About Your Diagnosis

Prostate cancer is the most common cancer among men in the United States. Nearly 300,000 new cases are diagnosed each year. It is estimated that 1 in 5 men has a diagnosis of prostate cancer in his lifetime. The cause of prostate cancer is unknown. Abnormal findings during a digital rectal examination or an abnormal prostate-specific antigen (PSA) blood test usually leads the physician to ordering transrectal ultrasonography (TRUS). A biopsy of the prostate is performed to confirm the diagnosis of prostate cancer. The PSA blood test can lead to early detection of prostate cancer even before there are any symptoms. This accounts for the high number of new cases diagnosed each year but also has led to controversy regarding therapy for early localized prostate cancer. The reason for the controversy is that prostate cancer generally is slow growing; some reports show that 80% of patients live 10 years without treatment. The decision is whether patients should undergo treatment, which places them at risk for complications, or undergo observation and be treated only when symptoms occur (watchful waiting), knowing that prostate cancer is curable if treated at an early stage.
Living With Your Diagnosis
Typical symptoms are difficulty starting the urine stream, waking up frequently at night to urinate, dribbling at the end of urination, blood in the urine, urinary urgency, and pain with urination. If the prostate cancer has spread (usually to bone), you may have back or hip pain.
Treatment
Once the diagnosis is made, staging is performed to determine whether the cancer is localized or has spread, or “metastasized” (Fig 1). Computed tomography (CT) of the abdomen and pelvis and a bone scan usually are ordered. If the tumor is confined to the prostate, the treatment options include the following:
1. Surgical removal of the prostate. The main complications are impotence (inability to have an erection) and urinary incontinence (leaking).
2. Radiation therapy. The main complications are diarrhea, blood-streaked stools and rectal and urinary urgency, frequency, and incontinence.
3. Radiation seed implants. Complications are similar to those of radiation therapy. If the tumor has spread, treatment is focused on elimination of the male hormone testosterone, which increases prostate tissue growth. Removal of all testosterone stimulation has been shown to cause remission. The testes produce 95% of the testosterone in the body; the other 5% comes from the adrenal gland. Therefore, treatment of advanced prostate cancer includes the following:
1. Surgical removal of both testes (orchiectomy). Complications are impotence, hot flashes, and loss of libido (sexual drive).
2. Use of medicines, including hormones, that inhibit formation of testosterone, such as estrogens, leuprolide, and flutamide. Complications are similar to those of orchiectomy.
The DOs
• Be aware of the controversy about PSA screening. Some authorities recommend an annual PSA blood test with digital rectal examination for all men older than 50 years or sooner for men who have a family member in his 40s or 50s with prostate cancer. There is no answer to what age to stop checking PSA level. This becomes a judgment and discussion between you and your physician. Most prostate cancers are slow growing and produce no clinical symptoms for as long as 10 years.
• Ask yourself the following questions and have an active role in making decisions about your treatment: Do you believe your life expectancy is more than 10 years? A 50-year-old man would say yes, but an 80-year-old would think twice. What about a 70-year-old man? Do you want to find out if you have prostate cancer by undergoing a biopsy? Do you want to go through surgical treatment or radiation therapy and its complications?
The DON’Ts
• Do not forget your options if you have localized prostate cancer. They are watchful waiting, surgical treatment, or radiation therapy.
• Do not be afraid to ask for second opinions. You can ask opinions from an oncologist (cancer specialist), urologist (specialist who deals with diseases of the urinary and genital tract), and your primary care physician.
When to Call Your Doctor
• If you have blood in the urine.
• If you have difficulty initiating the urine stream or cannot urinate.
• If you have urinary frequency, urgency, or pain.
• If you have prostate cancer and new onset of back, hip, or bone pain.