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Prostate cancer

Prostate cancer starts in the prostate gland, 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. Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over age 75. It is rarely found in men younger than 40.

Common causes and risk factors

  • Being a male 60 or older
  • Being an African-American male of any age
  • Having a father or brother with prostate cancer
  • Obesity or a diet high in fat, especially from red meat or dairy products

A common problem in almost all men as they grow older is an enlarged prostate (benign prostatic hyperplasia). This problem does not raise your risk of prostate cancer.

Symptoms

The PSA (prostate-specific antigen) 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.

These symptoms may also be caused by other, less serious conditions, so it is important to talk to your doctor if you experience any of them:

  • 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)

Diagnosis

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, which rate 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 , for 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-grade cancer. Most prostate cancers fall into this category.
Scores 8 - 10: High-grade cancer (poorly-differentiated cells)

Treatment

At Via Christi, prostate cancer treatments include almost every surgical and radiation option available anywhere for both prostate cancer and noncancerous prostate conditions, and are among the best outcomes in the country for treating prostate cancer, incontinence and impotence.

Your treatment will depend on what kind of cancer cells you have, how far they have spread, your age and general health and your preferences.

You'll meet with a surgical oncologist, radiation oncologist, medical oncologist and others on your health care team who together will develop the best treatment plan for you.

You and your doctor may decide to treat your cancer in one or a combination of these ways:

Hormone Therapy. Your doctor may combine surgery or radiation with hormone therapy. Taking certain medications by mouth can help shrink the tumor and slow its growth.

Radiation Therapy. This therapy uses high-dose X-rays to kill cancer cells and shrink tumors. It can be internal or external. You may receive radiation, like an X-ray, from outside the body. Or, the doctor may place radioactive material inside your body, near the cancer site. Radiation therapy is typically done Monday through Friday as directed by the radiation oncologist.

Surgery to remove your prostate gland. Before removing the prostate, the surgeon may remove some lymph nodes. Our treatments for prostate cancer include the da Vinci robotic surgical system LINK http://www.via-christi.org/robotic-surgery. This system allows us to perform minimally invasive, extremely precise nerve-sparing operations. It may result in more complete removal of the cancer. It also can help retain bladder control and potency for certain patients.

Watchful Waiting. If the cancer has not spread and you are around age 70 or older, you may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to see if your cancer has changed.

Prevention

Early detection is the best defense against prostate cancer. This may include such screening tests as a prostate-specific antigen (PSA) blood test and a digital rectal exam by your doctor, after a discussion of your medical history to determine what course of action is right for you.

  • Men with an average risk of prostate cancer should ask their doctor about screening by age 50.
  • Men at high risk of prostate cancer (African-Americans and/or those with a father, brother or son with prostate cancer) should ask their doctor about screening by age 45
  • Men at very high risk of prostate cancer (with more than one close relative with early-age prostate cancer) should ask their doctor about screening by age 40.

Screenings are recommended each year for men with PSA levels of 2.5 ng/ml or higher; but for men with a PSA of less than 2.5 ng/ml, repeat tests may only need to be done every two years.