What is prostate cancer?
Prostate cancer is the uncontrolled growth of malignant cells in the prostate, a walnut-sized male sex gland that surrounds the urethra. If detected late or left untreated, these mutated cells can spread throughout the body, causing severe pain, urinary problems or death.
Prostate cancer is the second most common and deadly cancer among American men, with nearly 29,000 dying from the disease in 2008. However, the five-year survival rate for men diagnosed with prostate cancer has increased from 67% to 99% in only the past 20 years. It is this type of progress that drives the Lank Center for Genitourinary Oncology (Prostate Cancer Radiation Oncology Service) staff at the Dana Farber/ Brigham and Women’s Cancer Center to work toward further improving outcomes by implementing, and helping to develop, the latest advances in prostate cancer treatment, screening and prevention.
What are the risk factors for prostate cancer?
The following factors have been found to impact a man’s risk of developing prostate cancer:
age - Men over the age of 65 account for more than two-thirds of all prostate cancer diagnoses.
race - Prostate cancer is much more prevalent among African-American men than it is among Caucasian-American men, possibly due to cancer-susceptibility genes that are more prevalent among African-American men.
diet - Increasing your intake of fiber, soy protein and lycopene (found in processed tomatoes) can all serve to inhibit the onset or spread of prostate cancer. A high-fat diet, on the other hand, increases your risk.
obesity - Obesity is not only a major contributor to diabetes and high cholesterol, but it is also thought to be a risk factor for developing prostate and other hormone-dependent cancers.
family history - A man is twice as likely to develop the disease if he has a father or brother with prostate cancer.
What are the symptoms of prostate cancer?
In its early stages, including when diagnosed early using the PSA (prostate-speciific antigen) blood test, prostate cancer reveals no symptoms. In its later stages, the following symptoms may occur:
urinary dysfunction - weak or interrupted flow, frequent urination or incontinence, difficulty or inability to urinate and painful urination
blood in the urine or semen
persistent back, hip or pelvic pain
erectile dysfunction
Given that there are typically no recognizable symptoms during the early stages of prostate cancer, men should be diligent about getting regular screenings.
How is prostate cancer diagnosed?
The best way to detect prostate cancer in its early stages is to get regular screenings. Here are the three most common screenings:
All these exams are typically done annually, starting at the age of 50 for most men and at the age of 45 for those in high-risk groups -African-American men or men with a family history of prostate cancer.
If the DRE or PSA detects any abnormalities, your physician may recommend further testing, such as:
transrectal ultrasound (TRUS) - uses sound waves to create an image of the prostate gland, thereby helping to detect tumors, estimate the size of the prostate and provide visual guidance during biopsies
computed tomography scan (CT/CAT scan) - imaging procedure that is more detailed than x-rays
magnetic resonance imaging (MRI) - provides even greater detail than a CT scan
radionuclide bone scan - a nuclear imaging technique to determine whether the cancer has spread from the prostate to the bones
lymph node and/or prostate biopsy - remove tissue samples for examination under a microscope
A biopsy is the only definitive means for confirming the presence of cancer.
How is prostate cancer treated?
Prostate cancer can be treated in a variety of ways. The method or methods employed depend both on the nature of the cancer and the desires of the patient. Here are the types of surgery or therapy that your physician will discuss with you:
radical prostatectomy - a procedure to remove the entire prostate gland and surrounding tissue
laparoscopic radical prostatectomy - a less-invasive type of radical prostatectomy that uses slender instruments to allow for smaller incisions
transurethral resection of the prostate (TURP) - removes part of the prostate without an incision by entering through the urethra
external radiation (external beam therapy) - sends high levels of radiation directly to the cancer cells in single doses
IMRT (intense modulated radiation therapy) - a type of external beam therapy that uses computer guidance to deliver precise radiation doses to specific areas within tumor
internal radiation (implant therapy) - implants radioactive seeds that emit small amounts of radiation over a period of weeks or months
innovative treatment combinations, including hormone therapy and chemotherapy combined with radiation therapy
orchiectomy - surgical removal of the testicles to stop production of hormones that stimulate prostate cancer cells
LHRH (luteinizing hormone-releasing hormone) analogs - drugs that suppress testosterone production
anti-androgens - block body's ability to use testosterone
What does the future hold for prostate cancer treatment?
Researchers at the Dana-Farber Cancer Institute (DFCI) continuously pursue research targeted toward improving the treatment of prostate cancer. Included among this body of work is the six-month trial Docetaxel plus 6-month Androgen Suppression and Radiation Therapy vs 6-Month Androgen Suppression and Radiation Therapy for Patients with High-Risk Localized or Locally Advanced Prostate Cancer, which is investigating the effectiveness of the chemotherapy drug docetaxel (Taxotere) in treating men with high risk cancer. Visit DFCI’s clinical trials website to learn more about the Taxotere study and other clinical trials.
How can I learn more?
Patients seeking more information about the Dana Farber/Brigham and Women’s Hospital Genitourinary Cancer Treatment Services, or wishing to schedule an appointment with a BWH physician, should call the Patient Referral Service number: 1-800-294-9999. This number is staffed 8:00am - 5:30pm, Monday through Friday.
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