Prostate Cancer - OnCare Cancer Center Prostate Cancer Intruduction

What is prostate cancer?

What is prostate cancer? Prostate cancer occurs when cells in the prostate gland grow out of control. There are often no early prostate cancer symptoms, but some men have urinary symptoms and discomfort. Prostate cancer treatment options are surgery, chemotherapy, cryotherapy, hormonal therapy, and/or radiation. In some instances, doctors recommend "watchful waiting."

After a prostate cancer diagnosis, tests are done to detect how the cancer has spread, if it has, outside the prostate. Not all men need every test. It depends on the characteristics of a man’s prostate cancer seen on biopsy. Tests to help determine the stage of prostate cancer include:

Diagnostic tests:

• Digital rectal exam (the infamous gloved finger)
• Prostate-specific antigen (blood test)
• Transrectal ultrasound
• MRI of the prostate using a rectal probe
• CT scan of the abdomen and pelvis, looking for prostate cancer metastasis to other organs
• MRI of the skeleton, or a nuclear medicine bone scan, to look for metastasis to bones
• Surgery to examine the lymph nodes in the pelvis for any prostate cancer spread

Cancer Stage:

The TNM System for Prostate Cancer Stages

As they do for most cancers, doctors use the TNM system of prostate cancer stages. The prostate cancer stages are described using three different aspects of tumor growth and spread. It’s called the TNM system for tumor, nodes, and metastasis:

T -- for tumor -- describes the size of the main area of prostate cancer.

N -- for nodes -- describes whether prostate cancer has spread to any lymph nodes and to what extent.

M -- for metastasis -- means distant spread of prostate cancer, for example, to the bones or liver.

There are other ways of classifying prostate cancer, such as the Gleason system. Sometimes, the TNM system and Gleason score are combined together to describe prostate cancer stage.

Prostate Cancer Stage I

In stage I, prostate cancer is found in the prostate only. Stage I prostate cancer is microscopic; it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.

Prostate Cancer Stage II

In stage II, the tumor has grown inside the prostate but hasn’t extended beyond it.

Prostate Cancer Stage III

Stage III prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.

Prostate Cancer Stage IV

In stage IV, the cancer has spread (metastasized) outside the prostate to other tissues. Stage IV prostate cancer commonly spreads to lymph nodes, the bones, liver, or lungs.

Accurately identifying the prostate cancer stage is extremely important. Prostate cancer stage helps determine the optimal treatment, as well as prognosis. For this reason, it’s worth going through extensive testing to get the correct prostate cancer stage.

Treatment

Deciding on the best treatment for cancer of the prostate is not always straightforward and a number of factors have to be taken into consideration. The most important of these are:

• Your general health
• The stage of the prostate cancer
• Whether the cancer has already spread beyond the prostate
• The likely adverse effects of the treatment
• Your age

Surgery

Surgery may be a treatment option for you depending on the type, size and spread of the cancer.

There are three types of surgery for prostate cancer

• Radical prostatectomy - removal of the prostate gland
• Trans-urethral resection of the prostate (TURP) - to relieve symptoms
• Orchidectomy (removal of testicles)

Radiotherapy

• Radiotherapy treats cancer by using high energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells.
• Radiotherapy for cancer of the prostate is usually given from a machine called a linear accelerator (external beam radiotherapy), but for some men with early prostate cancer it can be given by inserting small radioactive seeds into the tumour (brachytherapy).

Hormone therapy

• Cancer of the prostate is dependent on the male hormone, testosterone, for its growth.
• Testosterone is produced by the testicles.
• By reducing the amount of testosterone in the body it is possible to slow down or stop the growth of the cancer cells. It can shrink down the tumour and symptoms will often disappear completely.

Chemotherapy

• This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
• Although it is often used to treat some types of cancer, it is less commonly used to treat cancer of the prostate.
• Some of the more commonly used drugs are mitoxantrone, and estramustine (tablets).