Prostate Cancer

While researchers still do not know the exact answer to this question, they have identified some risk factors. These include environment, genetics and family history.

Incidence increases with age

More than 70% of all prostate cancers are diagnosed in men over age 65. Information regarding first-degree relatives (i.e., father, brother) has shown an over 2- to 11-fold increase in the risk of prostate cancer in men who have a history of this disease in their family.

The death rate for prostate cancer is more than 2 times higher in African-American men than in Caucasian men. Because of additional risk, earlier screening for prostate cancer is recommended for African-American men. According to the American Cancer Society, men aged 50 and older, and those over the age of 45 who are in high-risk groups, such as African-American men and men with a family history of prostate cancer, should have a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) once every year.

Symptoms of prostate cancer

As the tumor grows, it may spread from one part of the prostate to surrounding areas. Symptoms of prostate cancer may include:

• Frequent urination (especially at night)
• Weak urinary stream
• Inability to urinate
• Interruption of urinary stream (stopping and starting)
• Pain or burning on urination
• Blood in the urine
• Pain in lower back, pelvis or upper thighs

Stopping testicular production of testosterone may relieve many of these symptoms.

Diagnosing prostate cancer

Determining whether you have prostate cancer generally involves a series of tests and exams. Before starting the testing process, your physician may ask you questions about your medical history, your family history of cancer and any symptoms you may be having, particularly problems with urination. Then, your doctor will most likely proceed to one or more of the tests described below.

Digital Rectal Exam (DRE)

Because the prostate lies in front of the rectum, your physician can feel the prostate by inserting a gloved, lubricated finger into the rectum. This simple procedure is called a digital rectal examination (DRE). It allows your physician to determine whether the prostate is enlarged or has lumps or other types of abnormal texture.

Prostate-Specific Antigen (PSA) test

Used in addition to the DRE, a PSA test increases the likelihood of prostate cancer detection. PSA is the abbreviation for prostate-specific antigen, a substance produced by the prostate cells. A PSA test measures the level of PSA in the bloodstream and is reported as nanograms per milliliter , or ng/mL. Very little PSA escapes from a healthy prostate into the bloodstream, but certain prostate conditions can cause larger amounts of PSA to leak into the blood.

Two possible causes of a high PSA level are:

• a benign noncancerous enlargement of the prostate called benign prostatic hyperplasia (BPH)
• prostate cancer

A high level of PSA in the bloodstream is a warning sign that prostate cancer may be present. But since other kinds of prostate disease can also cause high PSA levels, PSA testing by itself cannot confirm the presence of prostate cancer. A high PSA level only indicates the possibility of prostate cancer and the need for additional evaluation by your physician. Conversely, a low PSA level does not always mean that prostate cancer is not present.

According to the American Cancer Society, men aged 50 and older, and those over the age of 45 who are in high-risk groups, such as African-American men and men with a family history of prostate cancer, should have a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) once every year. Any man who develops persistent urinary symptoms should contact his physician.

Transrectal Ultrasound (TRUS)

Transrectal Ultrasound (TRUS) is the use of soundwaves to create an image of the prostate. As the waves bounce off the prostate, they create a pattern that is converted into a picture by a computer. TRUS is used to detect abnormal prostate growth and to guide a biopsy of the abnormal prostate area.

MRI / CT SCAN PROSTATE (PET -CT SCAN)

MRI of Pelvis is done to determine the extent of prostatic gland involvement by cancer growth and also regarding Lymph node status.

Biopsy

A biopsy is the removal of a sample of tissue, which is then examined under a microscope to check for cancerous changes. Only a biopsy can definitely confirm prostate cancer.

Typically, the physician takes multiple tissue samples for biopsy. Keep in mind that it is still possible to have cancer, even if the biopsy is negative. This is because, even though multiple samples are taken during a biopsy, it can still miss some cancers.

If the biopsy is taken and prostate cancer is found, the tumor is graded in the medical lab. The grade estimates how aggressive a prostate cancer is; that is, how fast it is growing and the likelihood of its spreading. Sometimes you will hear the grade referred to as the Gleason grade.

Treatment options:

Prostate cancer treatment options

Earlier diagnosis of prostate cancer has increased since the introduction of the PSA blood test. As a result, the overall prognosis for prostate cancer patients has dramatically improved compared with years ago. Over the past 20 years, the overall survival rates for all stages of prostate cancer combined have increased from 67% to 97%. According to the American Cancer Society, the five-year relative survival rate for patients whose cancers are detected while still in the local and regional stages is 100%.

The major treatment options

The major treatment options for prostate cancer include:

• Hormonal therapy
• Surgery
• Radiation
• Chemotherapy
• Watchful waiting (Observation)

These options are not listed in any particular order. The options selected for your treatment will depend on several factors, including your age, the stage of your disease and the advice of your physician.

Hormonal therapy for prostate cancer

Testosterone is a concern for those diagnosed with prostate cancer. The goal of hormonal therapy for prostate cancer is to lower the production of testosterone and/or block its effects. Testosterone, a male sex hormone produced primarily by the testicles, can stimulate the growth of hormone-dependent prostate cancer. There are three major types of hormonal therapy:

Drugs that reduce testosterone production by the testicles

(i.e., LH-RH agonists)
Surgical removal of the testicles (also known as orchiectomy or castration)
Antiandrogen therapy to block the effects of testosterone
Luteinizing Hormone-Releasing Hormone (LH-RH) agonists

LH-RH agonists can decrease the amount of testosterone produced by a man's testicles, as effectively as surgical removal of the testicles. However, this effect is not immediate and occurs 2-4 weeks after initiation of therapy. Lupron Depot ® (leuprolide acetate for depot suspension), one of the LH-RH agonists, is used in the palliative treatment of advanced prostate cancer.

