Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man’s reproductive system. It wraps around the urethra—the tube that carries urine out of the body.
- Age: Aging increases the chances of developing prostate cancer
- Family history: Genetics are also thought to play a major role. If someone in the family has had prostate cancer, it is likely other members are at a higher than normal risk for its development.
- Race: Prostate cancer is more common in some racial and ethnic groups than in others, but medical experts do not know why. Researchers do not yet agree on the causes that can influence a man’s risk of developing the disease, either positively or negatively, but research is ongoing.
According to the National Cancer Institute, avoiding cancer risk factors such as smoking, being overweight, and lack of exercise may help prevent certain cancers. Increasing protective factors such as quitting smoking, eating a healthy diet, and exercising also may help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.
A 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, usually at a late stage. These symptoms can also be caused by other prostate problems:
- 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)
The urologist will recommend further testing the prostate if the patient has high PSA level and/or a rectal exam shows a large prostate or a hard, uneven surface.
If prostate cancer is suspected, the urologist will order an MRI, followed by biopsy. Biopsy is needed in order to actually diagnose prostate cancer. A sample of tissue is removed from the prostate and sent to a lab. The MRI provides the urologist with a more precise picture of what area of the prostate to biopsy.
If cancer is found, the urologist may order a CT scan and a bone scan to determine whether the cancer has spread.
The PSA blood test will also be used to monitor prostate 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 treatment depends on many things, including a cancer staging system called the Gleason score and overall health. Your doctor will discuss your treatment options.
For early-stage prostate cancer, this may include:
- Surgery, termed a radical prostatectomy, is being performed by the physicians with Clinical Urology Associates utilizing the new da Vinci Surgery System. (See robotic surgery on this site.)
- Radiation therapy, including brachytherapy and proton therapy
For older patients, the urologist may recommend simply monitoring the cancer with PSA tests and biopsies. Limiting the intervention for prostate cancer for the elderly may be because the patient’s normal life expectancy may be less than the expected length of time it would take for the cancer to become life-threatening; the urological surgeon may consider the surgery a less than ideal option as the elderly patient’s chances of serious complications would be greater than those of a younger patient; or the chance of change in the elderly patient’s quality of life.
If the prostate cancer does spread, treatment may include:
- Hormone therapy (medicines to reduce testosterone levels)
Surgery for Prostate Cancer
There are three main types of radical prostatectomy surgery. These procedures take about 3 to 4 hours:
- Radical retropubic prostatectomy: The urological surgeon will make a cut starting just below the belly button and reaching to the pubic bone.
- Laparoscopic radical prostatectomy: The surgeon makes several small cuts instead of one big cut. Long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts. This helps the surgeon see inside your belly during the procedure.
- Robotic-assisted laparoscopic prostatectomy: Sometimes laparoscopic surgery is done using a robotic system. The surgeon moves the robotic arm while sitting at a computer monitor near the operating table. The patients of Clinical Urologist Associates have the opportunity to have robotic-assisted laparoscopic.