|
Prostate cancer is one of the most common forms of cancer in men. About 200,000 American men are diagnosed with prostate cancer each year and 32,000 die annually of the disease. In recent decades, there has been a steady increase in the incidence of prostate cancer but doctors are making progress in treatment and survival rates are improving. What are its symptoms? How do you know if surgery is the best treatment for you? The following information should help you talk to a urologist about this condition.
What happens under normal conditions?
The prostate gland is about the size of a walnut. It is located between the bladder and the penis, and surrounds the urethra. The prostate gland is part of the male reproductive system. The primary function of this gland is to make and secrete ejaculatory fluid.
What is prostate cancer?
It is a disease that affects the cells of the prostate. It occurs when the normal process of cell growth within the prostate becomes abnormal due to a mass of tissue called a tumor. Like many cancers, the cause of prostate cancer is unknown. But doctors do know that it is more common in African-American men and men with a family history of the disease. Its growth is also contributed by the male sex hormone testosterone. Prostate cancer is very common, with every man having a one in six chance of getting prostate cancer within their lifetime. Now thanks to widespread knowledge about prostate check-ups, about 80 percent of the men who are found to have prostate cancer have a disease which seems to be confined to the prostate and is therefore responsive to treatments, including surgery.
What are the symptoms of prostate cancer?
In its early stages, prostate cancer may not cause any symptoms. But as it progresses, the following symptoms may appear: frequent urination (especially at night), problems with urination (inability, weakened flow, pain, burning, etc.), painful ejaculation, blood in urine or semen and/or frequent pain or stiffness in the back, hips or upper thighs.
How is prostate cancer diagnosed?
Ideally, prostate cancer should be detected when it is so small that there are no symptoms. Early detection can be achieved by a digital rectal examination (DRE) and a PSA test, which may prompt a doctor to order a prostate biopsy. This biopsy entails the use of an ultrasonic probe that is inserted into the rectum and a biopsy needle that is directed into various areas of the prostate gland. Believe it or not, this procedure is relatively painless and does not require hospitalization.
Once prostate cancer has been diagnosed by a prostate biopsy, the physician seeks to stage the disease; that is, to determine the extent of the cancer (i.e., the "T" stage) and whether it has spread to the lymph nodes and/or the bones. The T stage is determined mainly by the DRE and can be divided into the following categories:
T1: Doctor is unable to feel the tumor or see it with imaging (e.g., transrectal ultrasound)
T1a: Cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed
T1b: Cancer is found after TURP but is present in more than 5% of the tissue removed
T1c: Cancer is found by needle biopsy that was done because of an elevated PSA
T2: Doctor can feel the tumor when a digital rectal exam (DRE) is performed but the tumor still appears to be confined to the prostate
T2a: Cancer is found in one half or less of only one side (left or right) of the prostate
T2b: Cancer is found in more than half of only one side (left or right) of the prostate
T2c: Cancer is found in both sides of the prostate
T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles
T3a: Cancer extends outside the prostate but not to the seminal vesicles
T3b: Cancer has spread to the seminal vesicles
T4: Cancer has spread to tissues next to the prostate (other than the seminal vesicles), such as the sphincter, rectum and/or wall of the pelvis
To determine if the cancer has spread to the lymph nodes or bones, the physician may order a CT scan of the pelvis or a bone scan.
In addition to staging, the physician seeks to determine the so-called "aggressiveness" of the cancer. This is done in two ways. The first way is by determining the grade of the cancer; that is, how "angry" it looks under the microscope. Briefly, the most popular prostate cancer grading system is the Gleason score system and is designated between two and 10. Scores of two to four designate low aggressiveness, five to six as mildly aggressive, seven moderately aggressive and eight to 10 very high aggressiveness. The second sign of aggressiveness grading is the PSA level before biopsy. In general PSA levels less than 10 are ideal, levels between 10 and 20 are somewhat worrisome for more extensive disease and behavior while levels greater than 20 are very worrisome though cure is still sometimes possible.
When is surgery the best treatment for prostate cancer?
