The Prostate

The prostate, located below the bladder and in front of the rectum, is a walnut sized gland that makes the fluid that composes semen, the fluid that carries sperm. The urethra, the tube that carries urine from the bladder and out through the penis, is surrounded by the prostate.

 

Symptoms

Frequent urination, especially at night Inability to urinate Trouble starting to urinate Trouble holding back urination (incontinence) Pain during ejaculation A weak or interrupted urine flow Pain or a burning feeling during urination Blood in the semen or in the urine Frequent pain or stiffness in the lower back, hips, or upper thighs

Sometimes there are no symptoms or early prostate cancer. The National Cancer Institute offers these symptoms as possible indicators of prostate cancer, but they are symptoms of other disorders as well. If you are experiencing any of these symptoms, you should report them to a doctor. Only a physician can tell you whether or not there is a possibility of prostate cancer.

Prostate cancer, a slow growing cancer, is generally a disease of older men. Over 80% of prostate cancers occur in men over the age of 65. By age 80, up to 80% of men will have the disease. Some men have prostate cancer cells and live out their lives with the disease never knowing they had it.

 

Causes

The cause of prostate cancer is unknown. We do know, however, that there are certain risk factors. The most significant risk factors are a family history of the disease and being African-American. Prostate cancer has a higher incidence in men who are exposed to cadmium, who work in rubber manufacturing, farmers, mechanics, and sheet metal workers.

 

The Exam

A screening for prostate cancer usually begins with a rectal exam. The doctor inserts a gloved finger in the rectum to check the condition and size of the prostate gland. Since this exam does not cover the entire prostate, your doctor may also use an ultrasound which uses sound waves to see your bladder. The ultrasound can detect smaller abnormalities that may be too small to be felt by the doctor.

If your doctor detects anything abnormal, a needle biopsy may be done. A needle is inserted into the prostate either through the rectum of the perineum (located between the scrotum and the anus). Prostate cells are collected and examined.

PSA Prostate Specific Antigen is a protein secreted only by the cells in the prostate. PSA levels are detected by a blood test. Elevated levels of PSA may indicate prostate cancer, but they may indicate other disorders as well. The American Cancer Society recommends that all men over the age of 50 be screened yearly for PSA.

 

Treatment

The treatment your doctor will recommend depends on what stage your cancer is and other factors. The most common treatments are:

Hormone therapy	Male hormones such as testosterone cause prostate cells to grow. Drugs that decrease the amount of male hormones may be given to slow the prostate cancer growth. Giving female hormones is another possibility. With advanced prostate cancer, sometimes the testicles are removed to prevent testosterone production. Common side effects of hormonal therapy are breast development with female hormones and hot flashes.
Radiation therapy	In radiation therapy, high-energy x-rays kill cancer cells and shrink tumors. Radiation may be external (from a machine) or from putting materials that produce radiation (radioisotopes) into the body where the cancer cells are found (internal radiation therapy). Impotence is a potential side effect.
Surgical removal of the cancer	Cryosurgery freezes cancer cells, killing them. Transurethral resection is often performed to relieve symptoms that prostate cancer causes in men who cannot have a prostatectomy. A tool with a wire on the end is inserted through the urethra and the cancer is cut out in pieces. Radical prostatectomy removes the prostate and some surrounding tissue. This surgery may be done through the perineum (the area between the anus and the scrotum) or through the abdomen called a retropubic prostatectomy. Since this operation cannot be performed on men whose cancer has spread outside the prostate, your surgeon may first remove and examine pelvic lymph nodes for cancer cells. Impotence and incontinence are possible side effects of this surgery.

Recovery

Your treatment choices and chances of recovery depend on many factors including how advanced you cancer might be. Your doctor will discuss your prognosis thoroughly.