Prostate Cancer Overview
Definition of Prostate Cancer: Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). It usually occurs in older men. The prostate gland is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that makes up part of the semen.
Source: National Cancer Institute
Prostate Cancer in the U.S and Mississippi
There will be an estimated 192,280 new cases and 27,360 deaths from prostate cancer in the United States in 2009.
Click here for more information on Prostate Cancer from the National Cancer Institute.
In 2008, two thousand ten new cases of prostate cancer were expected to be diagnosed among men in Mississippi and 290 men were expected to die of prostate cancer in Mississippi. Prostate cancer incidence and mortality rates remain significantly higher in African American men than in white men. The 2000-2004 age-adjusted prostate cancer mortality rate for Mississippi was 38.0 per 100,000 population. Non-white men had a much higher age-adjusted rate (72.4 per 100,000) than white men (25.7 per 100,000). From 1988 to 1992, prostate cancer incidence rates decreased due to earlier diagnosis through early detection.Since then, incidence rates have declined and have leveled off, especially in the elderly.
Click here to view the Mississippi Comprehensive Cancer Control Plan 2006 - 2011.
Prostate Cancer at Forrest General Hospital
Prostate cancer at Forrest General is the second leading cancer site with 183 cases reported in the 2007 Cancer Registry data. It is the leading cancer site in men.
Symptoms of Prostate Cancer
The following symptoms may be caused by prostate cancer or other conditions. The presence of a symptom does not mean you have cancer but a doctor should be consulted if any of the following problems occur:
- Weak or interrupted flow of urine
- Frequent urination (especially at night)
- Trouble urinating
- Pain or burning during urination
- Blood in the urine or semen
- A pain in the back, hips, or pelvis that doesn't go away
- Painful ejaculation
Screening, Prevention and Risk Reduction
An man should talk with his physician about screening annually for prostate cancer beginning at age 50. Annual screening may be continued as long as a man has a life expectancy of at least 10 years. High risk men (African American men and men with a strong family history of one or more first degree relatives diagnosed with prostate cancer at an early age) should talk with their physician about prostate screening at age 45.
A risk factor is something that may increase the chance of developing a disease. Risk factors for prostate cancer include:
- Age: The risk of developing prostate cancer increases as a man gets older.
- Chemoprevention: Several agents, including difluoromethylornithine (DFMO), isoflavonoids, vitamin D, and lycopene have shown potential benefit in studies. Further studies are needed to confirm this.
- Diet and lifestyle: A diet high in fat, especially animal fat, may be associated with an increased risk of prostate cancer. More studies are needed to determine if a low-fat diet with more fruits and vegetables helps prevent prostate cancer.
The effect of folate (a nutrient in the vitamin B complex) on prostate cancer risk is under study. A 10-year study found that taking folic acid (man-made folate) supplements increased the risk of prostate cancer. In the same study, prostate cancer risk was lowered in the men who did not take the supplement but got enough folate in the foods they ate.
Studies show that a diet high in dairy products and calcium may be linked to an increased risk of prostate cancer, although the increase may be small.
- Hormonal prevention: Studies are underway to discover the role of certain drugs, such as finasteride, that reduce the amount of male hormone as preventive agents for prostate cancer.
- Race: The risk of prostate cancer is dramatically higher among blacks, intermediate among whites, and lowest among native Japanese. However, this increase in risk may be due to other factors associated with race. Studies have shown a link between levels of testosterone and prostate cancer risk, with black men having the highest levels.
There are two tests commonly used to screen for prostate cancer. Although these tests may find cancer in an individual, they have not been shown to decrease the risk of dying from cancer and possibly may trigger other diagnostic procedures or treatments that may cause harm. You should discuss prostate cancer screening with your physician to understand the risks.
The two most common prostate screening procedures are:
- Digital rectal exam (DRE): an exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for lumps or anything else that seems unusual or abnormal.
- Prostate-specific antigen test (PSA): a test that measures the level of PSA in the blood. PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. A high level of PSA may also be noted in men who have an infection or inflammation of the prostate or benign prostatic hyperplasia (non-cancerous enlargement of the prostate)
Other tests that may be used to detect and diagnose prostate cancer include transrectal ultrasound, transrectal biopsy, or transperineal biopsy. These are outpatient procedures that are usually performed in the radiology department of a hospital or in the physician's office.
Treatment of Prostate Cancer
There are four standard prostate cancer treatments. These are watchful waiting, radiation therapy, surgery and hormone therapy.
If watchful waiting is the chosen treatment, the physician will monitor the patient's condition without any treatment until symptoms appear or change. This form of treatment is usually chosen for older men with other medical problems that have early-stage disease.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Therapy may be provided by a Radiation Oncologists via two general methods:
- External radiation therapy: A machine outside the body is used to send radiation toward the cancer in the body.
- Internal radiation therapy or brachytherapy: The radioactive substance is sealed in needles, seeds, wires, or catheters and placed directly into or near the cancer.
The type of cancer and the stage (extent) of the cancer will play a part in determining the radiation treatment plan.
Surgical procedures may be recommended in men who are in good health. Surgical procedures include radical prostatectomy, transurethral prostatectomy (TURP), and pelvic lymphadenectomy. A urologist will generally perform this type of surgery.
Hormone therapy is a cancer treatment that stops cancer cells from growing by removing hormones or blocking the action of the hormone in the body. Hormones are produced by glands in the body and are circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow.
Before a treatment decision is made, the patient should understand each of these options including the benefits and the associated problems, how much recovery time is needed, how long the treatment will take, the relative cost of the treatment, and what is the expected result of the treatment. The benefits to the patient should outweigh the side effects or complications of the treatment.
The information on this web site is meant to be a high level review only. Your physicians will go over the treatment options with you in detail. Additional information can be found at the Forrest General Cancer Center or on the internet.
See Links to Cancer Resources for many good cancer related resources on the web.
Please click here to view a PowerPoint presentation about Prostate Brachytherapy.
Information reviewed by: Joseph Salloum, M.D., Radiation Oncology, South Mississippi Associates in Radiation Therapy, Forrest General Hospital Medical Director of Radiation Therapy