Conditions In Depth: Prostate Cancer
Prostate cancer is a disease in which cancer cells grow in the prostate. The prostate is a gland that surrounds the urethra, the tube that carries urine from the bladder to the end of the penis in men. Women do not have a prostate gland.
The Male Urogenital System
The prostate produces seminal fluid, which is needed to keep sperm healthy. The prostate releases the seminal fluid into the urethra where it combines with sperm to make semen. Normally, the cells of the prostate divide in a regulated manner. However, if cells begin dividing in an unregulated manner, a mass of tissue forms. This mass is called a tumor. A tumor can be benign or malignant.
A benign tumor is not cancerous. It will not spread to other parts of the body. In many older men, the prostate enlarges in this benign manner, called benign prostatic hypertrophy (BPH).
Cancer cells divide and damage tissue around them. They can enter the bloodstream and spread to other parts of the body. This can be life threatening. Prostate cancer produces local symptoms by producing pressure on the bladder, urethra, and surrounding tissues. It also has a tendency to spread beyond the prostate gland to the bones.
Prostate Cancer
According to the National Cancer Institute, an estimated 186,320 American men will be diagnosed with prostate cancer in 2008. An estimated 28,660 men will die of this condition.
With proper screening, prostate cancer can be detected early. And a variety of treatment options is available.
Treatments for Prostate Cancer
The treatment and management options of prostate cancer include surgery, radiation therapy and/or hormonal therapy. In some cases, chemotherapy may also be used if the cancer has spread and is resistant to other types of treatment. The type of treatment depends on the location and size of the tumor, the stage of the cancer, your age and general health, and other factors.
Curative treatment options:
- Surgery
- Radiation
Other options:
- Hormonal therapy
- Watchful waiting
Hormonal Therapy
The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
The type of treatment you will have will depend on the stage of the cancer, the size of the tumor, your age, and overall condition. The main prescription drug therapies used to treat prostate cancer are hormonal therapies.
Prostate cells need male hormones, called androgens, to grow and work properly. The aim of hormonal therapy is to reduce the amount of male hormones in your body so that prostate cells are not stimulated to grow. The most effective hormonal therapy is by surgical removal of the testes (bilateral orchiectomy). This is simple and effective, but irreversible. Often hormonal therapies are combined to achieve greater effects.
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
Common names include:
- Leuprolide (Lupron)
- Goserelin (Zoladex)
These medications decrease the production of the male hormone, testosterone, from your testicles. These medications are given by injection into a muscle every 3 or 4 months.
Possible side effects include:
- Impotence
- Hot flashes
- Loss of sexual desire
- Osteoporosis
- Fatigue
Anti-Androgens
Common names include:
- Flutamide (Eulexin)
- Bicalutamide (Casodex)
- Nilutamide (Nilandron)
Anti-androgens prevent your body from using the male hormones, called androgens, that are made by your body. These medications are given by pill.
Possible side effects include:
- Nausea
- Vomiting
- Diarrhea
- Breast growth or tenderness
Androgen Suppressants
Common name: ketoconazole (Nizoral)
Ketoconazole blocks the production of androgens. It is considered a second-line hormonal treatment and is usually used when other medications are not working.
With long-term use, ketoconazole may cause liver problems.
If you are taking medications, follow these general guidelines:
- Take your medication as directed. Do not change the amount or the schedule.
- Do not stop taking them without talking to your doctor.
- Do not share them.
- Know what the results and side effects are. Report them to your doctor.
- Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
- Plan ahead for refills so you don’t run out.
Surgical Procedures for Prostate Cancer
Surgical options for the treatment of prostate cancer include:
- Prostatectomy
- Orchiectomy
- Cryosurgery
Prostatectomy
Surgical removal of the prostate gland is called prostatectomy. It is a common treatment for prostate cancer. Removal of the prostate gland can cause impotence and urinary incontinence. Two commonly used methods of removing the prostate are:
- Radical retropubic prostatectomy — The surgeon makes an incision through the skin of the lower part of the abdomen and removes the prostate gland and surrounding lymph nodes. Newer techniques (nerve-sparing prostatectomy) may allow surgeons to avoid cutting into the nearby nerves that control erections.
- Radical perineal prostatectomy — This form of prostatectomy is not as common as radical retropubic prostatectomy. For this procedure, the surgeon makes an incision on the perineum, which is the skin between your rectum and scrotum, and removes the prostate but not the lymph nodes.
Orchiectomy
Orchiectomy is the removal of the testicles. The surgeon removes the testicles through an incision in the skin of the scrotum. This procedure is done to remove the major source of male hormones in the body and is considered a type of hormonal therapy. It is generally used only to manage hormone-responsive metastatic prostate cancer.
Prescription hormonal therapies are available as alternatives to orchiectomy. Your surgeon may recommend an orchiectomy or injectable (or oral) hormones when the prostate cancer is suitably large, involves the lymph nodes, or has spread beyond the pelvis. This treatment should not be offered for early stage cancer.
Orchiectomy may cause impotence and reduced sexual desire, as well as hot flashes, breast tenderness, and osteoporosis.
Other Treatments for Prostate Cancer-Watchful Waiting
Watchful waiting, also called expectant therapy, is sometimes recommended for elderly patients who have an early stage prostate cancer and no symptoms.
The theory behind watchful waiting is that some prostate cancers grow very slowly and may never develop into a symptomatic or life-threatening stage of cancer. For such a slow-growing cancer, the risks and side effects of the other possible treatments for prostate cancer (such as medication, surgery, and radiation therapy) may not seem worthwhile as compared with the low risk of the growth of prostate cancer.
However, no one knows for sure which prostate cancers are likely to grow quickly and which may grow slowly. After careful discussion with your doctor, you may choose watchful waiting. You will still receive close follow-up for any change in your condition.
When to contact your doctor
Call your doctor if you experience any of the following:
- Difficulty urinating, including decreased stream, pain, or burning on urination
- A pain that doesn’t go away, especially if it’s always in the same place
- Bone pain, numbness, or difficulty walking
- New or unusual lumps, bumps, or swelling
- Nausea, vomiting, diarrhea, or loss of appetite
- Unexplained weight loss
- A fever or cough that doesn’t go away
- Unusual rashes, bruises, or bleeding
- Any symptoms that you are concerned about
References
Causes, natural history and diagnosis of prostate cancer. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/. Accessed October 9, 2008.
Detailed guide: prostate cancer. American Cancer Society website. Available at: http://www.cancer.org/. Accessed October 9, 2008.
Prostate cancer. American Academy of Family Physicians website. Available at: http://www.aafp.org. Published February 2004. Accessed October 9, 2008.
Prostate cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/prostate. Accessed October 9, 2008.
United States Pharmacopeial Convention. USP DI. 21st ed. Englewood, CO: Micromedex; 2001.
University of Pittsburgh Cancer Institute website. http://www.upci.upmc.edu
Way LW. Current Surgical Diagnosis and Treatment. 10th ed. New York, NY: Appleton and Lange; 1994.
Edits to original content made by Cancer Care of Western New York.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.