PROSTATE CANCER
Introduction
When you're told you have prostate cancer, it's natural to be concerned about what you're future will be like. But most people who have prostate cancer can live a full and active life. In fact, when prostate cancer is diagnosed in its early stages - before it has spread outside the prostate - chances are excellent that it can be cured. If cancer is detected in its later stages, it can usually be controlled. By knowing how prostate cancer develops and is diagnosed, you can better understand what's happening to your body. And by knowing about treatment methods, you can understand what your options are for living with prostate cancer.
"I can't have cancer, I don't have symptoms."
Prostate cancer often doesn't produce symptoms. Symptoms are usually related to noncancerous problems of the prostate or of the urinary tract.
"I'm going to die from my cancer."
Most men don't die from their prostate cancer. Prostate cancer is one of the slowest-growing types of cancers, and can usually be controlled.
"Treatment will leave me impotent or incontinent."
Impotency or incontinence doesn't always occur. If it does, your urologist will discuss the various treatment options with you.
"I won't be able to live my life the way I used to."
With medical advances, the quality of life for men with prostate cancer has improved dramatically. Most men can enjoy a comfortable lifestyle.
Prostate Anatomy: Changes Can Occur with Age
As a younger man, you probably didn't worry about your prostate because it didn't affect your health. But as men age, some of the cells that make up the prostate may change, causing benign (noncancerous) or malignant (cancerous) tumours to grow. Knowing about prostate anatomy and the changes that occur can help you understand more about what the prostate does, where tumours may be located, and how they can be treated.
Normal Prostate
Your prostate is a gland about the size and shape of a walnut, located between the pubic bone and rectum. It surrounds the upper portion of the urethra, the tube that carries urine out of the bladder. Your prostate produces most of the semen in which sperm travel. During orgasm, this semen mixes with nutrients from the seminal vesicles and sperm from the testes. The testes also produce testosterone (the primary male hormone) which stimulate prostate function.
Abnormal Prostate
Non-cancerous tumours
Benign tumours are likely to develop inside your prostate beginning at about age 40 to 45. This condition called benign prostatic hyperplasia (BPH), is likely to be found during a routine digital rectal exam. The tumours squeeze your urethra, causing symptoms such as difficulty urinating.
Precancerous cells
Cells that don't look normal but haven't developed into a tumour can't be felt during a physical exam and don't produce symptoms. Your urologist may discover them while diagnosing or treating another condition. Your urologist will watch the cells closely to see how they develop.
Cancerous tumours
Malignant tumours usually develop in the outer portion of the prostate and can often be felt during an exam. Since early-stage tumours don't usually squeeze the urethra, they don't produce symptoms. The cancer cells, stimulated by testosterone, may stay within the prostate or spread to the seminal vesicles, lymph nodes or bones such as the spinal column.
Medical Evaluation: Looking at Your Condition
The first thing your urologist needs to do before recommending a treatment programme is to find out more about your condition. A physical exam, including a digital rectal exam, will help your urologist learn about your general health. You may be asked to take one or more diagnostic tests to pinpoint the type of cancer and location of the disease. These tests may also be used during future exams as guides for identifying changes in your condition.
Diagnostic Tests
Several state-of-the-art tests can be used to diagnose your condition. Some of these tests help your urologist confirm the diagnosis of cancer by eliminating other illnesses. Other tests provide more specific information about the cancer, and help your urologist keep track of how you respond to treatment.
Blood tests. PSA and PAP are chemicals produced by prostate cells. Elevated PSA levels in the blood may suggest cancer in the prostate. Elevated PAP may suggest the cancer has spread.
Ultrasound. Ultrasound uses sound waves to create a visual image of your prostate. The test may show how big know malignant tumours are and may locate cancers that can't be felt.
Biopsy. To find out if a tumour is malignant, a thin needle is used to remove one or more tissue samples from your prostate. Ultrasound is often used to guide the needle during a biopsy.
Bone scan. When bone is damaged, new bone is produced by the body's natural healing process. A bone scan can detect this repair, which may indicate cancer has spread to the bones.
CT or MRI scans. CT and MRI scans reveal more than standard x-rays. By creating detailed views of the tissues in your body, these scans may be able to show where malignant tumours are located.
