by Dr. C.H. Weaver M.D. Medically reviewed 8/2019
If you are like most American women, chances are you serve as the key decision-maker when it comes to the health of your family— whether it’s selecting a physician, deciding on treatment options, or taking steps to prevent the onset of illness. It’s a role that carries with it the awesome responsibility for making effective, informed decisions that give your loved ones the best chance of a good outcome and enduring health. This is particularly true when confronting the issue of cancer. And the cancer that is most likely to strike the men in your family, as they age, is prostate cancer.
What Exactly Is the Prostate?
The prostate is a walnut-size gland located between the bladder and the penis. It surrounds the urethra, the tube that carries urine from the bladder to the penis. When it becomes enlarged, a common condition with age, the urethra is squeezed and urinary problems can result. The prostate plays an important role in reproduction, being responsible for much of the seminal fluid produced by a man.
What Is Prostate Cancer?
When cellular growth goes awry in any organ, cancer is often the result. When this happens in the prostate, it is referred to as prostate cancer. Doctors refer to the most common type of prostate cancer as adenocarcinoma of the prostate, based on the particular type of cancer cells that have developed.
How Common Is Prostate Cancer?
With the exception of skin cancer, prostate is the most common cancer occurring in men. According to the National Cancer Institute (NCI), there are close to 3 million men living with prostate cancer in the United States. An additional 180,000 new cases of prostate cancer will be identified in 2016, and approximately 26,000 deaths will be associated with the disease.(1)
The good news is that most forms of prostate cancer are relatively indolent, or slow growing. As a result, the five-year survival rate following a diagnosis of prostate cancer is 98.9 percent. The NCI further states that while “an estimated 16 percent of men will be diagnosed with prostate cancer in their lifetime…only 3 percent will die of it.”(1)
Are There Clear Symptoms Associated with Prostate Cancer?
Prostate problems are relatively common in men over the age of 55, and these issues may be mistaken for cancer in some cases. An enlarged prostate, known as benign prostate hyperplasia (BPH), can be particularly troublesome, causing problems with urination, sexual function, and other symptoms. And while problematic, BPH is far more of a nuisance than a serious threat to a man’s health.
Though prostate cancer can mimic the symptoms of BPH, it can also be present without the appearance of symptoms, particularly in its early stages. When prostate cancer becomes advanced, other symptoms may be present, including bone pain (frequently occurring in the lower back) and unexplained weight loss.
How Is Prostate Cancer Diagnosed?
Preliminary diagnosis generally relies on screening, which consists of a blood test, known as a PSA (prostate specific antigen), accompanied by a digital rectal exam. Because the prostate is located directly in front of the rectum, a physician is able to palpate the gland with his or her finger to see if there are any obvious abnormalities. Neither test is definitive, which means that suspected cases of cancer must be biopsied.
When a man’s PSA reaches a certain threshold or there is perceived abnormality upon physical examination, the physician may recommend a biopsy. It should be noted that some physicians also recommend biopsies based on the rate of change in PSA levels, referred to as PSA velocity. Recent research suggests, however, that PSA velocity, by itself, is not a reliable measure on which to recommend biopsies.2
When performing a biopsy, a surgeon—most frequently a urologist—relies on ultrasound-guided imaging to insert needles into various sites on the prostate. The hollow needles extract tissue cores that can then be examined to determine the extent of the disease. Twelve samples are most commonly collected.
The cores are then examined by a pathologist, who rates them based on what is known as the Gleason score,3which ranges from 2 to 10; higher numbers signify a more serious expression of the disease.
If more-advanced disease is suspected, additional imaging studies may be performed to determine if the cancer has metastasized, or spread to bones or other organs. Based on the sum of the evidence collected through these various tests, patients are assigned a stage that indicates the extent of the disease. The earliest-stage cancers are described at Stage I; cancer that has spread to other portions of the body are Stage IV.
What Types of Treatment Are Recommended?
The stage of the tumor and one’s age at diagnosis may significantly guide treatment options. Because many forms of prostate cancer are slow growing, very early-stage tumors may warrant careful observation, known as active surveillance, rather than aggressive treatment.
