The term “primary tumor” refers to the original tumor within the prostate; secondary tumors are caused when the original cancer spreads to other locations in the body, also known as metastasis. Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate. Early stage prostate cancer produces few or no symptoms and can be difficult to detect.
Prostate cancer is the leading site of new cancer diagnoses and the second leading cause of cancer deaths in men.
According to the American Cancer Society (ACS), a risk factor is anything that affects the chances of developing a disease, such as prostate cancer. There are modifiable risk factors, like diet or smoking status, which can be changed by an individual. Unmodifiable risk factors include the person’s family history, age, or genetics. Having one or more risk factors does not mean you will get prostate cancer. Some prostate cancer patients had no risk factors prior to diagnosis. Understanding your individual risk and communicating with your primary health care provider is important to make informed decisions on your health and screening practices.
Prostate cancer is rare in men under 40 and the odds of developing the disease increase after age 50. 60% of prostate cancers are found in men over the age of 65, while 40% are found in men under 65. According to the American Cancer Society about 1 man in 8 will be diagnosed with prostate cancer during his lifetime.
Prostate cancer occurs more often in African American men and Caribbean men of African ancestry. African American men have the highest incidence and death rates. African American men are more than twice as likely to die of prostate cancer than white men (ACS).
Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. (The risk is higher for men who have a brother with the disease than for those who have a father with it.) The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.
Inherited gene changes may raise the risk of prostate cancer
The American Urological Association Foundation (AUAF) recommends that African American men with a family history of prostate cancer obtain a baseline prostate specific antigen (PSA) blood test along with a digital rectal exam (DRE) by age 35, and men of other races can begin at age 40. These tests can be performed quickly and easily please check with your health care provider.
Support for our Recommendations:
Recommendations by large health entities recommend age 50 to begin prostate cancer screening. The American Urological Association Foundation as well as prostate cancer survivor organizations believe delaying screening until age 50 can be risky. The American Urological Association Foundation (AUAF) is a group of doctors who are the most aware and well-informed about the nature of prostate cancer, which is why GPCC and the AUAF support early screening or consulting with a urologist to discuss what is appropriate for you and your individual care.
Screening Components
Prostate Specific Antigen (PSA) Tests: PSA is a protein that the prostate produces normally. Healthy and cancerous cells create PSA. A blood test is used to assess the level of PSA in the blood. A higher-than-normal level of PSA might indicate a problem with the prostate, including cancer.
Digital Rectal Exam (DRE): a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities of the prostate.
An abnormal age-adjusted prostate specific antigen (PSA) test or abnormal digital rectal (DRE) exam is an indication of prostate cancer but does not mean cancer is present. Abnormal findings of either test should be followed by a biopsy of the prostate cells to determine whether they are in fact cancerous.
Biopsy: a biopsy is a procedure in which a sample of tissue is taken from the prostate and then viewed under a microscope to check for abnormalities.
Prostate Health Index (phi): still being studied, phi is a new, more precise blood test that better distinguishes an aggressive cancer from a low-risk cancer.
The stage of your cancer is an assessment of where the cancer is located, whether it has spread to another area of your body (metastasized), and how it affects the rest of the body. It may be called the T-stage for prostate cancers.
Different types of cancer have varying success rates for treatment. Prostate cancer has a near 100% survival rate for early diagnosis and is overall, highly treatable.
The Gleason Grade refers to the degree of aggressiveness of a particular tumor based on the appearance of the tissue under a microscope. The Gleason grading system assigns a numerical score to each of the two largest areas of cancer in the tissue samples. The lowest possible combined Gleason Grade is 2, and the highest possible Gleason Grade is 10.
The Gleason grading process assigns a number ranging from 1–5 based on the degree of “cell differentiation” within the tissue sample from very well differentiated (i.e., least cancerous, most normal looking [grade 1] to very poorly differentiated and most cancerous [grade 5]).
Gleason Grades 1 and 2 closely resemble normal prostate tissue – in which the cells appear round, orderly and with defined borders. In grade 2, the cells are more loosely aggregated.
