Overview
Prostate cancer is any cancer affecting the prostate, the male gland, that produces seminal fluid. Prostate cancer is the most common cancer in men. Most prostate cancers are prone to slow growth. However, some can grow rapidly and can spread quickly to other organs.
The best chance for effective treatment of prostate cancer starts with early detection, meaning before it has spread beyond the prostate gland itself. This is the rationale behind the recommendation that men undergo regular prostate exams starting at the age of 50 or earlier if there is a family history or in certain populations.
In its early stages, prostate cancer can have no noticeable symptoms and may only be detected by an elevated PSA level (blood test) or nodule on rectal exam. In more advanced cases, symptoms can develop such as:
- Difficulty urinating
- Weak urine stream
- Unexplained weight loss
- Bone pain
- Rarely blood in urine or semen
While these symptoms are found in many other urological conditions, patients with these symptoms should consider prostate cancer screening.
Prostate cancer can lead to a variety of complications. As the cancer metastasizes, it can spread to the bone, lymph nodes or other organs through the blood or lymphatic system.
Men with prostate cancer can develop urinary incontinence both from the condition itself as well as some of its treatments. Erectile dysfunction is another possible complication due to treatment.
Treatment
Prostate cancer treatments depend mainly on the PSA level, stage and grade (aggressiveness) of the cancer. Doctors determine the aggressiveness from biopsy. Genetic testing of the cancer cells may indicate if gene mutations are present and give insight into which treatment method will be most effective. PSA is a blood test. Stage is determined by physical examination and sometimes imaging with CT scan and/or bone scan.
In some cases of prostate cancer, a urologist may opt for active surveillance rather than immediate treatment. That would include regular exams, PSA testing as well as intermittent prostate biopsies (often at 1-3 year intervals) and potentially MRI of the prostate to see if the prostate cancer is growing.
Surgery can be done in many cases to remove the prostate gland, some surrounding tissue and possibly lymph nodes. Surgeons can often perform a prostatectomy using minimally invasive surgery with robotic instruments. Other options include freezing affected tissue or blocking testosterone through drugs to slow or shrink the cancer.
Radiation therapy is another option for treatment of prostate cancer and in most cases achieves similar cancer control rates to surgery. This is done by a radiation oncologist. It may include blockage of testosterone with oral or injectable medications to improve outcomes.
Immunotherapy, and chemotherapy are all potential treatments, primarily when cancer has spread. These treatments may carry side effects.