Cystoscopy. A small instrument is inserted through the penis opening so the prostate can be viewed. Your urologist can then determine if a condition other than cancer is determining the problem.
Your Diagnosis: Choosing the Right Treatment for You
The more precise your diagnosis is, the more specific your treatment can be. So, to make sure you get the most effective treatment possible, your urologist uses the results of your evaluation to identify the type of cancer cells (grade) and their location (stage) in your body. This information, along with other factors such as your general health and age, will help your urologist determine the best course of treatment for you.
Grades: Type of Cancer
Low-grade cancer cells are usually uniform and grow slowly. High-grade cells usually vary in size and shape. Without treatment they spread quickly.
Stages: Location of Cancer
Lower-stage tumours are usually confined to the prostate. Higher-stage tumours can spread outside the prostate to tissues and bones.
Treating to Cure
If cancer is caught when it's at a low grade and stage, your chances for recovery are excellent. The cancer can usually be removed surgically or destroyed inside your body with radiation.
Treating to Control
If cancer is found when it's at a high grade and stage, its spread and effects can usually be managed. The cancer may be treated with surgery, radiation, hormone therapy and/or chemotherapy.
Surgery: Removing Diseased Tissue
If cancer appears to be confined to your prostate, your urologist may recommend surgery (a radical, or total, prostatectomy). Your urologist's goal is to remove your diseased prostate and all of the cancer. Once surgery begins, if it's discovered that the cancer has spread beyond your prostate, your prostate may not be removed (depending on the stage of the cancer). When you're back in your hospital room and alert, you and your urologist will discuss other treatment methods.
Before Surgery
You may have routine lab tests if you haven't had them recently. You'll meet with your anaesthesiologist to discuss the type of anaesthesia that will be used. Don't eat or drink anything after midnight the night before your surgery. Your urologist may instruct you to use an enema or laxative.
During Surgery.
The surgery usually takes two to five hours. Your urologist may make an incision in your abdomen (retropubic approach) or between your legs (perineal approach). Some lymph nodes may be evaluated to be sure the cancer hasn't spread into the nodes or area around your prostate. After your prostate has been removed and your bladder reattached, a catheter will be inserted through your penis opening. The catheter drains urine from your bladder and is held in place by an inflated balloon.
Risks and Complications
With any surgery, there is always a possibility of complications. Your urologist will discuss these and any other risks with you:
Infection
Pneumonia
Excessive bleeding
Impotence
Incontinence
Difficulty urinating
Bowel perforation
After Surgery
In the hospital
You'll wake up in the recovery room and then be taken to your hospital room. The catheter will be draining urine from your bladder into a sterile bag. Don't be alarmed if your urine is bloody or cloudy for a while. If your doctor asks you to, drink plenty of liquids to help flush out your bladder. Depending on the surgical approach used and your own rate of healing, you may be able to return home in three days to two weeks.
At home
Your urologist will tell you when your catheter can be removed. Stitches will be removed in one to two weeks if they weren't removed in the hospital. It may take from a couple of weeks to several months before you can control your bladder. Pain caused by your incision can be controlled with medication. To avoid straining the incision, don't move quickly, drive, lift anything heavy, or climb stairs until your urologist gives you the go-ahead. Eat a balanced diet to help avoid constipation.
Call your doctor if:
You have fever or chills.
Your incision is draining or increasingly painful or red.
Urine isn't draining from your catheter, or you can't urinate after the catheter has been removed.
Something unexpected, or something you weren't prepared for happens.
Radiation Therapy: Destroying Cancer Cells
Your urologist may refer you to a radiation oncologist, a cancer specialist who used radiation to treat the disease. The goal of radiation therapy is to damage cancer cells so they die, allowing healthy cells to replace them. Small daily doses of radiation may be beamed from a machine at the cancer, or doses of radiation ("seeds") may be implanted directly into the prostate. Whichever method is used, the level of radiation is safe for you and the people around you.
Targeting Cells from the Outside
A special machine called a linear accelerator aims radiation to the treatment area. With each dose of radiation, more and more cells are damaged, and the tumour gets smaller as the cells die. Beams of radiation enter from different angles so the least number of normal cells are affected.
