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Everything you wanted to know about prostate cancer but were afraid to ask
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The Health Journal asked Dr. Roger Buckley to answer some frequently asked questions about prostate cancer.
By Dr. Roger Buckley
What is the prostate?
The prostate is a walnut-sized male sex gland. It is located below the bladder and in front of the rectum. It secretes ejaculatory fluid.
Who is at risk for prostate cancer?
On average 325 Canadian men will be diagnosed with prostate cancer every week and 81 Canadian men will die of it. It accounts for one in four cancer diagnoses among Canadian men. The most common risk factor is age. More than 75 per cent of men diagnosed with prostate cancer each year are over the age of 65. There is some evidence that a high-fat diet may, in part, be responsible. Genetic factors also appear to play a role, particularly when the diagnosis is made in men under 60.
What are the symptoms?
Frequent, difficult or painful urination, especially during the night; dribbling urine; blood or pus in the urine; painful ejaculation; pain in the lower back, pelvic area or upper thighs.
Do these symptoms always mean cancer?
As men get older, their prostate may grow bigger and block the flow of urine or interfere with sexual function. This condition, called benign prostatic hyperplasia (BPH), can cause many of the same symptoms as prostate cancer. Though it may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. Check with your doctor.
Can prostate cancer be found before a man has symptoms?
Yes. Two tests are commonly used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate specific antigen (PSA). These tests can detect prostate cancers that have not caused symptoms, and should be done annually once you have reached 50.
How is prostate cancer diagnosed?
An urologist will recommend a series of Digital Rectum Exams (DRE) and PSA tests, or a transrectal ultrasound (TRUS) and prostate biopsy. The TRUS involves an ultrasound probe in the rectum that lasts about eight to 10 minutes.
During a biopsy, small pieces (six to eight may be required) of prostate tissue are removed and examined under a microscope for cancer. The biopsy is done quickly and most men find it causes only a small amount of discomfort.
How is prostate cancer treated?
Surgery is often recommended for men under age 70 with localized disease. The surgery, called radical prostatectomy, removes the lymph nodes and the prostate through an incision in the lower abdomen. Side effects of the surgery can include trouble with urinary control in five to 10 per cent of cases, and erectile dysfunction which occurs in 40 to 60 per cent.
For men with localized prostate cancer over age 70 or men under 70 who don’t wish to undergo surgery, radiation is the option. Two techniques radiate the prostate. In external beam radiation, the more traditional of the two, patients are given a small dose each day for about six weeks. Complications can include temporary diarrhea, bladder irritability and impotence. A new method of radiation called brachytherapy does require an operation to insert radioactive seeds into the prostate, but it may also reduce the incidence of impotence.
Hormone therapy is recommended to treat cancer that has metastasized to other areas of the body or has recurred after radiation or surgery. Therapy involves either pills and injections or removal of the testicles. Side effects include breast tenderness, weight gain in the middle, and loss of hair and sexual desire.
How does a patient decide the best treatment option for localized prostate cancer?
Choosing a treatment option involves the patient and his family and doctor. Considerations include the grade and stage of the cancer, the patient’s age and health, and the individual choices that each patient makes about the benefits and risks of each treatment option.
Dr. R. J. Buckley is a Toronto urologist.
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