What is the most effective treatment for prostate cancer?

We are not always just about the ladies; we have something for the men as well. It is with great pleasure to welcome back Doctor Trevor Baillie as he will explore prostate cancer.

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the centre of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes and protects sperm.

As men age various conditions can affect the prostate, including benign prostatic hypertrophy, prostatitis, prostate cancer.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (also called BPH) is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through). As men age, the prostate gland slowly grows bigger (or enlarges). As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. “Benign” means the enlargement isn’t caused by cancer or infection. “Hyperplasia” means enlargement.

Most symptoms of BPH start gradually. One symptom is the need to get up more often at night to urinate. Another symptom is the need to empty the bladder often during the day. Other symptoms include difficulty in starting the urine flow and dribbling after urination ends. The size and strength of the urine stream may decrease.

These symptoms can be caused by other things besides BPH. They may be signs of more serious diseases, such as a bladder infection or bladder cancer. Tell your doctor if you have any of these symptoms, so he or she can decide which tests to use to find the possible cause.

After your doctor takes a complete history of your symptoms, a rectal exam is the next step. In a rectal exam, your doctor checks your prostate by putting a gloved, lubricated finger into your rectum to feel the back of your prostate gland. This exam allows your doctor to feel the size of the prostate gland.

To make sure that your prostate problem is benign, your doctor may need to look at a sample of your urine for signs of infection. Your doctor may also do a blood test. An ultrasound exam or a biopsy of the prostate may help your doctor make the diagnosis.

Once your doctor is sure that your symptoms are caused by benign growth of the prostate gland, treatment can be recommended. However, your doctor may suggest that you wait to see if your symptoms get better. Sometimes mild symptoms get better on their own. If your symptoms get worse, your doctor may suggest another treatment option.

One option is a minimally invasive treatment. This means it does not involve surgery. Most of these treatments use heat to destroy prostate tissue that is pressing on the urethra. Minimally invasive treatments can usually be done by your doctor in his or her office rather than at a hospital.

Surgery is considered the most effective treatment and is used in men with strong symptoms that persist after other treatments are tried. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done through the urethra, leaving no scars. Surgery does have risks, such as bleeding, infection or impotence. These risks are generally small.

Prostatitis

Prostatitis is an inflammation of the prostate gland. Prostatitis can cause many symptoms, including the following:

• Difficult or painful urination 
• Frequent urination 
• Fever 
• Low-back pain 
• Pain in the penis, testicles or perineum (the area between the testicles and the anus) 
• Inability to get an erection 
• Decreased interest in sex 

Prostatitis may be easily confused with other infections in the urinary tract. If you think you have prostatitis, see your doctor.

There are 2 kinds of prostatitis: acute prostatitis and chronic bacterial prostatitis. Both are caused by an infection of the prostate. Some kinds of prostatitis may be a result of the muscles of the pelvis or the bladder not working correctly.

The treatment is based on the cause. Your doctor may do a rectal exam and test urine samples to find out the cause. In a rectal exam, your doctor may check your prostate by putting a gloved, lubricated finger into your rectum to feel the back of your prostate gland.

Antibiotics are used to treat prostatitis that is caused by an infection. You might have to take antibiotics for several weeks or a few months. If prostatitis is severe, you might have to go to a hospital for treatment with fluids and antibiotics.

Because doctors do not yet understand what causes prostatitis without infection, it can be hard to treat. Your doctor might try an antibiotic to treat a hidden infection. Other treatments are aimed at making you feel better.

Nonsteroidal anti-inflammatory medicines, such as ibuprofen or naproxen, and hot soaking baths may help you feel better. Some men get better by taking medicines that help the way the bladder or prostate gland work.

Men who have had prostatitis once are more likely to get it again. Antibiotics may not get into the prostate gland well. Small amounts of bacteria might “hide” in the prostate and not be killed by antibiotics. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a longer period of time to prevent another infection. Prostatitis that is not caused by infection is often chronic. If you have this kind of prostatitis, you might have to take medicine for a long time.

Prostatitis can usually be treated with medicine. Most of the time, surgery is not needed.

Although prostatitis can cause you discomfort, it does not cause cancer. Some doctors use a blood test called the prostate-specific antigen (PSA) to test for prostate cancer. If you have prostatitis, your PSA level might go up. This does not mean you have cancer. Your doctor will treat your prostatitis and may check your PSA level again.

Prostate Cancer

The body is made up of many types of cells. Normally, cells grow, divide and then die. Sometimes, cells mutate (change) and begin to grow and divide more quickly than normal cells. Rather than dying, these abnormal cells clump together to form tumors. If the tumors are cancerous (also called malignant tumors), they can invade and kill your body’s healthy tissues. From these tumors, cancer cells can metastasize (spread) and form new tumors in other parts of the body. By contrast, tumors that are not cancerous (also called benign tumors) do not spread to other parts of the body. Prostate cancer is abnormal cells in the prostate gland.

Like many types of cancer, prostate cancer can be aggressive. This means it grows quickly and can spread to other parts of the body. (When cancer spreads, doctors say the cancer has “metastasized.”) Prostate cancer can also grow more slowly.

If you have prostate cancer, it is important for your doctor to monitor the growth of your cancer carefully. If left unchecked, the cancer can grow quickly and spread to other organs in your body. This makes treatment much more difficult.

Prostate cancer is the most common type of cancer found in American men, other than skin cancer.

Although men of any age can get prostate cancer, it is found most often in men over age 50. In fact, more than 8 of 10 men with prostate cancer are over the age of 65.

For unknown reasons, African-American men are at higher risk than Caucasian men. Men with a family history of prostate cancer are at higher risk, too. In this case, family history means that your father or a brother had prostate cancer.

