Prostate Cancer

Prostate cancer is the one of the most common cancer men will develop. Over 200,000 new cases of prostate cancer are discovered each year and prostate cancer is responsible for 30,000 deaths annually.

Although the majority of prostate cancer is discovered in men older than 50 years old, it has been found in men in their late 30’s and 40’s.

Race and genetics may lead to an increase risk of developing prostate cancer.  It is well-documented that men who have a single first-degree relative suffering from prostate cancer has two-times the risk factor of developing prostate cancer while men with two or more first-degree relative suffering from prostate cancer has five times the risk of developing prostate cancer.  Studies have also shown that African-American men has a greater risk of not only developing prostate cancer but have a higher morbidity and mortality rate as well.  Recent advances in genomics are beginning to reveal a correlation between mutations in BRCA1 and BRCA2 genes and the development of prostate cancer.

Various other factors including but not limited to diet, level of sexual activity, obesity and exposure to herbicides like Agent Orange.

The prostate gland resides below the bladder and is part of the male reproductive system.  It along with the seminal vesicles are responsible for the production of seminal fluid and is where sperm and seminal fluid is combined to create semen during the ejaculatory process.  Because the prostate surrounds the urethra as well, it can impact the flow of urine if it enlarges and compress that channel.

The most common form of prostate cancer is adenocarcinoma. It commonly occurs in the posterior portion of the prostate that is closest to the rectum.  Such is why a digital rectal examination is one of the most critical methods of screening for prostate cancer.

Another method of screening prostate cancer is a blood test called the PSA.

Although there is much controversy surrounding the PSA blood test, early forms of prostate cancer is detected when it is combined with a digital rectal examination.

Suspicion of Prostate Cancer

When an individual is suspected of having prostate cancer, a prostate biopsy is usually performed under ultrasonic guidance.

The most common method is called a trans-rectal ultrasound guided needle biopsy of the prostate.  This procedure is usually performed in the urologist’s office and takes approximately five to ten minutes.  In most cases, a local anesthetic is used both topically and also injected into the surrounding areas of the prostate to minimize discomfort.

The short-term side effects caused by a prostate biopsies usually includes but are not limited to blood in the urine, blood in the stool, penile and rectal spotting as well as blood in the semen. Although all patients are screened for urinary tract infections and are prescribed antibiotics and instructions to perform an enema prior to the biopsy, rare cases of individuals developing sepsis after biopsies have occurred. In most cases, a full recovery occurs after the individual receives a course of intravenous antibiotic.

Once prostate cancer has been identified after a biopsy, the key information from that test usually includes the following:

• Gleason score – which is the sum of the two most prominent pattern of cancer discovered and it ranges from 2 to 10 (2 is non-aggressive while 10 is consider highly aggressive)
• The percentage of cancer found in each biopsy specimen

In addition, there is a growing number of additional DNA studies (PTEN / ERG / Prolaris / OncoType Dx, etc…) that can be performed on the cancer specimen to potentially provide more information on the aggressiveness of the disease.

Additional studies may also be indicated to determine the stage of the cancer as well as the potential treatment recommendations.  Such studies may include:

• Bone scan
• Computerized tomography (CAT) scan
• Positron emission tomography (PET) scan

Management of prostate cancer is dependent on the information gathered from the biopsy as well as the staging studies that are performed. In addition, the age of the individual as well as their overall health will further determine the proper treatment course.

Prostate Cancer Treatment Options:

• Active surveillance (regular office visit combined with blood test and prostate exams as well as possible follow-up prostate biopsies)
• Surgical removal of the prostate (Robotic-assisted vs open procedures)
• Radiation therapy (external beam radiation vs. brachytherapy)
• Cryoablation therapy
• High-frequency ultrasound (HIFU)
• Hormonal therapy (medical castration vs. surgical castration)
• Chemotherapy