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 The
prostate gland, located just below
the bladder, is about the size and shape of a walnut. It's primary function
is to produce semen, the fluid that carries sperm. The prostate surrounds
a portion of the urethra -- the tube that carries urine from the bladder.
When you're told you
have prostate cancer, it's natural to be concerned about what your future
might be like. But most people who have prostate cancer can live a full
and active life. In fact, when prostate cancer is diagnosed in its early
stages - before it has spread outside the prostate - chances are excellent
that it can be cured. If cancer is detected in its later stages, it can
usually be controlled. By knowing how prostate cancer develops and its
diagnosed, you better understand what's happening to your body. And by
knowing about treatment methods, you can understand what your options
are for living with prostate cancer.
"I can't have
cancer. I don't have symptoms."
Prostate cancer often
doesn't produce symptoms. Symptoms are usually related to non cancerous
problems of the prostate or of the urinary tract.
"I'm going to
die from my cancer:"
Most men don't die
from their prostate cancer. Prostate cancer is one of the slowest-growing
types of cancers, and can usually be controlled.
"Treatment will
leave me impotent or incontinent."
Impotency or incontinence
doesn't always occur. If it does, your urologist will discuss the various
treatment alternatives with you.
"I won't be able
to live my life the way I used to."
With medical advances,
the quality of life for men with prostate cancer has improved dramatically.
Most men can enjoy a comfortable lifestyle.
PROSTATE ANATOMY
CHANGES CAN OCCUR
WITH AGE
As a younger man,
you probably didn't worry about your prostate because it didn't affect
your health. But as men age, some of the cells that make up the prostate
may change, causing benign (noncancerous) or malignant (cancerous) tumors
to grow. Knowing about prostate anatomy and the changes that occur can
help you understand more about what the prostate does, where tumors may
be located, and how they can be treated.
NORMAL PROSTATE
Your prostate is a
gland about the size and shape of a walnut, located between the pubic
bone and rectum. It surrounds the upper portion of the urethra, the tube
that carries urine out of the bladder. Your prostate produces most of
the semen in which sperm travel. During orgasm, this semen mixes with
nutrients from the seminal vesicles and sperm produced by the testes.
The testes also produce testosterone (the primary male hormone), which
stimulates prostate function.
ABNORMAL PROSTATE
Noncancerous Tumors
Benign tumors are likely to develop inside your prostate beginning at
about age 40 to 45. This condition, called benign prostatic hyperplasia
(BPH), is likely to be found during a routine digital rectal exam. The
tumors squeeze your urethra, causing symptoms such as difficulty urinating.
 Precancerous
Cells
Cells that don't look normal but haven't developed into a tumor can't
be felt during a physical exam and don't producesymptoms. Your urologist
may discover them while diagnosing or treating another condition. Your
urologist will monitor your prostate closely to see how the cells develop.
Cancerous Tumors
Malignant tumors usually develop in the outer portion of the prostate.
Since early-stage tumors don't usually squeeze the urethra, they don't
produce symptoms, but can often be felt during an exam. However, some
tumors can't be felt, and may be detected by using other tests. The cancer
cells, stimulated by testosterone, may stay within the prostate or spread
to the seminal vesicles, lymph nodes, or bones such as the spinal column
MEDICAL EVALUATION
LOOKING AT YOUR CONDITION
The first thing your
urologist needs to do before recommending a treatment program is to find
out more about your condition. A physical exam, including a digital rectal
exam, will help your urologist learn about your general health. You may
be asked to take one or more diagnostic tests to pinpoint the type of
cancer and location of the disease. These tests may also be used during
future exams as guides for identifying changes in your condition.
DIAGNOSTIC TESTS
Several state-of-the
art tests can be used to evaluate your condition. Some of these tests
help your urologist confirm the diagnosis of cancer by eliminating other
illnesses. Other tests provide more specific information about the cancer,
and help your urologist keep track of how you respond to treatment.
 Blood
tests
PSA and PAP are chemicals produced by prostate cells. Elevated PSA levels
in the blood may suggest cancer in the prostate. Elevated PAP may suggest
the cancer has spread.
 Ultrasound
Ultrasound uses sound waves to create a visual image of your prostate.
The test may show how big known malignant tumors are, and may locate cancers
that can't be felt.
 Biopsy
To find out if a tumor is malignant, a thin needle is used to remove one
or more tissue samples from your prostate. Ultrasound is often used to
guide the needle during a biopsy.