In Gleason Grade 3 cells are beginning to lose their defined borders and are starting to group together into clumps.
Gleason Grade 4 is identified by loss of normal cell structure and a more pronounced clumping together of cancerous cells.
Gleason Grade 5 means that the cells have lost most, or all of their normal characteristics are very poorly differentiated and have essentially merged together into cancerous islands of cells.
Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score (also called the Gleason sum). More information is available at cancer.org.
The Positive Foundation’s guide to getting care.
Finding the right doctor and care team can be a challenge, but it doesn’t have to be.
- General Practitioners (See link to SZV website)
- St. Maarten Medical Center (www.smmc.sx)
*Not an endorsement or recommendation etc. It is important to PF to provide resources for anyone who may be facing prostate cancer on St. Maarten. This list is for information purposes only and is not an endorsement of any kind.
Contrary to men’s greatest fears, life does not end at diagnosis. Many men, their families, and loved ones may feel hopeless after the big reveal. PF works every day to support patients, survivors, and everyone affected by prostate cancer. You have taken the first steps already, let us provide guidance and resources to you in this process.
- Help coping with the emotions surrounding illness and treatment
- Peer support, counseling, medications
- What treatment options are available to you and how to access them
- How to self-manage your illness and programs to support you
- How to minimize the impact of the disease by adapting behaviors
- Patient education and counseling with your physician and healthcare team
- Support to change behaviors like smoking, diet, and exercise
- Minimizing disruptions at work, with family, and other areas of life
- Education for family and caregivers
- Assistance for daily living
- Legal assistance
- Financial assistance
- Education about your insurance and how to use your benefits
- Planning and counseling surrounding your care
- Access to supplemental resources like grants or funding
- Logistical help
- Getting your medications
- Transportation to and from treatment and appointments
A man diagnosed with localized or locally advanced prostate cancer has several treatment options.
A program of active surveillance has two goals:
- To provide definitive treatment for men with localized cancers that are likely to progress; and,
- To reduce the risk of treatment-related, quality-of-life side effects such as incontinence and impotence for men with cancers that are not likely to progress.
Active surveillance is not appropriate for every prostate cancer patient. Good candidates are men with a lower grade localized prostate cancer, a low PSA level, a low Gleason Score, and an appropriate clinical stage. Additional factors that men need to consider their age, general health, life expectancy, psychological makeup and then family’s history.
A typical program of active surveillance may include the following: a review of the candidate criteria described above; a discussion with your urologist regarding all possible treatment options; and, if appropriate, an active surveillance plan customized to your specific situation. The plan would typically include periodic physical exams and PSA testing as well as periodic biopsies as appropriate.
Choosing the best treatment for localized prostate cancer is generally based on the man’s age, the stage and grade of the cancer, the man’s general health and the man’s evaluation of the risks and benefits of each therapy option.
While there have been many studies of this, no local treatment option has been shown to have a distinct survival advantage for all patients. However, physicians may prefer a specific treatment depending on their specialty. One study found that 93% of urologists recommended surgery (also known as “radical prostatectomy”); and 72% of radiation oncologists recommended radiation. Patients should always seek a second opinion or the opinion of different specialists (e.g., urologists, radiation oncologists and medical oncologists) if they are uncertain about which treatment to pursue. Additionally, active surveillance, in which PSA levels are monitored but no treatment is performed, may be an option for some men.
Your goal is to be able to react quickly to seek additional treatment promptly if a worsening of the cancer occurs.
A radical prostatectomy is the surgical removal of the entire prostate gland. Many experts tend to recommend surgery when the cancer is thought to be contained within the prostate, such as in stage T1 and T2 cancers, and when the man is relatively young and healthy. During surgery, the entire prostate gland plus some surrounding tissue is removed. The surgery is almost always performed under general anesthesia. It is important to note that the experience and skill of the surgeon can be a major factor in the success of the surgery. This is true in all surgical procedures but is particularly true with a radical prostatectomy because of the challenging location of the prostate and the critical anatomy near the prostate.
