Prostate Cancer

See your health care provider if you have any of the following symptoms:

• Difficulty initiating and/or stopping a urine stream
• Frequent urination
• Pain on urination
• Pain on ejaculation

You should undergo regular screening for prostate cancer.

• Men aged 50 years and older should undergo a yearly digital rectal examination and blood testing for prostatic specific antigen (PSA).
• Men in the high-risk group, such as those with a family history of prostate cancer or of African American ethnicity, should begin screening as early as age 40 years.

Go to the nearest hospital emergency department right away if you have any of the following symptoms:

• Urinary tract infection - Burning pain on urination, urgency, frequent urination, especially with fever
• Bladder obstruction - Not urinating or urinating very little despite drinking enough fluid; producing little urine despite straining; pain due to a full bladder
• Acute kidney failure - Not urinating or urinating little, with little discomfort, despite drinking enough fluid
• Deep bone pain, especially in the back, hips, or thighs, or bone fracture - Possible sign of advanced prostate cancer that has spread to the bones

Spinal cord compression is a true emergency and may be the first sign of  cancer  . It occurs when the cancer has spread to vertebrae of the spine and tailbone region. The weakened vertebrae can collapse on the spinal cord, causing symptoms and problems with function.

• Symptoms depend on the level at which the spine is compressed.
• Typical symptoms that might signal acute spinal cord compression include weakness in the legs and difficulty walking, increased difficulty urinating or moving your bowels, difficulty controlling your bladder or bowels, and decreased sensation, numbness, or tingling in the groin or legs.
• These are often preceded by pain in the hip (usually one sided) or back lasting a few days or weeks.
• Such symptoms require immediate evaluation in the nearest hospital emergency department. Failure to be treated immediately can result in permanent spinal cord damage.

Other Therapy

Cry therapy: This technique involves inserting a probe through a small skin incision and freezing areas of cancer in the prostate.

• This therapy is reserved for cancer localized within the prostate as well as for men who are unable to withstand the conventional therapies such as surgery or radiation.
• The probe is guided to areas of cancer by using TRUS. Cancerous tissue appears on the ultrasound and allows the surgeon to monitor therapy and limit damage to normal prostate tissue.
• There are several advantages to using this procedure over surgery and radiation therapy. There is less blood loss, shorter hospital stay, shorter recovery times, and less pain than with conventional surgery.
• The long-term effectiveness of this procedure is unknown because it is a newer treatment.

Follow-up

Follow-up care is especially important for patients for whom a more conservative approach (such as watchful waiting) was taken to the treatment of prostate cancer. It is imperative that you see your urologist for digital rectal exams, PSA level tests, and other tests as recommended to follow the progression of cancer growth.

For men who have undergone radical prostatectomy, radiation therapy, or both, follow-up care is important to prevent recurrence of cancer.

• PSA has been shown useful in detecting recurrences. PSA levels should be less than 0.2 ng/mL after radical prostatectomy.
• PSA levels should be checked every 3 months for 1 year, every 6 months for the second year, and annually after that.
• You should have a physical examination, including digital rectal exam, every 3 months for 1 year, then every 6 months for a year, then yearly after that.

Prevention

Because the cause of prostate cancer is uncertain, preventing prostate cancer may not be possible. Certain risk factors, such as age, race, sex, and family history, cannot be changed. However, because diet has been implicated as a potential cause, living a healthy lifestyle may afford some protection.

• Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer.
• Eating certain foods that contain substances called antioxidants (vitamins C and E and beta carotene) may be protective.
• Some research suggests that taking vitamin E, an antioxidant, may reduce the risk of not only prostate cancer but also other cancers. This theory remains unproven.

Outlook

The prognosis in prostate cancer depends on the stage of the cancer and the degree of differentiation.

• Differentiation refers to how closely the cancer resembles normal tissue. The less differentiated the cancer, the poorer the prognosis.
• The stage refers to the extent of the cancer—whether it is localized or has spread beyond the prostate. The greater the degree of cancer spread, the poorer the outlook.

Five-year survival rates are very good for men with prostate cancer.

• According to the American Cancer Society, 92% of men with these cancers survive at least 5 years.
• Most prostate cancers are slow growing, as shown by the fact that 67% of men with prostate cancer survive at least 10 years.
• Sometimes, however, prostate cancers grow and spread rapidly. Therefore, early diagnosis is essential for a cure.

If you are elderly and have other medical conditions, watchful waiting may be the most prudent course.

• Therapy may be more harmful than the cancer.
• This is especially true if your life expectancy is less than 10 years.
• Many times, elderly men with prostate cancer actually die of something else, such as heart disease, not the slow-growing prostate cancer.
• You and your family members should discuss this with your urologist.