The National Cancer Institute estimates 233,000 new cases of prostate cancer will be diagnosed this year, and almost 99% of those diagnosed will survive 5 years or more – a dramatic increase in the last 30 years. More than 80% of prostate cancers are detected when they are confined to the prostate and are easily treatable.
Prostate cancer occurs when cancer cells form in the prostate, a walnut-sized gland in the male reproductive system that lies below the bladder and in front of the rectum, surrounds part of the urethra that empties urine from the bladder, and makes seminal fluid. Symptoms include weak flow of urine or urinary frequency; problems urinating or emptying the bladder; pain or burning while urinating; blood in the urine; or persistent pain in the back, hips or pelvis. However, noncancerous conditions may cause an enlarged prostate that leads to similar symptoms. Evaluation by a physician is key to determining the appropriate course of treatment.
A physical exam and history, digital rectal exam, and blood test to check for prostate-specific antigen (PSA) are all part of regular screening. If prostate cancer is suspected, a transrectal ultrasound, transrectal magnetic resonance imaging test (MRI), and transrectal biopsy may be performed to confirm the diagnosis and identify the cancer’s location to determine an effective course of treatment.
In older men who have confirmed, confined prostate cancer without other symptoms, “watchful waiting” or active surveillance of disease may be recommended. If cancer shows signs of growing, more aggressive treatment can begin.
Surgical options for prostate tumors include radical prostatectomy, which removes the prostate, surrounding tissue, and seminal vesicles through the abdominal wall or perineum, and transurethral resection of the prostate (TURP), which removes tissue from the prostate through the urethra. In addition to conventional surgical risks such as bleeding or infection, prostate surgery may also increase the risk of impotence, urine leakage, shortening of the penis, or inguinal hernia.
Radiation therapy may be administered to treat prostate cancer or relieve associated symptoms. External beam radiation may cause skin irritation, fatigue, and diarrhea. Internal radiation therapy using implanted radioactive seeds may also cause bleeding, infection, or risk of injury to healthy tissue. Radiation therapy for prostate cancer may also increase the risks of impotence and urinary problems.
Chemotherapy for prostate cancer that has spread may be given on a specific schedule orally or through the bloodstream. Side effects during treatment may include fatigue, nausea, vomiting, risk of infection, hair loss, loss of appetite, and diarrhea.
Immunotherapy boosts the body’s natural defenses to fight cancer. Targeted therapy identifies specific genes, proteins, or tissue environments that promote cancer growth and survival, and blocks those targets to inhibit the growth and spread of cancer cells.
Hormone therapy uses drugs that block male sex hormones, such as testosterone, that can stimulate prostate cancer cell growth. Some drugs approved for other conditions, such as the antifungal ketoconazole, inhibit androgen production. Rarely, an orchiectomy (surgical removal of one or both testicles) may be performed to stop the production of testosterone. Sexual side effects, hot flashes, bone thinning, diarrhea, nausea and itching may occur in men treated with hormone therapy.
A 2014 study published in European Urology showed that the immunotherapy vaccine PROSTVAC-V/TRICOM combined with hormone therapy resulted in a 74% complete response at 7 months in patients who had previously undergone surgery or radiation for prostate cancer, but had been resistant to hormone therapy. More immunotherapy agents are being explored in clinical trials worldwide for their potential in harnessing the body’s ability to fight cancer.
Prostate cancer is the most common cancer among men, after skin cancer, but it is also one of the most treatable. Find access to support groups, counseling, information, and resources for treatment financial assistance from the Prostate Cancer Foundation.