An increasingly popular alternative to a radical prostatectomy is robotic surgery. It is less invasive and has a quicker recovery time. Some proponents claim that is less likely to lead to incontinence or impotence. Clearly outcomes will vary from one patient to another.
If you choose surgery, be sure that you know the experience level and skill of the surgeon. Ask about the surgeon’s training and how many prostatectomies he or she performs on a regular basis. A skilled and experienced surgeon will have performed hundreds of prostatectomies and will typically perform multiple prostatectomies each week. Also, know the hospital.
Radiation involves the killing of cancer cells and surrounding tissues with radioactive material. Radiation therapy can be particularly appealing for men who are not good candidates for surgery because of their age, ill health or advanced disease stage. However, even for those who qualify for surgery, there may be distinct reasons why radiation is the best treatment option. After evaluating the benefits, risks and potential side effects of various local treatment options, some men may decide that some form of radiation therapy is the best treatment option for them.
There are two major categories of radiation therapy:
- External beam radiation (EBR), which is a non-invasive procedure in which high-intensity beams of radiation are directed at the target area; and
- Brachytherapy, which involves the implantation of radioactive metal seeds or pellets into the prostate either permanently or temporarily.
Based on the most recent data, cure rates appear to be similar to those of radical prostatectomy in patients with low-grade and low stage localized prostate cancer. In more advanced disease, radiation is sometimes used to treat a wider area surrounding the prostate and to include irradiation of regional lymph nodes to destroy locally advanced cancer.
Focal laser ablation (FLA) of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility.
Cryotherapy involves the destruction of the prostate tissue by a freezing process in which the entire prostate is turned into an “ice ball.” Probes containing liquid nitrogen or freezing argon gas are inserted into the prostate, causing cancer cells within the prostate to be destroyed as they thaw. Ultrasound imaging is used to ensure that the entire prostate has been frozen. The urethra is heated during the process so that it won’t be destroyed during the freezing process. <br>
Cryotherapy requires less time in the hospital than some other treatments and is less invasive than radical prostatectomy. However, erectile dysfunction, urinary problems and rectal damage may occur. There is not a large volume of data on the long-term effectiveness of cryotherapy as it is a relatively recent therapy in the U.S.
Most prostate cancer cells thrive on male hormones (androgens) such as testosterone. Androgens provide fuel to the fire of prostate cancer cell growth. Hormonal (or hormone-suppression) therapy is designed to turn off the production of the male hormones, or androgens.
If prostate cancer is diagnosed at an advanced stage (when it has spread beyond the prostate) or if the cancer returns after localized therapy such as surgery or radiation, additional treatment with hormonal therapy is typically initiated.
Recent studies have also shown that hormonal therapy, initiated prior to and following radiation therapy, may be more beneficial than radiation alone.
Proton therapy or proton beam therapy is a medical procedure. More specifically, it is a type of particle therapy that uses a beam of protons to radiate diseased tissue, most often in the treatment of cancer. Proton therapy’s chief advantage over other types of external beam radiotherapy is that as a charged particle the dose is deposited over a narrow range and there is minimal exit dose. (Source: Wikipedia.org) This treatment is relatively new compared to the first five approaches.
In October 2015 the FDA authorized a HIFU device for the ablation of prostate tissue. The treatment is administered through a trans-rectal probe and uses heat developed by focusing ultrasound waves into localized prostate tumors to kill cancerous cells. Promising results have been reported in people with prostate cancer. These treatments are performed under ultrasound imaging guidance, which allows for treatment planning and some minimal indication of the energy deposition. This is an outpatient procedure that usually lasts 1–3 hours. The standard ultrasound treatment of prostate cancer ablates the entire prostate, including the prostatic urethra. The urethra has regenerative ability that derives from a different type of tissue (bladder squamous-type epithelium) rather than prostatic tissue (glandular, fibrotic and muscular). While the urethra is an important anatomical structure, the sphincter and bladder neck are more important to maintaining the urinary function. During focused ultrasound treatment the sphincter and bladder neck are identified and not ablated.