Prostate Cancer

Prostate Cancer — Find Out the Facts

Whether your have worries about your prostate or simply curious, this information is intended to help you answer your questions. However, we recommend you discuss your remaining concerns with your physician.

What is Cancer?
Cancer is a disease characterized by the uncontrolled growth and spread of abnormal body cells. Normally, cells reproduce themselves by dividing so that growth occurs. Worn-out tissues are replaced and injuries are repaired in this manner. Occasionally, cells abnormally grow into a mass called a tumor. Some tumors are benign (noncancerous); others are malignant, or cancerous.

The growth of a benign tumor may interfere with body function, but these tumors are seldom life-threatening. Malignant tumors, on the other hand, invade and destroy normal tissue. By a process called metastasis, cells break away from a cancerous tumor and spread through the blood and lymphatic system to other parts of the body where they form new tumors. Sometimes cancer grows and spreads rapidly. In other cases, it develops and spreads slowly.

One common place for cancer to develop in men is the prostate gland.

What is the Prostate?
The prostate is a chestnut-sized sex gland. It is located just below the bladder and surrounds part of the urethra, the canal that carries urine from the bladder dring urination. The primary role of the prostate is to provide part of the fluid necessary for ejaculation.

How Common is Prostate Cancer?
According to the American Cancer Society, there are more than 100 different types of cancer. Among American men, prostate cancer is the second most common cause of cancer death. The risk of developing prostate cancer increases with age; it typically occurs in men age 40 and above. In fact, the American Cancer Society recommends that all mean over age 40 have a yearly medical check-up that includes a rectal exam. Yearly exams may help physicians detect prostate cancer at an early, treatable stage.

Symptoms of prostate cancer are often associates with benign prostate hypertrophy (BPH). Both conditions are common in older men, and one of the signs of both is the urge to urinate more often, which results from the prostate’s increased size. BPH is an excess growth in the innermost part of the prostate. It is not cancer. The only way to distinguish between BPH and prostate cancer is to have an examination by a physician.

What Causes Prostate Cancer?
The exact cause of prostate cancer is unknown. What is known about the disease is that it begins with a group of cancerous cells (a tumor) within the prostate gland. Initially, the tumor may not cause any symptoms. As the cancer progresses, the tumor can enlarge and eventually put pressure on surrounding parts of the body such as the urethra. The process causes a block in the flow of urine out to the bladder. At this stage of the disease, many men urinate more frequently than normal (usually the first symptom of the disease); sometimes the urination is difficult, even painful.

Are There Other Symptoms?
Other symptoms of prostate cancer include blood or pus in the urine or semen and/or painful ejaculation. It is important to remember that prostate cancer, especially in its early stages, may not produce any symptoms at all. This is why regular examinations are recommended. As prostate cancer speads from the prostate to nearby lymph nodes, bones or other organs, many men experience aches and pain in their bones or joints, especially in the back and hips.

Why Does Prostate Cancer Spread?
The growth and function of the normal prostate gland is dependent on the male hormone, testosterone. Testosterone is produced almost entirely by the testicles, although small amounts are also produced by the adrenal glands. Testosterone stimulates prostate cancer much in the same way kerosene fuels a fire. As long as the body produces testosterone, prostate cancer will continue to grown and spread.

How is Prostate Cancer Detected?
Doctors currently use a variety of methods to detect the presence of prostate cancer.

The most common method of detecting prostate cancer is through an examination of the rectum. To examine the prostate, a physician inserts a lubricated, gloved finger into the patients rectum to feel the size and shape of the prostate through the rectum wall. This procedure, called a digital rectal examination, takes very little time (less than a minute) and involved minimal discomfort for the patient.

Another test measures the presence of prostatic acid prhosphatase (PAP) in blood. The blood text for PAP was the first such test developed and put into general use. Prostatic acid phosphatase is an enzyme that is produced by normal prostate tissues. As prostate disease becomes more severe, the production of PAP increases and is reflected in the blood. Elevated levels of PAP are generally found in those individuals with more advanced disease, and has proven useful in helping the physician determine what stage of cancer the patient falls into. The PAP is also a test that is used to monitor prostate cancer patients, once prostate cancer has been determined.

Another common procedure, often used in conjunction with a digital rectal examination, is a blood text (prostate specific antigen or “PSA” text). This text measures the body’s level of prostate specific antigen. PSA is a protein which may be present in the blood of patients with prostate cancer. WHen the body’s PSA levels are elevated, it may be an indicator of the presence of prostate cancer.

