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Prostate Cancer

Prostate cancer is a malignancy of the prostate gland which is a chestnut size gland situated between the urinary bladder and the male urethra. This tumor is very common and the incidence increases with age.

A ninety year old man has about ninety percent chance of having prostate cancer.


Diagnosis

Diagnosis is made by finger examination by a physician. He will suspect a malignancy when he feels a nodule on the prostate or if the prostate feels hard. He will then do an ultrasound exam of the prostate.


Often he will decide to perform a biopsy. This is done by taking needle samples of the prostate through the ultrasound guide placed in the rectum
.

Pathology

The pathologist will study the specimens. He will make the diagnosis of cancer. He will determine if this is a slow or fast growing cancer. He will assign a number called Gleason score. A score of two is considered slow, a score of ten will indicate a very fast growing tumor.


Metastatic Workup

It is important to know if the cancer is still contained within the boundaries of the prostate gland. A CAT scan of the pelvis and a bone scan are usually ordered. If these are negative that means the cancer is limited to the prostate.


PSA is a blood test that helps us diagnose problems with the prostate. In most instances, a PSA of less than four is considered normal. A PSA between four and ten may be indicative of prostate cancer in 25 percent of cases. For a more detailed discussion please see our other brochure on PSA.


Treatment

Localized disease

  1. Surgery

  •  Radical Retropubic Prostatectomy with pelvic lymph node dissection: This is the best treatment as far as survival is concerned .

  •  Perineal Prostatectomy:  This procedure may lead to incomplete removal of the prostate.

   2.  Radiation Therapy

External Beam: The results may be comparable to surgery for up to seven years .

  • Treatment is given using a modern linear accelerator made by either Varian or Siemens.

  • A course of treatment consists of 35 to 40 treatments.

  • Treatment is given daily, Monday through Friday, so a course of treatment is 7 to 8 weeks.

  • Each treatment generally takes less than 1/2 an hour

  • Before a course of treatment is started there is a consultation with an Radiation Oncologist and a process called a "simulation".  This process will map out how the beam will be aimed at the prostate and how normal tissue will be protected.  It will take about one hour and will be performed using an X-ray machine or CT scanner.

  • There will be a period of about 2 days before treatment starts.  During this time the protective blocks will be made and the doses calculated.

  • After about 25 treatments the area treated is reduced to cover just the prostate.  This will normally require another simulation process but without a 2 day break.

  • After the 25th treatment, only the smaller area (prostate) will be treated for the remaining 10 to 15 treatments.

  • The patient does not become radioactive and can carry on usual activities, play with the grandchildren, etc.

  • Only the pelvis is treated, not the rest of the body. Therefore, there is no nausea, vomiting or hair loss (except maybe pubic hair).  The patient may feel a little tired.

  • Symptoms during treatment often start the 3rd week.  

    •  Bladder irritation is the most frequent symptom and may include urinary discomfort.

    •  Rectum irritation including diarrhea and sometimes the feeling of needing to go. Also, a little blood may be passed.

  • Symptoms can be helped by medication and usually clear up about a month or so after treatment.

  • Patients can have sex.

  • A low residue diet is preferable during treatment

  • No need to modify other treatments or medications

    3. Brachytherapy

  • This is a procedure where radioactive needles are placed in the prostate.  The long term effects of this treatment are unknown at this time.

    4. Cryotherapy

  • This consists of freezing the prostate. The problem with Cryotherapy is treating all the cancerous tissue without harming the surrounding organs.

    5. Hormonal Therapy

  • Since the prostate gland depends on its growth and maintenance on the male hormone testosterone then medications or procedures that reduce its amount in the body will consequently control the prostate cancer for a variable length of time .

    6. Observation

  • In elderly patients with low Gleason score, observation without any treatment will usually be indicated.

    7. Chemotherapy
    8. Immunotherapy
    9. High Frequency Ultrasound