radionuclide Bone Scan and Magnetic Resonance Imaging (MRI). The first site of the cancer beyond the prostate is usually the pelvic lymph nodes and the most common site of distant metastatic disease is bone.

Treatment of the prostate cancer
Treatment for prostate cancer depends on the following factors: the stage of the cancer, the age of the patient, and existing or suspected medical problems with the patient. Size, grade, and serum PSA levels will provide some prognostic information. The purpose of treatment is to remove the cancer or to eliminate the supply of hormone that encourages the growth of the cancer.

1. Radical Prostatectomy - Developed almost 100 years ago at Johns Hopkins University, it is the most common treatment for cancer confined to the prostate. In this procedure, the entire prostate, with its enveloping fascial layers and seminal vesicles, is removed. Radical prostatectomy often results in impotence and urinary incontinence. Lately surgeons at Johns Hopkins University developed an approach that allows the surgeon to remove the prostate without damaging nerves that control erections and urination. This procedure is not successful for aggressive types of cancer and cancers that spread beyond the prostate.

2. Cryoablation - uses ultrasound to locate the prostate. Nitrogen or argon gas is then circulated into the prostate and forms an "ice ball" which covers the organ and cancer. This kills the cancer cells and shrinks the prostate effectively removing it without the need of invasive surgery. Dr Bahn from Crittenton hospital in Rochester reported 15 percent failure rates and only 3 percent incontinence rates .He also warns that this procedure must be done with utmost care by well-trained health care professionals.

3. Radiation Therapy - - there are two types or radiation therapy. External beam radiation uses high-energy X-rays to kill or reduce the growth of the cancer cells. This therapy is used to treat cancer confined to the prostate and nearby tissues. After the treatment, thirty to forty percent of patients experience some degree of impotence, urinary incontinence, frequent urination, urge incontinence, and burning sensation while urination. Internal radiation therapy (brachyterapy) uses small radioactive pellets placed in the area where cancer is found. These pellets provide small and constant source of radiation for several weeks or months. This therapy results in incontinence, pain during urination, and impotence.

4. Hormonal Treatment - If the prostate cancer has spread to other parts of the body, hormonal treatment is recommended. Male hormones promote the growth of cancer cells; therefore, the goal of this therapy is to deprive the cancer cells of male hormones. This can be accomplished by surgically removing the testicles, called orchiectomy (testosterone is produced in the testicles), or giving a medication that suppresses the ability to produce male hormones. Leutenizing hormone-releasing hormone (LHRH) agonist is used to decrease the amount of testosterone produced by men's body. Side effects of this treatment include loss of sex drive, erection problems, hot flashes, nausea, and diarrhea.

According the New England Journal of Medicine, a combination of both radiation and hormone therapy is more effective than radiation therapy alone in extending patients' lives. In the study involving around 400 men whose cancer spread beyond the prostate but still was confined to the pelvis, it was found that 79% of patients receiving both LHRH analog called Goserelin (marketed as Zoladex) had a five year survival rate following treatment as compared to 72% of men receiving radiation alone. Of these surviving patients 84% receiving combination treatment were classified as "disease free" as compared to only 48% of those in the radiation group.

Conclusion
Prostate cancer can be and usually is diagnosed at an early stage. It also can be treated with fewer side effects. In the future, new research will promise new ways to prevent the disease, new ways to diagnose it at earlier stages, and new ways to treat it more effectively in advanced stages of the cancer.

The information contained above is intended for general reference purposes only and does not substitute for professional medical advice.

Last Updated: 05-Feb-2009

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