The PSA is the newest monitoring tool developed for use in prostate cancer. The PSA protein is produced exlusively by prostate tissue. This is the factor that makes this test so useful. In a patient with a normal prostate, levels of PSA can be measured. In even the earliest stages of prostate disease, the patient’s level of PSA begins to increase and is detectable with this test. This allows the physician to uncover changes in the patient that may not be evident upon physical examination.

Another way to detect prostate cancer is through the use of ultrasound. During this procedure, a physician places a small instrument into the rectum which produces painless soundwaves that reflect off the prostate. The reflected sound waves are then transformed into an image of the prostate on a television screen which the physician can view.

If prostate cancer is suspected, the physician may remove a small sample of prostate tissue through a needle biopsy. The tissue sample is then examined under a miscroscope to determine whether it contains cancer cells. This is the only other way to effectively diagnose prostate cancer.

What are the Stages and Treatment Options for Prostate Cancer?
It is important that the physician determine the extent or stage of the patient’s prostate cancer so that the best treatment option can be pursued. The treatment of prostate cancer depends on the stage of the tumor. In developing a treatment plan, it is important that the patient and physician discuss the advantages and disadvantages of each treatment. The following are detailed descriptions of the four stages of prostate cancer and treatment options:

• Stage A
The tumor is located within the prostate gland and is too small to be detected during a rectal examination, but may be deted through other diagnostic procedures. This stage of prostate cancer generally produces no symptoms and treatment can be considered “curative.” A patient has several treatment options if diagnosed with Stage A prostate cancer. Treatment options include surgical removal of the prostate or radiation therapy.

• Surgial Removal of the Prostate
A procedure called a prostatectomy (removal of the prostate) can be performed to prevent early-stage prostate cancer from spreading further. During this procedure, a pelvic node dissection (removal of possible cancer carrying lymph nodes near the prostate) is often performed. Side effects associated with prosatectomy may include impotence and incontinence. Impotence occurs in a high percentage of patients; however, new surgical techniques are minimizing this rish. As in any surgical procedure, complications can occur which require further attention.

• Radiation Therapy
This process uses high-energy x-rays to kill prostate cancer cells. As an alternative, small nonhazardous radioactive pellets can be surgically implanted into the patient’s prostate. This form of therapy is good for patients who wish to avoid an operation and the possible risk of incontinence and impotence. Side effects with radiation therapy include fatigue, skin reactions in treated areas, frequent and painful urination, upset stomach, diarrhea and rectal irritation or bleeding. Most of these side effects disappear once treatment is stopped.

• Stage B
The tumor is still located within the prostate gland, but it has grown to the point where it can be felt during a rectal examination. There are often no symptoms associated with prostate cancer at this stage. Treatment for Stage B prostate cancer can be considered “curative.” Common treatment options in this stage include surgical removal of the prostate and radiation therapy (see Stage A for detailed descriptions).

• Stage C
The tumor has spread from the prostate to other areas just around the prostate. A common symptom in this stage is difficulty in urinating. Some physicians may elect to treat the cancer by surgical removal of the prostate, radiation therapy or a combination of each (see Stage A for detailed descriptions).

The objective of treatment in Stage C is to slow the spread of prostate cancer and relieve symptoms such as pain and difficulty in urinating.

Another treatment option in Stage C is hormonal therapy. The goal of hormonal therapy is to decrease the testicles’ production of testosterone, which fuels prostate cancer. Hormone manipulation cannot cure prostate cancer, but it can slow the cancer’s growth, reduce the size of the tumor and alleviate the symptoms assocaites with the disease. There are several methods to reduce the body’s production of testosterone.

• Surgical Removal of the Testicles
Traditional treatment for advanced prostate cancer has involved the surgical removal of the testicles. The medical term for this type of surgery is orchiectomy. An orchiectomy can be done as an out-patient procedure, but it may require hospitilization and anesthesia. During the procedure, a surgeon removes the patient’s testicles. Removal of the testicles effectively reduces the production of testosterone and reduces the pain, difficulty in urination and other symptoms associated with prostate cancer. Common side effects include impotence and hot flashes.