Doctors also use LH-RH agonist therapy to slow the spread of cancerous cells and help alleviate or ease the symptoms associated with advanced prostate cancer. However, LH-RH agonists are not a cure for prostate cancer.

Orchiectomy

Orchiectomy, also known as castration, is a surgical procedure that completely removes the testicles. It is usually an outpatient procedure. Orchiectomy produces an immediate and permanent reduction in testosterone and has modest surgically-related complications. Hot flashes, impotence and loss of interest in sex are side effects associated with orchiectomy. Although this procedure is not a cure, it may delay the advance of the disease.

Antiandrogen therapy

Another treatment alternative for advanced prostate cancer involves the use of hormone-blocking drugs called antiandrogens. Antiandrogens block the body's ability to use androgens, such as testosterone. However, antiandrogens are not a cure for prostate cancer.

Examples of antiandrogens include: Eulexin ® (flutamide), Casodex ® (bicalutamide tablets), and Nilandron ® (nilutamide tablets).

Eulexin ® , Casodex ® and Nilandron ® are not trademarks of TAP Pharmaceutical Products Inc.

Alternatives to hormonal therapy

For some men with prostate cancer, hormonal therapy may not be the appropriate choice of therapy. Other options include surgery , radiation , chemotherapy , or watchful waiting (observation) .

Lupron Depot is indicated for the palliative treatment of advanced prostate cancer. The most common side effect associated with Lupron Depot is hot flashes. Like other treatment options, LH-RH agonists may cause impotence. Symptoms may worsen over the first few weeks of treatment. Periodic monitoring of PSA and serum testosterone levels is recommended. The -4 Month 30 mg, -3 Month 22.5 mg and 7.5 mg dosage forms are not indicated for use in women.

Surgical treatment for prostate cancer

The goal of surgery is to remove all the cancer. Techniques that may be used by surgeons to remove the prostate are described below.

Laparoscopic / Robotic Radical prostatectomy

Surgical removal of the entire prostate gland is called radical prostatectomy. Radical prostatectomy is usually performed to remove early-stage prostate cancer that has not yet spread to other parts of the body.

Often, biopsy of the pelvic lymph nodes is also performed to find out if the cancer has spread outside the prostate. Careful removal and examination of the lymph nodes — pelvic lymph node dissection — has traditionally been the final check to see if the cancer has spread. If radical prostatectomy is a treatment option for you, be sure to discuss the benefits and risks with your physician.

Side effects after radical prostatectomy for prostate cancer include incontinence and impotence. Most men experience urinary incontinence after surgery. Many continue to have intermittent problems with dribbling caused by coughing or exertion.

Impotence, also known as erectile dysfunction, is the inability to achieve an erection sufficient for sexual intercourse. The risk of impotence may be reduced by nerve-sparing surgery. This technique carefully avoids cutting or stretching two bundles of nerves and blood vessels that run closely along the surface of the prostate gland and are needed for an erection. Success of preserving potency depends upon the age of the patient, the status of the nerves and muscular tissue, and the stage of the cancer. However, nerve sparing surgery is not possible for everyone. Sometimes the cancer is too large or is located too close to the nerves.

Cryosurgery

Cryosurgery uses liquid nitrogen to freeze and kill prostate cancer cells. The procedure takes about 2 hours, and requires anesthesia (either general or spinal). It may also require a hospital stay of 1-2 days.

During cryosurgery, a warming catheter inserted through the penis protects the urethra, and incontinence is seldom a problem. However, the overlying nerve bundles usually freeze, so most men become impotent.

Radiation therapy for prostate cancer

For some men with prostate cancer, surgery may not be the appropriate choice of therapy.

Radiation therapy uses high-energy x-rays, either beamed from a machine (external beam radiation) or emitted by radioactive seeds (internal radiation) implanted in the prostate, to kill cancer cells.

During external radiation, the region around the prostate, as well as the area around the pelvis, receive varying doses of radiation, although the primary target is the prostate gland itself. Side effects may include diarrhea, frequent and painful urination, rectal irritation or bleeding, and impotence.

Internal radiation therapy makes use of tiny radioactive seeds or implants, placed directly into or next to the prostate gland to kill cancerous cells. This is also known as interstitial implantation or brachytherapy.

Compared with external beam radiation, brachytherapy may offer certain advantages:

• The seeds can be implanted precisely in the tumor.
• A higher dose can be used with potentially less damage to surrounding tissue.
• Implanting the seeds takes less time than a full course of external beam radiation treatment.
• Side effects include post-implant discomfort, urinary incontinence and impotence.
• Chemotherapy for prostate cancer

Chemotherapy is treatment with drugs to destroy cancer cells. These drugs work by destroying those cells that divide or turnover rapidly. However, chemotherapy can also affect normal cells that actively divide, such as those in bone marrow, gastrointestinal mucosa (lining) and hair follicles.

Different chemotherapy drugs cause different side effects. The most common side effects are feeling tired, nausea and vomiting, mouth sores, hair loss and a low white blood-cell count. To minimize the side effects, chemotherapy drugs are carefully monitored by your physician according to the amount and number of times that they are administered.

Watchful waiting for prostate cancer

Another option is watchful waiting, also known as "observation" or "surveillance." These patients receive no active treatment unless symptoms appear. They may be asked to schedule regular medical checkups and report any new symptoms to the doctor immediately.