 Bone
Scan
When bone is damaged, new bone is produced by the body's natural healing
process. A bone scan can detect this repair, which may indicate cancer
has spread to the bones.
 CT
or MRI Scans
CT and MRI scans reveal more than standard x-rays. By creating detailed
views of the tissues in you body, these scans may be able to show where
malignant tumors are located.
 Cystoscopy
A small instrument called a cystoscope is inserted through the penis opening
so the prostate can be viewed. Your urologist can then determine if a
condition other than cancer is causing a problem.
YOUR DIAGNOSIS
CHOOSING THE RIGHT
TREATMENT FOR YOU
The more precise your
diagnosis is, the more specific your treatment can be. So, to make sure
you get the most effective treatment possible, your urologist uses the
results of your evaluation to identify the type of cancer cells (grade)
and their location (stage) in your body. This information, along with
other factors such as your general health and age, will help your urologist
determine the best course of treatment for you.
Grades: Type of cancer
Low-grade cancer cells usually are uniform and grow slowly. High-grade
cells usually vary in size and shape. Without treatment, they spread quickly
Stages: Location of
cancer
Lower-stage tumors are usually confined to the prostate. Higher-stage
tumors can spread outside the prostate to tissues and bones.
Treating to cure
If cancer is caught when it's at a low grade and stage, your chances for
recovery are excellent. The cancer can usually be removed surgically or
destroyed inside your body with radiation.
Treating to control
If cancer is found when it's at a high grade and stage, its spread and
effects can usually be managed. The cancer may be treated with surgery,
radiation, hormone therapy, and/or chemotherapy.
Watchful waiting
Depending on your age, health, and type of tumor, your doctor may recommend
no immediate treatment. This is called "watchful waiting." Your
doctor is monitoring your condition closely. Based on your condition,
your doctor will determine how often you will need to return for regular
follow-up exams as well as possible treatment in the future.
SURGERY
REMOVING DISEASED
TISSUE
If cancer appears
to be confined to your prostate, your urologist may recommend surgery
(a radical, or total, prostatectomy). Your urologist's goal is to remove
your diseased prostate and all of the cancer. Once surgery begins, if
it's discovered that the cancer has spread beyond your prostate, your
prostate may not be removed (depending on the stage of the cancer). When
you're back in your hospital room and alert, you and your urologist will
discuss other treatment methods.
BEFORE SURGERY
You may have routine lab tests if you haven't had them recently. You and
your doctor may discuss whether you should donate your own blood in the
event you need a transfusion during surgery. Also, you'll meet with your
anesthesiologist to discuss the type of anesthesia that will be used to
keep you comfortable or asleep during surgery. Don't eat or drink anything
after midnight the night before your surgery. Your urologist may instruct
you to use an enema or laxative.
DURING SURGERY
The surgery usually takes two to five hours. Your urologist may make an
incision in your abdomen (restropubic approach) or between your legs (perineal
approach). Some lymph nodes may be evaluated to be sure the cancer hasn't
spread into the nodes or area around your prostate. After your prostate
has been removed and your bladder reattached, a catheter will be inserted
through your penis opening. The catheter drains urine from your bladder
and is held in place by an inflated balloon.
Risks and Complications
With any surgery, there is always a possibility of complications. Your
urologist will discuss the risks with you.
AFTER SURGERY
In the Hospital
You'll wake up in the recovery room and then be taken to your hospital
room. The catheter will be draining urine from your bladder into a sterile
bag. Don't be alarmed if your urine is bloody or cloudy for a while. If
your doctor asks you to, drink plenty of liquids to help flush out your
bladder. Depending on the surgical approach used and your own rate of
healing, you may be able to return home in three to six days.
At Home
Your urologist will tell you when your catheter can be removed. Stitches
will be removed in one to two weeks if they weren't removed in the hospital.
It may take from a couple of weeks to several months before you can control
your bladder. Pain caused by your incision can be controlled with medications.
To avoid straining the incision, don't move quickly, drive, lift anything
heavy, or climb stairs until your urologist gives you the go-ahead. Eat
a balanced diet to help avoid constipation.
RADIATION THERAPY
DESTROYING CANCER
CELLS
Your urologist may refer you to a radiation oncologist, a cancer specialist
who uses radiation therapy to treat the disease. The goal of radiation
therapy is to damage cancer cells so they die, allowing healthy cells
to replace them. Small daily doses of radiation may be beamed from a machine
at the cancer, or doses of radiation ("seeds") may be implanted
directly into the prostate. Whichever method is used, the level of radiation
is safe for you and the people around you.
