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Prostate Cancer Treatment
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Screening For Prostate Cancer

Although widely used, the prostate specific antigen (PSA) screen test is currently the subject of a huge controversy related to it's effectiveness to predict who has prostate cancer.


PROSTATE CANCER TREATMENT

Prostate cancer is the most common cause of cancer in men and is the second cause of cancer-related death in men after lung cancer. In the US alone, each year over 200,000 men are newly diagnosed with the disease, and over 40,000 die from it. This article is a short overview of prostate cancer treatment options.


Who Gets Prostate Cancer?

The first obvious answer is men. That is, men over 50 years of age. At age 80, almost 50% of men have cancerous cells in their prostate, although in most cases the size of the tumor is too small to cause symptoms. African-American men are more prone to develop prostate cancer. In addition, men with a family history of the disease have an increased risk. Last but not least, diets high in saturated fats (animal fats) increase the risk of prostate cancer.

How Can I Know If I Have Prostate Cancer?

Unfortunately, prostate cancer does not cause symptoms until rather late in its course. When the tumor becomes large enough, patients may complain of urinary retention and voiding difficulty caused by uretheral compression or neurological symptoms due to spinal nerves compressions by methastases. Back pain and bone fractures are also sometimes late manifestations of the disease.

The only way to detect prostate cancer earlier, though far from perfect, is by using the two available screening tests: the digital rectal exam of the prostate gland and the PSA measurement.

If the screening tests are suggestive of prostate cancer, further tests are usually done, like a fine needle biopsy of the prostate with subsequent microscopic analysis of the tissue to determine whether cancer is present. MRI and bone scans are also used to determine the presence of metasthases.

The Prostate Cancer Research Foundation of Canada has an excellent online Prostate Cancer Risk Assessment Tool which allows you to find out whether you are at an increased risk of developing prostate cancer. What I like about it is that it addresses many of the lifestyle factors associated with cancer in general and with prostate cancer in particular.

What Treatment Options Are Available For Prostate Cancer?

Prostate cancer treatment is very much dependent on the stage of the disease. Here is a short version of the four stages:

  1. Stage 1: the cancer is very small and completely inside the prostate gland which feels normal when a rectal examination is done.
  2. Stage 2: the cancer is still inside the prostate gland, but is larger and a lump or hard area can be felt when a rectal examination is done.
  3. Stage 3: the cancer has broken through the covering of the prostate and may have grown into the neck of the bladder or the seminal vesicle.
  4. Stage 4: the cancer has spread to another part of the body.
In addition to the stage of the prostate cancer, the age of the patient is also important when it comes to treatment choice. As an example, an 85 years ol patient with a stage 1 tumor has an excellent 10-year survival chance with watchful waiting, and will not reap a significant benefit from more invasive thrapies, like surgery. Conversely, in a younger patient with localized cancer, surgery may be an excellent option capable of curing the disease.

Prostate Cancer Treatment: Watchful Waiting

As mentioned above, watchful waiting is simply observing the progress of the disease without taking aggressive therapeutic measures. It usually is indicated for slow-growing tumours or elderly patients.

Prostate Cancer Treatment: Surgery

Surgery is the most common treatment for prostate cancers. There are several surgical techniques used:

Prostate Cancer Treatment: Radiation Therapy

Radiation therapy is widely used and indicated for most forms of prostate cancer. It is an alternative to radical prostatectomy, although it is not clear yet whether it has the same rates of success.

Several radiation techniques are used:

Prostate Cancer Treatment: Hormone Therapy

The purpose of hormone therapy is to lower testosterone levels. While hormonal therapy does not kill cancer cells, it reduces he size of prostate tumours in about 80% of men.

For many men, it will be recommended as well as surgery. It is sometimes used before radiotherapy (see below) to reduce the size of the tumour.

Hormone therapy lowers testosterone levels in different ways. Finasteride (Proscar), for example, blocks the conversion of a natural chemical into active testosterone. Alternatively, orchidectomy - surgical removal of both testicles, stops the production of testosterone.

Dr Gily

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