Men who are obese and eat a diet high in fat are also at a higher risk for prostate cancer.

There are advantages and disadvantages to screening for prostate cancer. You should talk to your doctor about whether or not you should be screened. Your doctor will help assess the balance of risks and benefits to screening based on factors like your age, family history and current health.

Prostate cancer, especially in its early stages, often does not have any symptoms. Symptoms are more likely to appear as the cancer grows.

Call your doctor if you have any of these symptoms:

• Difficulty starting to urinate 
• Less force to the stream of urine 
• Dribbling after you finish urinating 
• Frequent urination, especially at night 
• Blood or pus in the urine 
• Blood in the semen 
• Pain while urinating 
• Pain with ejaculation 
• Hip and lower back pain that does not go away over time 
• Pain in the lower part of your pelvis 
• Unintended weight loss and/or loss of appetite 

Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. This is called a digital rectal exam. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suggest additional testing to check for prostate cancer.

Another way to check for prostate cancer is with a blood test called the PSA test. PSA is short for prostate-specific antigen. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level can also be high because of less serious causes, such as infection or prostate enlargement.

If prostate cancer is caught early and before it has spread to other parts of the body, it can often be treated successfully.

For early stages of prostate cancer, one option is “watchful waiting.” Watchful waiting means seeing your doctor often so he or she can track the cancer. This can include frequent blood tests and rectal exams to check the growth of the cancer. This may be a good option for those with slow-growing cancer, or men who are elderly and/or in poor health. At any time during watchful waiting, you can choose to switch to another treatment.

It is important to realize that watchful waiting does not involve medication or treatment that will kill the cancer. It is just an observation period. If the cancer suddenly starts to grow more quickly or begins to cause symptoms, you may need to switch to a more aggressive treatment option.

Surgery, radiation and drug therapy are options that can treat your prostate cancer. These treatments can cause side effects, such as impotence and incontinence, but these side effects usually disappear after treatment. 

The treatment options for prostate cancer depend in part on your age, your overall health and whether the tumor has spread. For tumors that are still inside the prostate, radiation therapy (using x-rays that kill the cancer cells) and a surgery called radical prostatectomy are common treatment options. “Watchful waiting” is also a treatment option. In this approach, no treatment is given until the tumor gets bigger. Watchful waiting may be the best choice for an older man who has a higher risk of dying from something other than his prostate cancer.

Usually, tumors that have grown beyond the edge of the prostate can’t be cured with either radiation or surgery. They can be treated with hormones that slow the cancer’s growth. 

Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. After the prostate gland is taken out through an incision, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.

Other kinds of prostate surgery are less invasive and have different risks and recovery rates. Your doctor will help decide which type of surgery is the best option for you. Laparoscopic surgery helps the surgeon see inside your body using a thin tube with a tiny camera attached to it. Small cuts are made near the tumor site, and thin tools are used to remove the tumor and surrounding tissue. Some hospitals also have robots to assist in this kind of surgery. The doctor operates the robot arm from a computer.

Erectile dysfunction

When a man can’t get an erection to have sex or can’t keep an erection long enough to finish having sex, it’s called erectile dysfunction. (It used to be called impotence). Erectile dysfunction can occur at any age, but it is more common in men older than 75.

Erectile dysfunction doesn’t have to be a part of getting older. It’s true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex.

Erectile dysfunction can be caused by:

• Diabetes (high blood sugar) 
• Hypertension (high blood pressure) 
• Atherosclerosis (hardening of the arteries) 
• Stress, anxiety or depression 
• Alcohol and tobacco use 
• Some prescription medications, such as antidepressants, pain medicine and medicine for high blood pressure 
• Fatigue 
• Brain or spinal-cord injuries 
• Hypogonadism (which leads to lower testosterone levels) 
• Multiple sclerosis 
• Parkinson’s disease 
• Radiation therapy to the testicles 
• Stroke 
• Some types of prostate or bladder surgery 

If you can’t keep your blood sugar or your blood pressure under control, you can get erectile dysfunction. It’s important that you take your medicines for these problems just the way your doctor tells you.

Sometimes your hormones get out of balance and this causes erectile dysfunction. Your doctor will decide if you need blood tests to check your hormones.

Some medicines can cause erectile dysfunction. If this is true for you, your doctor may take you off that medicine or give you a different one.

Drinking too much alcohol, smoking too much and abusing drugs can also cause erectile dysfunction.

Problems in your relationship with your sexual partner can also cause erectile dysfunction. Improving your relationship may help your sex life. If you decide to seek therapy, it will probably be most effective if your sex partner is included. Couples can learn new ways to please one another and to show affection. This can reduce anxiety about having erections.

Feelings that can lead to erectile dysfunction:

• Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence 
• Feeling stressed, including stress from work or family situations 
• Being troubled by problems in your relationship with your sex partner 
• Feeling depressed 
• Feeling so self-conscious that you can’t enjoy sex 
• Thinking that your partner is reacting negatively to you 

Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for diseases and disorders. Other tests may also be needed. Your doctor will determine which tests are right for you.

How erectile dysfunction is treated depends on what is causing it. After your doctor checks you for medical problems and medicines that might cause erectile dysfunction, he or she may have you try a medicine to help with erectile dysfunction. Sildenafil, tadalfil and vardenafil are medicines that are taken by mouth. Not everyone can use these medicines. Your doctor may talk to you about alprostadil if oral medicines aren’t an option for you. Alprostadil is a synthetic version of prostaglandin E. It can be injected into the penis or inserted as a tiny suppository into the urethra. Your doctor will help you decide which treatment is best for you.

If the medicines aren’t right for you, you could also try using a penile implant, vacuum pump devices, or you could have surgery. Your doctor may send you to a urologist to talk about these options.