Major Forms of Cancer - Cancer of the prostate



Cancer of the prostate is the second most common cancer among men and is second only to lung cancer in number of deaths per year; about 38,000 people die of prostate cancer each year. The incidence increases with advancing age from the fifth decade of life, when prostatic cancer cells are found in nearly 20 percent of all men examined, to those in their 70s, an age when 60 percent of the men have been found to have cancer cells in their prostate glands. Fortunately, only 15 percent of the men with evidence of latent carcinoma of the prostate ever develop clinical symptoms of cancer before death.

Symptoms

Because the prostate encircles the urethra, which is the outlet from the bladder, any prostatic problem can cause such problems as increased frequency of urination or discomfort in urinating.

Detection

A diagnostic exam of the prostate through the wall of the rectum is a regular part of a physical examination for men over the age of 40. If the physician feels a lump or hardened area, further tests are ordered. The presence of a lump in the prostate need not be evidence of cancer; about half of such lumps and nodules are caused by fibrosis, calcium deposits, or other noncancerous bodies.

Other diagnostic methods include examination by a cytoscope, a laboratory examination of tissue and prostatic fluid samples, and the examination of a urinary pyelogram, which indicates obstructions from the prostate walls.

A blood test for prostate specific antigen (PSA) has brought a 600 percent increase in new cases of prostate cancer since the mid 1980s. The test indicates high levels of an enzyme produced by the prostate gland, revealing both potentially lethal cancers and slow-growing tumors that may never threaten life.

Treatment

When diagnosed, each patient must consider a variety of complex issues such as his overall state of health and life expectancy, the degree and aggressiveness of the cancer, and expectations concerning full sexual capacity. Patients who put off surgery and other treatments must be ready to undergo frequent examinations, as well as able to live with the idea of cancer in their bodies.

Men sixty-five and over diagnosed with prostate cancer are urged to undertake a wait-and-see approach that involves frequent examination and testing to evaluate the cancer; the cancer grows so slowly in older men that death is likely to be from other causes. Frequent testing is important because an unmonitered, small cancer may spread past the point of successful treatment.

In the event of an aggressive tumor, radical surgery, or prostatectomy, is advised. This removal of the prostate, usually supported by the administration of estrogen or hormone therapy, is thought to offer the highest cure rate for those with cancer still confined to the gland. Possible risks include stress incontinence, to a lesser extent complete incontinence, and permanent impotence. After standard prostatectomy, between 60 and 90 percent of men will become impotent depending on their age. If the surgery does not require removing the nerves on the sides of the prostate the impotence rate drops to 25 to 30 percent for men under 60.

Radiation therapy, usually administered in seven five-day weeks, is an alternative to prostatectomy and another option for patients whose cancer has spread beyond the prostate. This therapy has the same risks as radical surgery, incontinence and impotence, but is considered less effective in producing a permanent cure.

Another option is hormone therapy, which consists of either an orchectomy(the surgical removal of the testicles because of the close physiological relationship between the testicles and prostate) or the disruption of the normal production of testosterone by the introduction of hormones or antihormones. Use of female hormones may cause water retention, painful breast enlargement, and cardiovascular complications. Hormonal therapy is not a cure, but can slow the development of aggressive tumors, and may be a viable option for patients who for health or other reasons, are unable to undergo radiation treatment or surgery.

Causes

The causes of prostate cancer are not completely understood, but certain risk factors for developing the disease have been identified. The chance of developing prostate cancer increases markedly after age 50. It is twice as common among African-Americans as among white Americans. Prostate cancer may have a genetic component; it has been shown that having a father or brother with prostate cancer doubles a man's risk of getting the disease. Most studies indicate that a diet high in fat increases the risk of developing the disease, while regular exercise and maintenance of a healthy weight reduces the risk.



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