Prostate Cancer
Questions and Answers

Prostate cancer poses a risk for every man 50 and older. One in nine men will develop prostate cancer at some stage in his life. Many men have faced the disease, were treated successfully, and have gone on to lead normal, healthy lives. Among these are General Norman Schwarzkoph (USA, Ret.), Senators Bob Dole, Alan Cranston and Ted Stevens, Supreme Court Justice John Paul Stevens, financier Michael Milken, comedian Jerry Lewis and golfer Arnold Palmer.

Men are often reluctant to discuss prostate cancer or ask questions about it. A Gallup poll indicated that less than half of men with the disease cared to learn the full range of treatment options. A Lou Harris poll has found that 30 percent of men with prostate cancer never discussed with their physician how various treatment options might affect their lifestyle.

Q: What is the function of the prostate?

A: The prostate is a small pear-shaped gland, about the size of a walnut, located in the front of the rectum and below the bladder. It produces fluid that helps transport semen during ejaculation.

The prostate is made up of cells that normally divide and reproduce to keep the body healthy. When cells become abnormal for any reason, they divide and reproduce in greater than normal quantity, producing a cancerous tumor. Cancer cells can spread to other areas of the body.

Q: Who gets prostate cancer?

A: All men over the age of 50 are at risk. AfricanAmericans and men whose family history includes prostate cancer are at greater risk. No one knows what causes prostate cancer, but some studies indicate that a diet high in fat can contribute to the disease.

Some men as young as 40 have been diagnosed. Annual screening is advised for men between 50 and 70, and earlier for those with a strong family history of prostate cancer.

Q: How can I be screened for prostate cancer?

A: Screening is done by the digital rectal exam and the prostate-specific antigen (PSA) test. In the digital rectal exam, a doctor inserts a gloved, lubricated finger into the rectum, to feel the back of the prostate for lumps. The PSA test measures a substance in the blood produced by cells in the prostate. An increased PSA level may indicate cancerous cells.

If your doctor believes you may have prostate cancer based on these tests, he may order a thin needle biopsy of the prostate to check for cancer.

Q: What are the symptoms of prostate cancer?

A: In its early stages, there are no symptoms. This is why regular screening is so important. As a cancer continues to grow, the following may happen: frequent urination or difficulty urinating; blood in the urine or semen; painful or burning urination; and/or difficulty in holding back urine. If the cancer has spread, symptoms may include pain or stiffness in the lower back, hips or upper thighs and bones. A man with any of these problems should see his doctor to determine if they are related to prostate cancer.

Q: What is the most effective form of treatment?

A: Previously, surgery was considered the most effective form of treatment.

Today, there are more choices. The incidence of side effects and complications, however, differs widely among the various treatments, and should be considered on an individual basis.

Q: What should I do if I am diagnosed with prostate cancer?

A: When prostate cancer is diagnosed, you should continue to maintain a lifestyle as normal as possible. Prostate cancer does not usually spread rapidly. Take time, one to two months if necessary, to learn more about the disease and discuss it with your family and doctor before you determine the treatment option that is best for you.

Q: What are the treatment options?

A: Several treatment options exist including prostatectomy, external radiation therapy, implant radiation, hormonal therapy and watchful waiting.

Prostatectomy is the surgical removal of the entire prostate gland and the surrounding lymph nodes. Side effects may include incontinence and, more often, impotence. There are two types of radiation therapy: external and internal.

External radiation is the most widely used and versatile type of radiation. It requires that the patient visit his doctor on a daily basis for seven to eight weeks. Radiation beams are directed to the tumor, killing the cancer cells.

Recently, a new form of radiation therapy, called three-dimensional conformal treatment, has allowed doctors to ÒshapeÓ the radiation beams around the cancerous area, delivering a more effective dose of radiation.

Side effects of external radiation include some burning with urination and more frequent urination, especially during the night.

Patients also commonly have more frequent bowel movements. All of these side effects usually subside within two weeks of the end of the treatment. Urinary incontinence or rectal damage are quite unusual with modern radiotherapy. Sexual impotence occurs in approximately 40% of patients, beginning one year or more after completion of treatment.

With implant radiation, radioactive ÒseedsÓ are implanted directly into the tumor within the prostate. The procedure typically takes 30 minutes and patients often go home after a few hours. Implant radiation is safe because the radiation dose drops sharply as the distance increases from the seed itself. This means the prostate gland can receive high-dose radiation. Side effects of implant radiation therapy may include: difficulty urinating; pain while urinating; and a decrease in the force of the urine stream. This procedure may also result in impotence and urinary incontinence.

Hormonal therapy blocks the production of male hormones necessary for the growth of the cancerous cells. Its side effects include loss of sexual desire, impotence, and hot flashes. Hormonal therapy may be used temporarily to shrink the prostate prior to surgery or radiation therapy.

Watchful waiting involves periodic PSA tests and examinations of the cancer to determine its growth (some cancers are very slow growing.) Treatment is started only if the cancer is causing symptoms or is growing.

Q: Where can I get more information?

A: Your primary care physician and prostate cancer specialists, urologists, radiation oncologists or medical oncologists can provide you with information on prostate cancer as well as information on how to contact support groups in your area and throughout the country.

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