“I consider prostate cancer the ‘snail’ of the cancer world because it tends to be so slow-growing,” says Robert Brookland, MD, a radiation oncologist at the Greater Baltimore Medical Center’s Sandra and Malcolm Berman Cancer Institute. “In many cases, we don’t even need to treat it; we can just monitor it carefully over time. If there are higher-risk features, effective treatment options are available.”
Arriving at a diagnosisAlthough some men are found to have a lump or growth on a prostate exam that leads to further testing, prostate cancer doesn’t often present with any obvious symptoms. Instead, it is usually discovered through other urology-based complaints or a prostate specific antigen (PSA) blood test in combination with a digital rectal exam.
“If the prostate cancer becomes more advanced, men may experience voiding symptoms such as more frequent urination, burning with urination, or blood in the urine or semen,” says David Goldstein, MD, a staff physician in GBMC’s division of urology and senior partner at Chesapeake Urology Associates. “As prostate cancer can spread to other parts of the body, especially bone, men with advanced prostate cancer may have pains or aches elsewhere.”
Once it has been determined that additional evaluation is needed, a prostate biopsy may be recommended. This will provide proof that there is prostate cancer present. The cancer is then given a grade based on the pattern of abnormal cells detected, and is staged based on where they are located, with higher stages indicating metastasis beyond the initial site to other locations.
Treatment optionsBecause prostate cancer often develops so slowly, some patients may choose to simply monitor their conditions instead of pursuing treatment.
“If it’s decided that treatment is appropriate, the most common options include robotic-assisted laparoscopic removal of the prostate, external-beam radiation therapy, or insertion of radioactive seeds into the prostate,” Dr. Goldstein describes.
Side effects of prostate cancer treatment can include increased frequency of urination, short-term urinary incontinence or rectal irritation, and a decline in sexual function. Some side effects resolve on their own within a few months of treatment, but if not, effective medications and coping strategies are available.
Psychological impactsAny cancer diagnosis is likely to generate stress and anxiety for patients and their families. Fortunately, in many prostate cancer cases, the disease itself doesn’t usually affect the patient’s quality of life much at all unless it becomes advanced. GBMC and Chesapeake Urology Associates provide a full range of services, including support groups, to assist with managing these and other aspects of the disease.
“The two most prominent concerns I hear beyond ‘Am I going to be able to beat this cancer?’ are about loss of bladder control and loss of sexual function, both of which are very treatable conditions,” assures Dr. Brookland.
Risk factorsMen over 50, African American men, and men with a family history may be at higher risk, but direct attributions and causes of prostate cancer remain somewhat mysterious.
“There is a genetic association in about 15% of prostate cancer cases, but for the vast majority, we really have no idea why it affects one person and not another,” Dr. Brookland says. “The biggest risk factor, of course, is just being male.”
“Aside from age, race and family history, there are studies that suggest a link between a high-fat diet and increased risk of prostate cancer,” Dr. Goldstein adds. “Obesity has also been associated with higher risks of prostate cancer and death from prostate cancer.”
Men who were exposed to Agent Orange during military service in Vietnam and develop prostate cancer may be eligible for compensation through the Department of Veterans Affairs (consult your local VA branch for more information).
The best defenseOther than generally following a healthy diet and engaging in regular exercise, there aren’t any special precautions men need to take to lower their prostate cancer risks.
“It’s important to have a conversation with your primary care physician and, if you have one, your urologist to discuss appropriate screening schedules,” Dr. Goldstein advises. “Most guidelines recommend an annual PSA blood test and digital rectal exam starting in the 40s and continuing at least until age 70.” African American men and men with a strong family history of prostate cancer should consider starting their screening at age 40.