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Prostate cancer is the most common cancer
of the American man. The controversy around this very common cancer focuses on the fact
that the vast majority of men with prostate cancer do not die because of the disease, but
rather of other causes. Family history raises a man’s risk several times; black men
are at four times greater risk of prostate cancer death than white men.
Symptoms
Most men with prostate cancer have no symptoms. However, those men that have symptoms may
experience symptoms which can mimic benign prostate hypertrophy (BPH). Symptoms can
include urinary frequency, hesitancy, intermittency, nocturia, dribbling, and weak stream.
Rapidly progressing symptoms that develop over a few months are more indicative of
prostate cancer; symptoms from BPH can remain stable for a number of years. When the
cancer spreads to the bone, disease may present with bone pain, particularly in the spine.
Diagnosis
A. Digital rectal examination
B. Prostate-specific antigen (PSA; a protein which is elevated in prostate cancer cases)
C. Transrectal ultrasound involves placement of an ultrasound transducer in the rectum.
D. Needle biopsy
Treatment
Treatment of prostate cancer depends on the extent of disease. The aim of treating early
disease, localized to the prostate, is to achieve cure. However, the goal for treatment of
advanced disease that has spread beyond the prostate capsule is improvement of symptoms.
A. Localized disease (only within the prostate) is usually managed with watchful waiting,
radical prostatectomy (removal of the prostate), or radiation therapy. The dilemma in
deciding whether, or how, to treat localized disease is that there are no studies that
demonstrate improved mortality with earlier detection or treatment of prostate cancer.
B. Advanced disease may require surgical resection for relief of urinary symptoms.
Radiation therapy is often used for pain relief due to when the cancer is in the bone. The
mainstay of symptomatic advanced disease is hormone therapy. The goal is symptom control,
not cure.
1. Orchiectomy (removal of testicles) reduces testosterone levels and is useful in the
treatment.
2. Estrogen therapy appears to be more effective when given earlier in the course of the
disease.
3. Other hormones and agents are also used
Prevention and Screening
The cause of prostate cancer remains unknown, thus no methods of prevention have been
identified. The theory behind prostate cancer screening programs is that early diagnosis
and treatment will improve outcomes; this theory remains unproved. The American Cancer
Society recommends annual PSA testing and digital rectal examination in men more than 50
years old and similar screening for men older than age 40 at high risk (family history,
black). However, other authorities do not recommend screening because of the lack of
proven effectiveness and the risk of lower quality of life resulting from the
complications of therapy.
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