Prostate Cancer

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.

The prostate is a gland in the male reproductive system located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that makes up part of the semen.

Prostatecancer is founad mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms.

The symptoms listed below can occur with prostate cancer (Most of the time these symptoms are caused by other prostate problems that are not cancer):

  • Delayed or slowed start of urinary stream
  • Dribbling or leakage of urine, most often after urinating
  • Slow urinary stream
  • Straining when urinating, or not being able to empty out all of the urine
  • Blood in the urine or semen
  • Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)
  • Prostate biopsy is the only test that can confirm the diagnosis. Tissue from the prostate is viewed underneath a microscope. Biopsy results are reported using something called a Gleason grade and a Gleason score.

The Gleason grade is how aggressive the prostate cancer might be. It grades tumors on a scale of 1 - 5, based on how different from normal tissue the cells are.

Often, more than one Gleason grade is present within the same tissue sample. The Gleason grade is therefore used to create a Gleason score by adding the two most predominant grades together (a scale of 2 - 10). The higher the Gleason score, the more likely the cancer is to have spread beyond the prostate gland:

  • Scores 2 - 4: Low-grade cancer
  • Scores 5 - 7: Intermediate- (or in the middle-) grade cancer. Most prostate cancers fall into this category.
  • Scores 8 - 10: High-grade cancer (poorly-differentiated cells)

There are two reasons your doctor may perform a prostate biopsy:

  • Your PSA blood test is high.
  • A rectal exam may show a large prostate or a hard, irregular surface. Because of PSA testing, prostate cancer is diagnosed during a rectal exam much less often.

The PSA blood test will also be used to monitor your cancer after treatment. Often, PSA levels will begin to rise before there are any symptoms. An abnormal digital rectal exam may be the only sign of prostate cancer (even if the PSA is normal).

The following tests may be done to determine if the cancer has spread:

  • CT scan
  • Bone scan

Treatment

Surgery

Surgery is usually only recommended after a thorough evaluation and discussion of the benefits and risks of the procedure.

Surgery to remove the prostate and some of the tissue around it is an option when the cancer has not spread beyond the prostate gland. This sugary is called radical prostatectomy. It can also be done with robotic surgery.

Radiation Therapy

Radiation therapy uses high-powered x-rays or radioactive seeds to kill cancer cells.

Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used for pain relief when cancer has spread to the bone.

HIFU - High Intentsity Focused Ultrasound

High Intensity Focused Ultrasound, or HIFU, is a therapy that destroys tissue with rapid heat elevation, which essentially "cooks" the tissue. Ultrasound energy, or sound waves, is focused at a specific location and at that "focal point" the temperature raises to 90 degrees Celsius in a matter of seconds.
"Dr. Blumenthal is one of only a few select physicians performing HIFU treatment in the mid-Atlantic region".
Click here to learn more about HIFU

Hormone Therapy

Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is any treatment that decreases the effect of testosterone on prostate cancer. These treatments can prevent further growth and spread of cancer.

Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms. There are two types of drugs used for hormone therapy.

The primary type is called a luteinizing hormone-releasing hormones (LH-RH) agonist:

These medicines block the body from making testosterone. The drugs must be given by injection, usually every 3 - 6 months.
They include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix.

The other medications used are called androgen-blocking drugs.

They are often given along with the above drugs.
They include flutamide, bicalutamide, and nilutamide.

Medical Management/Monitoring

After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including serial PSA blood tests (usually every 3 months to 1 year).

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