What is it?
An unregulated growth of prostate cells that has to potential to spread to other parts of the body. It is the most common cancer after skin cancer. Although it can often be slow growing it is still the second most common cause of cancer death in men.
How do we look for it?
There have been two traditional methods for looking for prostate cancer while it is still treatable. The much feared and talked about prostate rectal exam is a way to feel areas in the prostate which are abnormal and could be cancerous tumors.
A discussion of the benefits and pitfalls of PSA screening is a more complicated issue. However my personal belief is that much can still be gained by using PSA but it must be tailored to each individual patient. There is no one ‘good’ or ‘bad’ value that can be applied to everyone. It is best to find a physician who can help balance the benefits of over and under screening and apply this to you as an individual patient.
How do we treat it?
A diagnosis of prostate cancer can be a scary thing. The good news is that although prostate cancer can be aggressive, most of them are actually slow growing. Therefore the first decision to consider is whether your cancer could be safely monitored or should be treated. Based on many factors such as type and volume of cancer as well your personal health and age, your physician may offer Active Surveillance. This is close monitoring and only switching to treatment if it seems as though the cancer is becoming more aggressive. Some people however will have more aggressive cancer and may need treatment. The most common types of treatment are surgery and radiation.
Prior to robotic surgery, the traditional open surgery to remove the prostate was effective at curing many of prostate cancer. This involved removing the entire prostate while the cancer is inside. As techniques have been refined robotic surgery has become a preferred approach to remove the prostate. If your surgeon is trained and experienced with this technique they may have seen improvement in sexual function, urinary continence, and quicker recovery compared to open surgery. Not only do we want an effective cancer cure, we strive to do so with the least amount of side effects possible.
In addition to refinement in surgical technique, radiation programs have also been evolving. There are many good treatment options for using radiation to treat prostate cancer. This can range from several weeks of external radiation to implanted radioactive seeds into the prostate. Sometimes people will get a combination of the two. Often a 1-2 year course of testosterone withdrawal is used during radiation treatment to help achieve a better response rate however includes some side effects.
There are several other less commonly used approaches to treat prostate cancer. One of these involves freezing the prostate in a surgical procedure call Cryotherapy. Another uses ultrasound waves which heat the prostate to kill tissue. In the future these may have enough long term data to become more standard therapies.
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What does the prostate do?
For most older men it mostly causes trouble. It can be the source of urinary dysfunction and obstruction. As mentioned above there is also a high incidence in the US of cancers arising from the prostate. However the prostate does serve a very important role earlier in life. It is the junction of the urethra, the vas deferens (carry the sperm from the testicles) and the seminal vesicles. The prostate helps generate the semen and propel it on its way to make our next generation.
How does it cause problems?
As many men age the prostate can continue to grow. Since the urethra runs through the prostate almost like a straw this channel can gradually become narrowed as the prostate expands. This obstruction can cause slowing of stream, hesitancy and even retention of urine. Eventually the bladder has to compensate like any muscle and gets stronger and thicker to force the urine out the smaller opening. This is why many men who have a weak stream also have to always be on the look out for the nearest restroom. The bladder may not empty as well and the thicker more muscular bladder often doesn’t store urine as well. This often leads to both ‘obstructive’ and ‘irritative’ symptoms.
What can we do about it?
The first course of action in men with urinary symptoms is to evaluate the root cause. There are many reasons similar symptoms can be reported and the more accurate our diagnosis is, the better the treatment response will be. Tests may range from feeling the size of the prostate on exam, using an ultrasound to determine the emptying ability of the bladder, and sometimes looking with a camera in the urethra, prostate and bladder to rule out other potential causes of symptoms.
If a prostate cause has been deemed the most likely culprit there are two classes of medications that are typically started. One is used to help open the prostate and relax the muscles inside it which can quickly improve flow. Another class reduces the size of the gland and overtime will make urination easier. Often one or both of these will be enough to ease urinary symptoms.
Sometimes symptoms persist after medication use or a person can be unable to void at all. In certain instances surgery may be the most direct and quick route to improve urination. There are many variations on the traditional TURP, (trans-urethral resection of prostate) also known as the ‘roto-rooter’. This can range from removing tissue to vaporizing prostate with lasers or cautery. Some in office procedures such an microwave therapy has also been developed but these often lack the long term efficacy of the more traditional approaches.
Would it be helpful to discuss your prostate issues and options?