Prostate Cancer
In Office Procedures

Prostate Cancer

The Prostate gland sits like a collar around the neck of the bladder. It is made up of glandular tissue and muscle fibers that surround a portion of the urethra, the channel through which you urinate. Adenocarcinoma of the prostate is the clinical term for a cancerous tumor in the prostate gland. As the prostate cancer grows, it spreads to nearby tissues, lymph nodes, bone, liver, and lungs. Localized prostate cancer is amenable to cure, which is why it is important to find it early, before it spreads.

Prostate cancer is the most common type of cancer in men in the United States, with over 225,000 new cases each year. African- American men have the highest incidence of prostate cancer. Asian men have the lowest incidence, but this rate increases sharply when they immigrate to the United States, suggesting environmental dietary factors. The risk also rises with increasing age, as 60% of newly diagnosed cases occur in men over the age of 70 years.

Early prostate cancer is usually discovered as a result of routine digital rectal examination (DRE) or screening blood test for prostate specific antigen (PSA). Symptoms can not be distinguished from those caused by benign enlargement of the prostate (BPH), such as slowing of the stream, urgency, and frequency. Weight loss and back pain should prompt a visit to the urologist.

Treatment Options

Radical Prostatectomy. This is the surgical removal of the entire prostate gland and surrounding tissues, performed in the hospital under anesthesia. A catheter is placed in the bladder to allow the bladder to heal to the urethra. Risks of surgery include bleeding, infection, incontinence (involuntary loss of urine), rectal damage, and impotence (25- 90% risk, depending on the age of the patient).

Radiation Therapy. There are two types of radiation used for treatment, X- rays and radioactive seed implantation (brachytherapy).

X-rays, or external beam radiation, are given over a course of 38-40 treatments, to cover the entire prostate. Side effects occur if the surrounding tissues receive too much radiation, and include urinary frequency, urge incontinence, bleeding from the bladder or rectum, diarrhea, and impotence (about 50% risk)

Brachytherapy is performed under anesthesia. An ultrasound probe in the rectum is used to guide placement of needles through perineum into the prostate. The number and placement of the radioactive seeds is determined by the urologist and radiation over a period of months. Side effects include bleeding, diarrhea, and impotence (about 25%). For higher risk tumors this treatment is sometimes combined with X-rays and hormone therapy.

Cryosurgery. Specially designed needles are placed into the prostate through the perineum under ultrasound control. These are used to freeze the prostate at below minus 40 degrees centigrade, killing the cancer cells. Side effects include incontinence (about 5%), fistula between the urethra and the rectum (less then 1%), and impotence (about 90% if the entire prostate is treated). Nerve sparing cryosurgery is available to preserve erections.

Hormone Therapy. Prostate cancer is hormone sensitive. In the absence of testosterone, the main male hormone, parts of the cancer die and most of the rest of it stops growing for a while This treatment is used to shrink the size of the prostate, in combination with radiation to improve treatment results, and to slow the growth of the cancer in patients whose tumors have already spread. It is not curative by itself.