Prostate cancer is a common, but usually slow-growing cancer (compared to other types of cancer). The prostate gland is part of the male reproductive system. It is surrounded by other glands, nerves and organs involved in urinary, sexual, and bowel function. Although you can live without a prostate, its location makes prostate cancer difficult to treat. One in every six men (17%) will develop prostate cancer in his lifetime, and 3% of all men will die of this disease (over 27,000 men per year). Prostate cancer is the second leading cause of cancer death in the United States (behind lung cancer).
Early prostate cancer has no symptoms. Therefore, screening is essential. Two tests are commonly used to detect prostate cancer. One is a blood test called prostate specific antigen or PSA. The other is a digital rectal exam (DRE). Men should start yearly screening at age 40. Some men with risk factors choose to take a PSA test prior to age 40 in order to establish a baseline level for future comparison. Once the disease is detected, there may be several effective treatment options.
Every person’s situation is unique. Factors that influence a treatment decision include age, overall health, extent (stage) of the disease, aggressiveness (grade) of the disease, and personal preference of the patient. Nine out of ten prostate cancer cases are caught early. Most of these cases are best treated with either removal or destruction of the prostate gland. However, in some elderly men with very early and indolent disease, careful observation (“watchful waiting”) is the most appropriate choice. Patients who are diagnosed late may benefit most from hormonal or chemotherapeutic medications.
Removal of the prostate (prostatectomy) can be performed in many different ways. The goal of each method is complete removal of the gland with minimal disturbance of the surrounding structures (nerves, muscle fibers, urethral tube, bladder, and rectum):
- Traditional open surgery (retropubic prostatectomy) uses a large incision in the middle of the lower abdomen to remove the prostate.
- Perineal prostatectomy involves an incision between the scrotum and the anus.
- Robotic prostatectomy is a type of laparoscopic surgery in which the surgeon inserts a thin telescope into the abdomen through a small incision. The surgeon then uses a highly precise machine to control tiny surgical instruments inserted through other small incisions. This procedure may increase accuracy, but as with all surgery, the level of experience and skill of the surgeon is critical.
Destruction of the prostate can be performed by various forms of radiation (external beam, seeds, and others), prostate freezing (cryotherapy), and high-intensity focused ultrasound (HIFU). The pros and cons of each treatment option depend upon each patient’s unique situation.
Q: What is a PSA blood test?
A: Prostate-specific antigen, or PSA, is a protein made by prostate cells. Some of this protein is released into the blood stream and can be measured with a simple blood test. Since prostate cancer cells tend to release more PSA than normal cells, this test is often used for diagnosing prostate cancer. However, since so many factors can affect PSA levels, the reliability of this test is limited.
Q: What information should I bring to my first office visit with Scott D. Miller, MD?
A: Please bring any pertinent laboratory, radiology, and pathology reports. Completing our patient information forms (available on our website) prior to your arrival will help inform Dr. Scott Miller regarding your medical history, medications and allergies.
Q: What are the risk factors for developing prostate cancer?
A: The most significant risk factors are family history, age, and African-American race.
Q: What are the risk factors that raise the chance that my prostate cancer has spread to other areas of the body?
A: The most significant risk factors for having disease outside of the prostate include high PSA, high volume of disease on the needle biopsy, high Gleason grade, and presence of a prostate nodule by finger examination. A small amount of disease outside of the prostate, whether close or distant, can be difficult to detect by any type of x-ray test.
Q: What is meant by the term “cancer stage”?
A: “Cancer stage” refers to the extent and location of disease, regardless of aggressiveness.
Q: What is meant by the term “cancer grade”?
A: “Cancer grade” refers to the aggressiveness of disease, regardless of extent and location. This determination is made by microscopic examination by the pathologist.
Q: What tests do I need prior to making a treatment choice?
A: In most cases, no tests beyond biopsy, PSA, and digital rectal exam are needed. In high risk cases, bone scan, CT scan, or other x-ray tests can be useful.
Screening and early detection are the first steps toward the successful management of prostate cancer. However, obtaining enough information to make an informed treatment decision is essential. Below are some useful links.