Before treatment
Your radiation oncologist will design a treatment plan for you based on an evaluation of your disease and overall health. Before treatment begins, you'll go through a simulation, a process during which the areas to be irradiated are determined.
During treatment
For each visit, you'll be asked to change into a gown. A technologist will position you on the linear accelerator table. Short doses of radiation will be aimed at the target areas. A treatment lasts a few minutes, and is given once a day, five days a week, for five to seven weeks. Because some tissue nearby is affected, you may experience side effects.
After treatment
You can resume your normal activities shortly after each visit. You may still notice some side-effects after your full course of treatment has ended, but these usually clear up within several weeks.
Side effect during treatment
Mild to moderate diarrhoea
Some tanning and drying of the skin in treated area
Frequent urination, possibly with a slight burning sensation
Some loss of pubic hair
Mild weight loss and fatigue
Targeting Cells from the Inside
A constant dose of radiation may be given by "seeding" your prostate. When you're under anaesthesia, these "seeds" (actually tiny pieces of radioactive material) are implanted permanently or temporarily by a needle by using the perineal approach. Permanent low-dose implants remain in the body, and produce decreasing amounts of radiation for about a year. Temporary high-dose implants require a three- to four-day hospital stay, after which the "seeds" are removed. Because tissue nearby is hardly affected, there are fewer side effects from radioactive implants than from treatment with a linear accelerator.
Risks and complications
Your radiation oncologist will discuss the risks and potential complications of radiation therapy with you. A few patients may develop impotence. Even fewer may develop long-term bowel and bladder effects.
Other Therapies: Slowing Growth and Spread
Most prostate cancer cells need testosterone to grow. Fortunately, there are several types of hormone therapy to slow the growth and spread of these cells by reducing the amount of testosterone circulating in your body. Your urologist can explain the benefits and side-effects of each type of hormone therapy and discuss chemotherapy and radiation as possible ways to relieve pain and control the cancer.
Hormone Therapy
Your urologist may recommend hormone therapy to block the flow or remove the source of testosterone. You may receive a form of the female hormone oestrogen like DES (diethylstilbestrol), a form of GnRH (gonadotropin-releasing hormone), or the drug flutamide by pill or injection. Because testosterone is constantly produced by your body, these treatments need to be taken indefinitely. Or your testes may be removed in an orchiectomy; this is a one-time-only treatment.
DES blocks chemicals released by the pituitary gland that cause the testes to produce testosterone.
GnRH upsets the regulatory mechanism in the pituitary gland so testosterone is no longer produced.
Flutamide prevents testosterone produced by the adrenal gland from acting on the prostate.
Orchiectomy eliminates the major source of testosterone.
Risks and complications
Cardiovascular problems
Hot flashes
Breast enlargement
Impotence or loss of sex drive
Supplementary Therapy
Chemotherapy, which seeks out and destroys cancer cells, may be used in addition to or instead of hormone therapy. Radiation therapy may be combined with hormone therapy to control cancer.
Maintaining Your Health
By following your course of treatment, you can play an important part in maintaining your health. Take the time to understand your disease and ask questions. Protect your health by having regular check-ups. And rest assured that as your health improves you can enjoy an active lifestyle.
Follow-up is Lifelong
Schedule appointments with your urologist to follow-up on your treatment and monitor your ongoing health. That way you can make certain that all the cancer has been removed or contained and that a new problem isn't developing. During these check-ups you can expect a general evaluation of your health. You may also have more diagnostic tests to see how you're responding to treatment or if your exam reveals anything suspicious.
Looking to the Future
Most men with prostate cancer can live a normal lifespan and enjoy a high quality of life. Because every person is different and responds differently to treatment, the outcome of your treatment can't be guaranteed. But by working together with your urologist, you should be able to control your condition now and live life to its fullest.
Reaching Out for Support
You may have many different feelings about living with prostate cancer. But you don't have to keep them to yourself. By sharing your concerns with others, you can get the emotional support you need during and after treatment.
Feel free to asks questions of any member of your health care team. These professionals can address your concerns about diagnosis and treatment.
Even if it's hard for you to talk openly about your emotions, you can maintain loving relationships by talking with your family and friends.
Local cancer organisations can put you in touch with support groups for people who are living with cancer.
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