The prostate is a gland located in front of the rectum and below the urinary bladder in men. It makes some of the fluid that protects and nourishes sperm cells in semen. Prostate cancer is the second leading cause of cancer death in men. “Prevalence of prostate cancer is thought to be about one in every six men,” said Dr. Thomas Slabaugh Jr. Early screening is essential. In its initial stages, prostate cancer rarely produces symptoms, which is why it is hard to detect.
The American Cancer Society (ACS) recommends physicians discuss screening with patients who are at age 50, are at average risk of prostate cancer and are expected to live at least 10 more years. This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African-American men and men who have a first-degree relative (father, brother or son) diagnosed with prostate cancer at an early age (younger than age 65). The discussion should take place at age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). The ACS says prostate cancer is very rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50.
“Just like with any other cancer, we don’t have an idea exactly of what causes it,” Slabaugh said. “We do know genetic mutations are involved and men with a family history of prostate cancer are more prone to those genetic mutations that would cause the cancer, but that doesn’t mean that men without it in their family don’t get it.”
Screening for prostate cancer is typically done using the prostate-specific antigen test, or PSA, combined with a digital rectal exam. Most healthy men have PSA levels under 4 nanograms per milliliter (ng/mL) of blood. An elevated PSA level is a primary indication of possible cancer.
“Surgery has long been known to be the most effective long-term treatment for prostate cancer,” Slabaugh said. “There are other treatments available, so every patient’s case is looked at independently as the physician determines what the more appropriate therapy is for the patient.”
One other treatment option is called “watchful waiting” or active surveillance. This is possible because prostate cancer grows very slowly. “It’s a treatment option that’s good for low-risk prostate cancer, and it’s a very common therapy,” Slabaugh said. “Basically you watch the PSA and the digital rectum exam and if there are changes to either of those, it would warrant further work up and/or treatment. But if things remain stable, then you can continue with the watchful waiting protocol.”
When it is necessary to remove the prostate, most physicians utilize robotics.
“Robotic prostectomy has become the most common surgical therapy for prostate cancer,” Slabaugh said. “It has really caught on in the last few years. Probably 80 to 90 percent of prostatectomies in this country are now done robotically.”
The robotic technique is an enhancement of minimally invasive laproscopic surgery. “Things are a little bit more precise and more accurate with robotic prostectomy,” Slabaugh said. “Recovery is much faster when compared with open surgery.” Incisions are smaller and infections rates are smaller with robotic techniques.
Slabaugh said medication after surgery depends on whether or not the cancer is confined within the prostate and has been completely excised. “Sometimes the cancer has gone outside the prostate and the patient will have to have radiation afterwards,” he said. Often hormonal therapy is indicated, depending on pathological findings at the time of surgery.
“Prostate cancer treatment is known for having side effects, so when you’re deciding how to treat a patient you have to balance the cancer treatment along with the side effects,” Slabaugh said. “Some of these include leakage of urine, an inability to control urine and erectile dysfunction.”
By Tanya J. Tyler, Associate Editor