How Do I Know If I Have Prostate Cancer?
Two tests are used to look for prostate cancer: a digital rectal exam and a PSA blood test.
The PSA blood test looks for something called prostate-specific antigen in the blood. Who should have a PSA test and when is controversial:
- The U.S. Preventive Services Task Force does not recommend regular PSA tests. The task force say the tests may find cancers that are so slow growing that treatment, which can have serious side effects, would offer no benefit.
- The American Cancer Society (ACS) recommends a discussion between the doctor and patient about the pros and cons of PSA tests. Men shouldn't get the test unless their doctor has given them this information, says the ACS. The ACS recommends that the discussion start at age 50 for most men at average risk for prostate cancer, or age 40 to 45 for those at high risk of prostate cancer.
- The American Urologic Association (AUA) also recommends men talk with their doctor about the pros and cons of the PSA test. The AUA says men who want to be tested should start at age 40.
PSA levels
in blood are higher if there is prostate cancer, making it a valuable
tool in finding early prostate cancer. But PSA levels can also be high
from infection or inflammation in the prostate or from an enlarged prostate.
It
is important to discuss this test with your doctor before having one. A
high PSA level does not mean that you have cancer; a normal PSA level
does not mean you don't have cancer.
If PSA levels are high or have gone up since the last PSA test, your doctor will do a biopsy of the prostate gland using a small ultrasound probe inserted in the rectum (transrectal ultrasound). Tissue samples will be tested for cancer.
If cancer is found, the doctor will do abdominal and pelvic X-rays to see if the cancer has spread outside the prostate. A CT scan and a bone scan may also be done.
For men who have high PSA levels but biopsies don’t find cancer, there is a urine test known as a PCA-3 that looks for cancer. This test can prevent the need for repeat biopsies in some men.
What Are the Treatments for Prostate Cancer?
Once
the decision is made to treat prostate cancer, your doctor will decide
the type of treatment. Decisions about how to treat this cancer are
complex, and it makes sense for men to seek a second opinion before
making a treatment decision. Treatment may include doing nothing, a
single therapy, or some combination of radiation, surgery, hormone therapy, and rarely chemotherapy. The choice depends on many things. Prostate cancer that hasn’t spread usually can be cured with surgery or radiation.
What Are the Treatments for Prostate Cancer? continued...
Watchful Waiting
Since
prostate cancer can grow slowly and may not be fatal in many men, some
patients -- after discussing the options with their doctors -- opt for
"watchful waiting." Watchful waiting means not treating it. Instead, the
doctor regularly checks the prostate cancer for signs that it is
becoming more aggressive. Watchful waiting recommended for men who are
older or have other life-threatening conditions. In these cases, a less
aggressive cancer may be growing so slowly that it's not likely to be
fatal.
Surgery
The standard
operation, a radical retropubic prostatectomy, removes the prostate and
nearby lymph nodes. In most cases, surgeons can remove the gland
without cutting nerves that control erections or the bladder, making impotence or incontinence
much less common than in the past. Depending on the man's age and the
amount of surgery needed to remove all the cancer, nerve-sparing
operations allow about 40%-65% of men who were able to get erections
before surgery to be able to do so after surgery without the need for erectile dysfunction treatments.
Laparoscopic
robotic prostatectomy is a surgery using a laparoscope aided by robotic
arms. This operation is now the most popular form of radical
prostatectomy in the United States.
After surgery,
most men have temporary urine leakage, called incontinence, but they
usually regain complete urinary control over time. If it is severe or
lasts a long time, incontinence can be managed with special disposable
underwear, exercises, condom catheters, biofeedback, penile clamps, implants around the urethra, or a urethral sling.
After surgery or radiation, men may have impotence. Treatment for this side effect includes drugs such as Viagra, Levitra, and Cialis. Other treatments include teaching the man to perform a painless self-injection into the penis (of a drug called Caverject),
or vacuum pumps. These treatments work in 15% to 40% cases of impotence
after surgery and 50% to 75% cases of impotence after radiation. A penile prosthesis is only used when all other options have failed.
Radiation
Radiation
is often the main treatment for prostate cancer that has not spread. It
may also be given as follow-up to surgery. Radiation may also be used,
in advanced cases, to relieve pain
from the spread of cancer to bones. Incontinence and impotence also
occur with radiation. Radiation to the pelvis may also be done if PSA
levels rise after surgery.
An advanced form of
radiation, known as intensity modulated radiation therapy (IMRT), can
increase the dose of radiation to the prostate with fewer side effects
to the surrounding tissues. Proton beam therapy can increase the
radiation dose to the prostate even more. But proton therapy is
controversial as it has not been proven to be superior to IMRT. A more
focused form of radiation, known as stereotactic radiation, is being
used for early forms of prostate cancer. This treatment also has not
been shown to improve the outcome of prostate cancer. Stereotactic
radiation for prostate cancer is still new.
What Are the Treatments for Prostate Cancer? continued...
Radioactive
seeds (brachytherapy) deliver radiation to the prostate with little
damage to surrounding tissues. During the procedure, the tiny
radioactive seeds, each like a grain of rice, are implanted in the
prostate gland using ultrasound guidance. The implants remain in place
permanently and become inactive after many months. In some patients,
brachytherapy may be used with traditional radiation. In some patients,
if the prostate gland is too large for brachytherapy, hormone therapy
can shrink the prostate to allow brachytherapy to be done.
Hormone Therapy
Hormone
therapy is the recommended treatment for advanced prostate cancer.
Since testosterone can make prostate cancer grow, hormone therapy works
by tricking the body to stop making testosterone, thus stopping or
slowing the cancer's growth. Even advanced cases that cannot be cured
may be controlled for many years with hormone therapy. But there is a
higher risk of heart disease with this treatment. Fractures are also a risk due to thinning of bone. Medications are given to reduce the risk of osteoporosis and fractures.
Testosterone
can also be removed from the bloodstream by surgically removing the
testicles (orchiectomy) or by giving female hormones such as estrogen
or other drugs that block testosterone production. Estrogen therapy is
no longer used routinely. Patients generally prefer the
testosterone-blocking drug treatment because it is effective, less
invasive, and causes fewer side effects than surgery or female hormone
drugs.
Other Treatments
Chemotherapy and vaccines
are effective for some men with advanced prostate cancer who didn’t do
well on hormone therapy. Provenge is a new prostate cancer vaccine that
helps men with advanced prostate cancer live longer. Unlike most
vaccines, Provenge is used for treatment, not prevention. Provenge
doesn't cure prostate cancer. It stimulates the immune system to fight
the cancer.
The goal of prostate cancer treatment
is long-term survival, and that is likelier in men diagnosed with early
prostate cancer. All prostate cancer survivors should be examined
regularly and have their PSA and testosterone levels monitored closely
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