When treatment is required, the urologist may recommend either radiation therapy or the surgical removal of the prostate, known as a radical prostatectomy. Radiation therapy can take several forms, with the most common being an external beam of radiation to target the prostate and kill cancer cells. The most common form of external radiation is image modulated radiation therapy (IMRT). IMRT generally involves five treatments per week for eight weeks.
A small number of cancer centers offer another form of external radiation known as proton therapy. Proton therapy is controversial4 because its cost greatly exceeds that of IMRT, and numerous experts have argued that there is insufficient data to prove that it is more effective or less toxic.
For patients who do not want to undergo repeated treatments, referred to as fractions, brachytherapy provides a highly effective option. Brachytherapy involves a single, surgical insertion of radioactive seeds into the cancerous portions of the prostate.
Before deciding on a treatment option, it is vitally important that you and your loved one understand the nature of each, as well as its potential short- and long-term side effects. It is advisable to get more than one opinion. Consider scheduling a consultation with both a urologist and a radiation oncologist. You may also find it helpful to do some research into the disease and your treatment options.
Are There Significant Side Effects of Treatment?
Prostate cancer treatment, whether involving surgery or radiation, can cause a host of short- and long-term side effects. Transient side effects are generally tolerated well. Long-term problems with incontinence and or erectile dysfunction, however, can have a major impact on a man’s quality of life. Though estimates vary widely, it is reasonable to assume that such long-term or permanent side effects may occur in significant percentage5 of all patients.
When surgery is performed, a nerve associated with sexual function can be severed. A skilled surgeon may be able to spare the nerve, but there are no assurances. Radiation often damages the nerve, though the onset of symptoms may be delayed by as much as one to two years. You should actively question your physicians about their outcomes—specifically the frequency with which their patients experience long-term problems with incontinence and/or impotency.
What Is the Most Important Thing You Can Do to Help Your Partner When He Is Diagnosed with Prostate Cancer?
First, encourage your loved one to slow down, despite the anxiety generated by a potential diagnosis of cancer, and gather the information needed to make truly informed decisions before proceeding with a biopsy or treatment. A great deal has been written about the over diagnosis and over treatment of prostate cancer in recent years—with much of the controversy centering on the appropriateness of PSA testing among relatively young patients. Before undergoing a biopsy, talk to your doctor(s) about their confidence in the PSA scores and whether it may be wise to repeat the test in three to six months before proceeding to a biopsy.
This is your first step as you seek to become an expert on the disease, its presentation, and treatment. Once you have availed yourself of the best available information and medical opinions, you are ready to serve as an advocate who ensures that your loved one receives the most appropriate treatment based on the particular stage of disease. Remember, that may mean active surveillance rather than active treatment. You want him neither over treated nor under treated, both of which are real possibilities with prostate cancer.
Finally, be sure you tune in to the potential impact of the disease and its treatment on your loved one’s quality of life, as well as his self-esteem. Issues of sexual function affect both of you, and being able to engage in open and effective dialogue is important to the health of the relationship. You may wish to seek help from a counselor trained to address such issues.
Though prostate cancer is often cured, it may nonetheless take a toll on the family. The more empowered you and your loved one are with information, the greater your probability of limiting this toll and ensuring the best possible outcome from treatment.
- SEER Cancer Statistics Fact Sheets: Prostate Cancer. National Cancer Institute website. Available at: http://seer.cancer.gov/statfacts/html/ prost.html. Accessed July 25, 2016.
- PSA Velocity Does Not Improve Prostate Cancer Detection. National Cancer Institute website. Available at: http://www.cancer.gov/types/prostate/research/psa-velocity-detection. Accessed July 25, 2016.
- Understanding Your Pathology Report: Prostate Cancer. American Cancer Society website. Available at: http://www.cancer.org/treatment/ understandingyourdiagnosis/understandingyourpathologyreport/prostatepathology/prostate-cancer-pathology. Accessed July 25, 2016.
- Wisenbaugh ES, Andrews PE, Ferrigni RG et al. Proton beam therapy for localized prostate cancer 101: Basics, controversies, and facts. Reviews in Urology. 2014;16(2):67-75. doi: PMC4080851.
- Pardo Y, Guedea F, Aguiló F et al. Quality-of-life impact of primary treatments for localized prostate cancer in patients without hormonal treatment. Journal of Clinical Oncology. 2010;28(31):4687-96. doi: 10.1200/ JCO.2009.25.3245.