TARGETING CELLS FROM
THE OUTSIDE
External beam radiotherapy uses a special machine called a linear accelerator
that aims radiation to the treatment area. With each dose of radiation,
more and more cancer cells are damaged, and the tumor gets smaller as
these cells die. Beams of radiation enter from different angles so the
least number of normal cells are affected.
Before Treatment
Your radiation oncologist will design a treatment plan for you based on
an evaluation of your disease and overall health. Before treatment begins,
you'll go through a simulation, a process during which the areas to be
irradiated are determined.
During Treatment
For each visit, you'll be asked to change into a gown. A radiation therapist
will position you on the linear accelerator table. A short treatment of
radiation will be aimed at the target areas. A treatment lasts a few minutes,
and is given once a day, five days a week, for five to seven weeks. Because
some tissue nearby is affected, you may experience side effects.
Side Effects During
Treatment
- Frequent urination,
possibly with a slight burning sensation
- Mild to moderate
diarrhea
- Some tanning and
drying of skin in treated area
- Some loss of pubic
hair
- Fatigue and mild
weight loss
After Treatment
You can resume your normal activities shortly after each visit. You may
still notice some side effects after your full course of treatment has
ended, but these usually clear up within several weeks.
TARGETING CELLS
FROM THE INSIDE
A high dose of radiation may be given by "seeding" your prostate.
When you're under anesthesia, these "seeds" (actually tiny pieces
of radioactive material) are implanted in your prostate through needles
using the perineal approach. Most commonly used, permanent radioactive
implants remain in the body and produce decreasing amounts of radiation
for about a year. Other seeding alternatives, such as temporary radioactive
implants, may also be used.
Because tissue nearby
is hardly affected, there may be fewer side effects from radioactive implants
than from treatment with a linear accelerator.
OTHER THERAPIES
SLOWING GROWTH AND
SPREAD
Most prostate cancer
cells need testosterone to grow. Fortunately, there are several types
of hormone therapy to slow the growth and spread of these cells by changing
the amount of testosterone circulating in your body. Your urologist can
explain the benefits and side effects of each type of hormone therapy,
and discuss chemotherapy and radiation as possible ways to relieve pain
and control the cancer.
HORMONE THERAPY
Your urologist may
recommend hormone therapy, given by a pill or injection, to block the
flow or remove the source of testosterone. You may receive a form of the
female hormone estrogen such as DES (diethylstilbestrol) or a form of
GnRH (Gonadotropin-releasing hormone). Another form of hormone therapy
uses drugs called antiandrogens, such as flutamide. Because testosterone
is constantly produced by your body, these treatments may need to be taken
indefinitely. Or your testes may be removed in an orchiectomy.
Chemotherapy, which
seeks out and destroys cancer cells, may be used in addition to or instead
of hormone therapy. Radiation therapy may be combined with hormone therapy
to control cancer.
MAINTAINING YOUR
HEALTH
By following your
course of treatment, you can play an important part in maintaining your
health. Take the time to understand your disease and ask questions. Protect
your health by having regular checkups, eating well, watching your weight,
exercising, and, if you smoke, quitting. And rest assured that as your
health improves, you can enjoy an active lifestyle.
FOLLOW-UP IS LIFELONG
Schedule appointments with your urologist to follow up on treatment and
to monitor your ongoing health. That way you can make certain all the
cancer has been removed or contained and that a new problem isn't developing.
During these checkups you can expect a general evaluation of your health.
You may also have more diagnostic tests to see how you're responding to
treatment or if your exam reveals anything suspicious.
LOOKING TO THE FUTURE
Most men with prostate cancer can live a normal lifespan and enjoy a high
quality of life. Because every person is different and responds differently
to treatment, the outcome of your treatment can't be guaranteed. But by
working together with your urologist, you should be able to control your
condition now and live life to its fullest.
REACHING OUT FOR SUPPORT
You may have many
different feelings about living with prostate cancer. But you don't have
to keep them to yourself. By sharing your concerns with others, you can
get the emotional support you need during and after treatment.
Feel free to ask questions
of any member of your health care team. These professionals can address
your concerns about diagnosis and treatment.
Even if it's hard
for you to talk openly about your emotions, you can maintain loving relationships
by talking with your family and friends.
The Cancer Information
Service (1-800-4-CANCER), or organizations like the American Cancer Society,
can put you in touch with support groups for people who are living with
cancer.
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