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Prostate Cancer

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What is Prostate Cancer?

The prostate is a walnut-shaped gland. It is located only in men where it creates seminal fluid. The gland is located deep in the pelvis sandwiched between the bladder and the rectum. Cancers arising from the prostate are the second most common cancers among men in the United States (after skin cancers). The risk of developing prostate cancer increases with age. One in six men will be diagnosed with prostate cancer within their lifetimes.

While it is a serious disease, it’s important to know that most men diagnosed will not die from it. In fact, nearly 3 million men in the United States who have been diagnosed with prostate cancer are still alive today. This is largely due to early cancer detection with screening and improved treatment techniques. Usually these cancers are slow growing and are confined to the prostate gland. Because of this, they can grow to an advanced stage without causing obvious symptoms.

Preventing Prostate Cancer:

Maintaining a healthy diet and level of physical activity can reduce the risk of developing many types of cancers. It also improves chances of survival with cancer. Gender, age and family history are risk factors associated with developing prostate cancer. A strong family history of cancer or a known genetic mutation is reason to consult your doctor.

The following factors increase risk of diagnosis and mortality from prostate cancer:

Race and ethnicity – Prostate cancer is more common in African-American men, and in Caribbean men of African ancestry, than men of other races. These men are also more than twice as likely to die of prostate cancer as white men. Reasons for these racial and ethnic differences are unclear.

Family history – Having a father or brother with prostate cancer more than doubles a man’s risk. The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.

Interestingly, studies have not shown a clear link between certain lifestyles and dietary factors. However, there is recent evidence that certain food choices might be directly related to reducing the risk of cancer in men.

Some good choices:

Tomatoes and other red foods. Tomatoes, watermelon and other red foods owe their bright color to a powerful antioxidant called lycopene. Studies show men who consume it regularly have a lower incidence of prostate cancer.

Coffee! Several studies over three decades suggest that a serious coffee habit is linked to a lower risk of fatal prostate cancer. Drinking an average of three cups of coffee per day is estimated to reduce your risk of fatal prostate cancer by more than 10 percent. But the benefits might not extend to those who are only occasional coffee drinkers.

Good fats. Studies show a general link between animal fats and an increased risk of all cancers. Whenever possible, replace animal-based fats with plant-based fats. This includes olive oil instead of butter, nuts or seeds instead of cheese, and avocadoes or olives instead of packaged snacks. Also, overcooking meats produces carcinogens, so be careful not to grill or broil your meat to well done.

Screening for Prostate Cancer

Men should undergo yearly screening for prostate cancer after a discussion with their physician beginning at age 40-50. This recommendation is based on guidelines from several cancer organizations. This include the American Cancer Society. Evidence shows improvement in outcomes with early detection and treatment. If you have a strong family history of cancer or a known genetic mutation, consult your doctor.

Prostate screening tests includes both a digital rectal exam (DRE) and prostate-specific antigen (PSA) test. During the DRE the doctor inserts a gloved and lubricated finger into the rectum to examine the prostate. The PSA screening test involves taking a blood sample to measure an antigen in the blood specific to prostate. PSA testing is a more accurate and reliable test than DRE, so those that refuse DRE should still receive a PSA test for screening.

Work with your doctor to define a screening plan. This is especially important for those at high-risk or those experiencing urinary or sexual dysfunction symptoms.

Prostate Cancer Treatment

Prostate cancer treatment is more effective when it’s detected early. Early detection allows more treatment options and less therapy. If screening identifies a person at risk a biopsy is performed. If biopsy confirms cancer, additional studies will be performed to determine cancer stage. For example, additional imaging such as CT, MRI and bone imaging studies are ordered for more advanced staged prostate cancer.

For men there are several good treatment options for prostate cancer.

These includes radiation therapy, surgery, hormonal therapy, cryoablation, chemotherapy and active surveillance. That is why it is important to be seen by a Urologist and a Radiation Oncologist before selecting a treatment. Radiation therapy and surgery are the most commonly used treatments to cure prostate cancer. Many different types of radiation and surgery are available.

Treatment with Radiation Therapy

Radiation therapy can be given with two methods:

External beam radiation therapy (EBRT) is radiation delivered from outside of the body. Think of high energy, targeted X-rays.
Brachytherapy is radiation given by placing a radioactive sources directly inside the body.

Even among these two methods of radiation therapy, many variations exists. For example, EBRT can be given with different particles such as photons or protons. Additionally, EBRT can be given anywhere from 45 treatments to only 5 treatments with SBRT. EBRT is planned and delivered with many techniques such as Arc Therapy (VMAT) and intensity modulated radiation therapy (IMRT). Finally, EBRT can be delivered in combination with brachytherapy.

Likewise brachytherapy is delivered in many ways. Low-dose rate (LDR) brachytherapy, also known as a seed implant, places many rice-sized seeds in the prostate. These seeds deliver a low dose of radiation over a long time. Importantly, LDR brachytherapy makes the patient radioactive so it is important to take precautions. Alternatively, high-dose rate (HDR) brachytherapy places needles inside the prostate. Radiation is delivered through by a radiation source through these needles. The needles and radiation source are both removed following the procedure.

Side effects of radiation include painful, frequent or urgent urination as well as loose stools. Erectile dysfunction is also a risk. This is why we utilize the most advanced techniques for my patients including VMAT planning with MRI imaging and hydrogel spacers. These techniques greatly reduce risk of side effects.

We are proud to be the first in Florence to offer SBRT to our prostate cancer patients. SBRT has many advantages over traditional radiation.

Treatment with Surgery

Surgery, or radical prostatectomy, involves removing the prostate gland. In addition, some surrounding tissues are removed and lymph nodes sampled. Prostatectomy is performed in several ways:

Robotic assistance surgery. Instruments attached to a robot are inserted through several small incisions. The surgeon operates from a console with hand controls to move the instruments. This allows for more precise motions.
Retropubic prostatectomy involves making an incision through the lower abdomen and removing the prostate.
Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction.

Variations exist among the surgery techniques. For example specialized centers offer a nerve sparing robotic approach to minimize the effects of the surgery. It is important to discuss type of procedure with surgeon. Recommendations will vary based on experience, your age, body type, cancer and overall health.

Prostate Cancer Outcomes

Recent advances in prevention, detection and treatment have significantly improved outcomes for prostate cancer. Advances include radiation, surgery, hormonal therapy and chemotherapy. It’s as important as ever to raise prostate cancer awareness. This is a great way to improve outcomes.

Learn more about prostate cancer at the American Cancer Society.