• LH-RH (Leutinizing Hormone — Releasing Hormone Analogs
A newer treatment option, LH-RH analogs, are man-made adaptions of a natural occuring hormone, which aid in the production of testosterone. When taken monthly, LH-RH analogs shut down testosterone production from the testicles. LH-RH analog treatment is also effective in relieving the pain, difficulty in urinating and other symptoms associated with prostate cancer.

Preferably, LH-RH analogs are administered as a once-a-month injection while in the physician’s office. A daily, self-administered injection is also available. The most common side effect associated with LH-RH analog treatment is hot flashes. Some men may also experience a temporary increase in their urinary symptoms or pain during the first few weeks of treatment. Like other treatment options, LH-RH analogs may cause impotence.

• Combination Therapy
Another treatment alternative for advanced prostate cancer patients involves the use of a hormone-blocking drug, taken orally on a daily basis, in conjunction with an LH-RH analog. The LH-RH analog stops the production of testosterone by the testicles, while the hormone-blocking drug blocks the small additional amount of testosterone produced by the adrenal glands. Side effects of combination therapy include hot flashes, nausea and vomiting, diarrhea and impotence.

• Female Hormones
Another way to decrease the production of testosterone by the testicles is by taking the female hormone, estrogen. Estrogen therapy is relatively simple and involved taking a tablet three times a day. Estrogen works by counteracting the male hormone testosterone. Although effective in reducing testosterone levels, the side effects of female hormone therapy can include water retention, breast growth and tenderness, stomach upset, nausea and vomiting. In addition, this therapy may cuase or increase serious circulatory system problems, such as blood clots and stroke.

• Stage D
The tumor has spread to other parts of the body such as the bones or lymph nodes. Common symptoms in this stage include difficulty in urinating, bone pain, weight loss and fatigue. Surgery and hormonal therapy (see Stage C for detailed descriptions) are common treatment options in this advanced stage of prostate cancer. In addition, chemotherapy may be used, usually after multiple forms of therapy have been tried. The goal of treatment in Stage D prostate cancer is to relieve pain, difficulty in urinating and other symptoms.

• Chemotherapy
Chemotherapy is the use of anticancer drugs which circulate throughout the body in the blood stream and kill rapidly growing cells. This includes cancer cells as well as some normal, healthy ones. To minimize harm to healthy cells, the anticancer drugs are carefully controlled in dosage and frequency. There are a variety of chemotherapy drugs which are often used in combination with one another. They are used mainly to relieve the symptoms of advanced prostate cancer. There are many side effects associated with chemotherapy.

Who Treats Prostate Cancer?
If prostate problems are discovered, a physician may refer the patient to a specialist called a urologist. A urologist is a physician and surgeon who is specially trained in the diagnosis and treatment of diseases of the urinary tract and genital tract in patients of any age of sex. The urologist will determine if a patient’s prostate symptoms are caused by prostate enlargment or prostate cancer. In some cases, a patient may be referred to an oncologist, a specialist in the treatment of cancer. Treatment options should be fully understood and discusses with a physician so that a treatment course can be decided upon.

How Does One Cope With Prostate Cancer?
It is natural for a man who first learns that he has prostate cancer to feel angry, anxious and uncertain. These same feelings are often experienced by family members and close friends. One of the best ways to deal with these feelings is to talk about them openly and honestly with other prostate cancer patients and families who share similar experiences. Since the problems are similar, support and encouragement can be provided. You may wish to ask your physician to put you in touch with other patients who would be willing to discuss their situation with you. Sometimes these discussions take place in the form of Prostate Cancer Support Groups. Consult your physician to learn if there are any support groups in your area.

How to Recieve More Information on Prostate Cancer
The American Foundation for Urologic Disease, Inc. (AFUD) has formed a support group (US TOO) for prostate cancer patients. TO learn more about prostate cancer, AFUD and US TOO you can call (800) 242-2383 or write to:

American Foundation for Urologic Disease, Inc.
1120 North Charles Street, Suite 401
Baltimore, MD 21201

The American Cancer Society (ACS) and the National Cancer Institute (NCI) can also provide you with additional information free of charge by calling your local ACS office of by calling the NCI’S toll-free Cancer Information Service (800) 4-CANCER or by writing:

Office of Cancer Communication
National Cancer Institute
Building 31, Room 10A24
9000 Rockville Pike
Bethesda, MD 20892

Reprinted from the pamphlet, “Prostate Cancer: What Everyone Should Know,” copyright © 1992 Abbott Laboratories.