Symptoms of Prostate Cancer
Prostate cancer usually causes no symptoms until it reaches an advanced stage. Sometimes, symptoms similar to those of benign prostatic hyperplasia (BPH) develop, including difficulty urinating and a need to urinate frequently or urgently. However, these symptoms do not develop until after the cancer grows large enough to compress the urethra and partially block the flow of urine. Later, prostate cancer may cause bloody urine or a sudden inability to urinate.
symptoms of prostate cancer develop only after it spreads (metastasizes). The areas most often affected by cancer spread are bones (typically the pelvis, ribs, or vertebrae). Bone metastasis tends to be painful and may weaken a bone enough for it to easily fracture. Spread to the bones of the spine (vertebrae) affects the spinal cord and can cause pain, numbness, weakness.
Diagnosis Of Prostate Cancer
Doctors may suspect prostate cancer based on the symptoms, the results of a digital rectal examination, or the results of screening blood tests. The screening blood test is a measurement of prostate-specific antigen (PSA) levels. PSA is a substance produced only by prostate gland tissue.
In some men, doctors recommend an MRI that focuses on the prostate to obtain detailed images that could indicate more aggressive cancer. The radiologist reading the MRI identifies abnormal areas that may help doctors choose which areas to biopsy (but the MRI does not make biopsy unnecessary).
Prognosis For Prostate Cancer
Prognosis for most men with prostate cancer is very good. Most older men with prostate cancer tend to live as long as other men their age who have similar general health and do not have prostate cancer. For many men, long-term remission or even cure is possible. The prognosis depends upon the cancer’s grade and stage. High-grade cancers have a poor prognosis unless treated very early. Cancers that have spread to surrounding tissues also have a poorer prognosis. Metastatic prostate cancer has no cure. Most men with metastatic cancer live about 1 to 3 years after diagnosis, but some live for many years.
Treatment Of Prostate Cancer
Choosing among treatment options can be complicated. Because studies have not directly compared one treatment to another, doctors are uncertain which treatment is most effective. Furthermore, for some men, doctors are not sure whether treatment will prolong life. Such men include those who are not expected to live very long (either because of old age or serious health problems) and those with low prostate-specific antigen (PSA) levels who have low-grade cancers confined to the prostate. Thus, men often make their decision by balancing their degree of discomfort in living with a cancer that might or might not harm them against the possible side effects of treatment. Surgery, radiation therapy, and hormonal therapy. For all of these reasons, men’s preferences are a bigger consideration in choosing treatment for prostate cancer than they are for many other disorders.
Treatment for prostate cancer usually involves one of three strategies based on the aggressiveness of the cancer and how far the cancer has spread:
Active surveillance
Curative treatment
Palliative treatment
Surgically removing the prostate (prostatectomy) is useful for cancer that is confined to the prostate. Prostatectomy is usually not done if staging tests show the cancer has spread. Prostatectomy is very effective in curing low-grade, slowly growing cancers but is less effective in high-grade, fast-growing cancers. Such cancers are more likely to have spread even if spread is not detectable with staging tests at the time of diagnosis.
Prostatectomy requires general or spinal anesthesia, an overnight hospital stay, and a surgical incision. Following surgery, men must have a catheter in their penis for a week or two until the connection between the bladder and urethra heals. Doctors do not routinely give chemotherapy or hormone therapy before or after surgery. In men whose prostate cancer is found to be aggressive (high-grade, fast-growing) at the time of surgery and whose PSA increases, consideration is being given to radiation therapy (with hormone therapy) after surgery.
In open radical prostatectomy, the entire prostate, the seminal vesicles, and part of the vas deferens are removed through an incision in the lower abdomen or, rarely, in the area between the scrotum and anus. Lymph nodes may also be removed to check for cancer. In the laparoscopic and robot-assisted laparoscopic procedures, the same structures are removed, but these procedures are done through smaller incisions and result in less postoperative pain and blood loss and typically a faster recovery.
Radical prostatectomy, irrespective of technique, is the surgery done when trying to cure prostate cancer. More than 90% of men with cancer confined to the prostate live at least 10 years after radical prostatectomy. Younger men who can otherwise expect to live at least 10 to 15 more years are most likely to benefit from radical prostatectomy. However, the procedure causes some leakage of urine in up to 10% of men. Temporary incontinence develops in most men and may last for several months. Incontinence is less likely in younger men.