In general, prostate cancer surgery is best performed in patients with T1 or T2 (confined to the prostate gland) or very small T3 stage disease; PSA levels less than 20 and a Gleason score of less than eight. In certain circumstances, patients with more serious parameters are offered surgery also. Finally, prostate cancer surgery is usually restricted to men who have a 10-year or more life expectancy and are in sufficient health to withstand the risks of major surgery.
What are some risk factors associated with prostate cancer surgery?
Risk factors for surgery are urinary incontinence and impotence. Incontinence is rare with occurrence in less than 5 percent of all surgical cases. However, when it does occur, there are procedures that can solve the problem. Impotence, if experienced post-surgery, can also be treated by a variety of medications and/or technical devices like penile prostheses.
What are the different types of prostate cancer surgery?
Retropubic prostatectomy: During this procedure, the surgeon makes an incision through the lower abdomen. The surgeon can remove the prostate, surrounding tissue and pelvic lymph nodes (if necessary).
Perineal prostatectomy: During this procedure, the surgeon removes the prostate through an incision in the skin between the scrotum and the anus. In general, the perineal surgery is a little easier on the patient, but it may be somewhat inefficient if the cancer is serious and the lymph nodes need to be examined before the prostate is removed.
Laparoscopic prostatectomy: This type of surgery eliminates the need for a large surgical incision to remove the prostate. As a result, the patient may experience less pain and scarring, faster recovery and less risk of infection. During this procedure a telescopic instrument called a laparoscope is inserted into the abdomen through a small incision at the belly button. A camera attached to the laparoscope allows surgeons to view inside the abdomen and perform the surgery without having to make a large incision. Usually, four more small incisions are made in the abdomen to accommodate surgical instruments and the surgery is performed. A patient is not eligible for this type of surgery if they have had previous pelvic surgery.
What can be expected after surgical treatment?
While in the hospital, the patient begins his recovery and pain is managed with medication. Resumption of a regular diet can usually occur by the second day. Usually, the patient is discharged from the hospital with a catheter in place and is taught how to manage it. The catheter is removed usually on a return visit to the surgeon's clinic, and exercises (called Kegel exercises) are begun by the patient to strengthen the urinary control valve. Urinary control (continence) can be immediate or take up to six months.
Likewise, erectile potency may be immediate or may take up to one year to return following surgery. Usually, if erections are not sufficient for intercourse at one month, additional therapies are used until the erections become sufficient. One does not lose the ability to have an orgasm. However the orgasm is "dry" — very little (if any) ejaculation comes out — so the ability to procreate is generally lost.
After the surgery, the surgeon reviews the final assessment of the removed prostate and (if applicable) the lymph nodes. Based on this "final pathology," a follow-up plan is developed. If the pathology is especially serious (e.g., spread to the seminal vesicles or lymph nodes) additional therapy may be recommended. This may include radiation therapy and/or hormone treatment. If the pathology is not especially serious, the follow-up plan entails regular visits to a physician and a regular PSA test. The PSA level should be less than 0.1ng/ml. If it is greater, especially if it is greater than 0.5 ng/ml, then cancer is still present and additional therapies are recommended.
Frequently asked questions:
When can I resume normal activity after the surgery?
The time varies, but usually it is between three to six weeks.
Will I know if I am cured after surgery?
Not completely and it certainly varies depending on the severity of the cancer removed. In general, one must have PSA test values of less than 0.1 ng/ml for ten years before cure is certain.
I worry about potency but I am most afraid of incontinence. What are the odds?
That depends mostly on the surgeon and his/her experience. Usually, incontinence is temporary and does not last long although it can persist for as much as six to nine months. With more experienced surgeons, the risk of permanent incontinence is 2 to 5 percent after prostate cancer surgery.
Where can I get more information?
Prostate Specific Antigen (PSA).
Prostate Specific Antigen (PSA) (Zinio format).
AUA Guidelines Patient Guides: Prostate Cancer Awareness for Men
Download the free Zinio reader or the free Acrobat reader.
|
