Prostate cancer is the most common cancer in men. You are one of several hundred thousand American men who will have been diagnosed with this problem this year. It is very important to know that when discovered early, prostate cancer is usually curable. Even when not discovered early, it is a very manageable condition.
Abundant educational materials will be provided to you in an effort to help answer the many questions that you will probably have. Of note, prostate cancer tends to run in families, and it would therefore be prudent for male children to be checked on an annual basis starting at age 40 (with PSA testing and digital rectal exams).
Once the diagnosis of prostate cancer is made, the next step is staging, testing to see if the disease is localized to the prostate or has spread to adjacent or distant organs. The following tests are typically used to stage prostate cancer:
Sonography to image the upper urinary tracts and ensure absence of obstruction.
Cystoscopy to assess prostatic obstruction and ensure absence of bladder base involvement or other bladder pathology.
Bone Scan to assess the bony skeleton for spread; this can often be avoided when the PSA is less than 10 ng/ml.
Computerized Tomography and/or Magnetic Resonance Imaging to image the prostate gland and adjacent structures including seminal vesicles and lymph glands; these tests can often be avoided when the PSA level is not significantly elevated.
Treatment options are predicated upon your age, general health, prostate cancer stage, pathology report, as well as the presence of symptoms related to prostate enlargement. If the cancer is localized to the prostate, the two major treatment options are surgical removal of the prostate gland (radical prostatectomy) versus prostate radiation (brachytherapy and external radiation). In general, if you are young and in good health, the option of choice is usually surgery as this has been shown to be the most effective means of long-term cure. However, radiation therapy is often a very acceptable alternative, particularly if you are older or have compromised health. Androgen deprivation therapy usually involves an injection of a medication that suppresses the male hormone that stimulates prostate growth. This is used under several different circumstances—in the elderly and infirm, in patients with advanced disease, to temporize when treatment must be delayed, to reduce the size of an enlarged prostate, and often in conjunction with radiation therapy. Another option is no treatment—usually only used if the life expectancy is short.
Once the prostate cancer is treated, careful follow up is imperative. For the first year, a PSA is obtained every three months, then subsequently every six months. After successful treatment, the PSA should revert to undetectable or very low levels and remain so.
For more information on prostate cancer:
930 N. York Road, Suite 50
American Foundation of Urological Disease
300 W. Pratt Street, Suite 401
Andrew L. Siegel, M.D.
255 W. Spring Valley Ave.