Prostate Cancer

By Thomas J. Doyle, Jr. MD

Prostate cancer is the most common form of cancer in men and the second leading cause of male cancer deaths. It is estimated that nearly 400,000 new cases of prostate cancer will be diagnosed this year and as many as 250,000 men will die of prostate cancer this year in the United States.

The incidence of prostate cancer increases with age, with 80 percent of cases diagnosed in men 65 years or older. Prostate cancer is also found in men as young as the early 40ęs and there are family genetic links. Men with a father, brother or other closely related male diagnosed with prostate cancer at ages younger than 65 are at special risk as are men of Afro-American descent.

The question arises as to what a male can can do to protect himself. There are no definitive symptoms in the early stages when prostate cancer is treatable and curable. Family linkage and possibly symptoms of urinary problems may be the only tip-off. Examination with a digital rectal examination (DRE) and monitoring of the prostatic specific antigen (PSA) are necessary for early detection. These tests should begin at age 50. If there is a family history of the disease, or in men of Afro-American descent, these examinations should begin at age 40. Symptoms of urinary infection that do not respond to treatment may also be suspect at any age and should lead to DRE and PSA measurement.

The goal is early detection. A rising PSA or a PSA above 4.0 level may be the first indication of trouble, as may an abnormal DRE at any PSA level. These findings would prompt a biopsy of the prostate done through the rectum in conjunction with an ultrasound examination of the prostate to determine if cancer is present.

Prostate cancer is potentially curable if discovered while localized to the prostate. Most cancers discovered with a PSA less than 10 are curable. This explains the need for routine examination and monitoring to detect the cancer at an early stage. If the cancer becomes locally advanced or displays features of aggressive behavior, the chance of a cure decreases. Early detection is our best insurance.

Treatment for localized prostate cancer, i.e. confined to the prostate, is traditionally by surgery to remove the prostate gland or radiation therapy. Dr. Steinmetz, Northwest Radiation Oncology Associates, wrote about the most current and newest form of radiation therapy with radiation seed implant to the prostate in the Winter 1999, Healthy Viewpoints. This treatment is proving very effective in selective patients, sometimes in conjunction with hormone therapy and/or external beam radiation therapy. This therapy is administered in Eau Claire by urologists and radiation therapists working together. It requires general anesthesia but is administered as an outpatient. Recovery may require 60 to 90 days as the radiation exerts its effect on the prostate. Major complications can include urinary voiding symptoms, impotence or erectile dysfunction, and bowel symptoms because of the effects of radiation.

The more traditional surgical removal of the entire prostate is not the same as the classic –ream” job or –rotor-rooter” job to which men refer. That procedure is for urinary blockage and only removes the obstructing tissue. Cancer treatment requires removal of the entire prostate to be curative, along with the seminal vesicles behind the prostate (a part of the reproductive tract), and usually includes the sampling of lymph nodes adjacent to the prostate. This procedure is done through an incision in the lower abdomen between the umbilicus (belly button) and pubic bone over the bladder. Complications can include significant bleeding, infection, rectal injury, impotence or erectile dysfunction, and varying degrees of urinary incontinence.

The procedure has evolved over time and results are much better now with decreased complications. Few patients require a transfusion, hospitalization is usually only 48 to 72 hours after surgery, diet begins within 24 hours after the surgery, and rectal injuries are rare. Urinary control problems have improved and are significant in only one to two percent of men. Potency sparing procedures are done and effectively preserve this function in up to 60 percent of men, especially in conjunction with oral medications (Viagra) or other techniques to enhance erection function. Preservation of erectile function is largely a function of a manęs potency prior to surgery, which is relative to his age. Unfortunately potency naturally declines with age and other diseases, as the incidence of prostate cancer rises. Potency can best be preserved in association with radical prostate removal in younger, sexually active men who do not need hormonal or radiation therapy and whom do not suffer other medical illnesses associated with erection problems.

If potency preservation is important to an individual, medication can usually be administered to recover this ability after surgery in older men or in men with medical problems interfering with the function. Also the availability of a penile prosthesis implant assures that erection can be recovered in any man after surgery.

All men should know their PSA level just as they are concerned about their blood pressure and cholesterol levels. Be sure your doctor checks your prostate gland at the time of your physical examinations especially if you are Afro-American or have a family history of prostate cancer. Ask to have your PSA checked. If your cancer is advanced, early treatment will prolong your life and delay painful and uncomfortable consequences of advanced disease. If surgery or radiation treatments fail to cure your cancer, intervention can delay progression of disease and troublesome symptoms and complications.

For more information, call Western Wisconsin UrologyŽ 715.835.6548