American Medical Association Family Medical Guide - American Medical Association [558]
The American Cancer Society recommends an annual PSA test along with an annual digital rectal examination for all men over age 50, and at age 45 for younger men who have an increased risk of developing the disease—such as African Americans and men whose father or brother has prostate cancer. Talk to your doctor about the PSA test so you can make an informed decision about having the test.
Treatment
Treatments for prostate cancer include surgery, radiation therapy, hormone therapy, chemotherapy, cryotherapy, or combinations of these. Your doctor will work with you to develop an appropriate treatment plan based on the benefits, possible side effects, and risks of each treatment; your age; your overall health; your preferences; the likelihood of your living at least 10 more years; and the stage of your cancer. Doctors may recommend watchful waiting for older men whose cancer is at an early stage and is growing slowly. Watchful waiting involves regular digital rectal examinations, a PSA test every 3 to 6 months, and, in some cases, an annual prostate biopsy.
Radical prostatectomy is the most common surgical procedure for prostate cancer. Doctors perform this procedure to treat cancer that has not spread beyond the prostate. In a radical prostatectomy, the surgeon removes the entire prostate and the seminal vesicles, along with surrounding tissue and pelvic lymph nodes. In rare cases, doctors perform TURP to relieve symptoms before using other treatments. TURP is usually used to treat benign prostatic hyperplasia (see page 832). To treat cancer that has not spread beyond the prostate gland, surgeons occasionally perform a procedure called cryosurgery, in which cancerous cells are destroyed by freezing them with a metal probe. Cryosurgery is not used routinely for treating prostate cancer.
A doctor may use one or two types of radiation therapy—external radiation therapy or internal radiation therapy (also called brachytherapy)—to treat prostate cancer. In external radiation therapy, the doctor uses a machine to aim high-power rays (gamma rays or X-rays) or particles (electrons, protons, or neutrons) directly at the tumor and sometimes at surrounding lymph nodes. In brachytherapy, the doctor permanently inserts low-level radioactive pellets (each about the size of a grain of rice) into the prostate gland using ultrasound (see page 111) or CT scanning (see page 112) to guide the procedure. The pellets release radiation for a number of weeks or months.
Doctors usually use hormone therapy alone to treat prostate cancer that has spread to other parts of the body or that has recurred after treatment. The goal of hormone therapy is to lower the levels of androgens (male sex hormones such as testosterone, which can stimulate growth of cancer cells in the prostate gland), thereby shrinking the cancer or slowing its growth. The two most commonly used methods for lowering androgen levels are a surgical procedure called orchiectomy (removal of the testicles, the source of androgens) or regular injections of testosterone-lowering drugs.
Because the adrenal glands produce small amounts of androgens, drugs called antiandrogens are sometimes used to curb production of the hormones by these glands. Antiandrogens are usually taken in pills one to three times a day and are most effective when used along with hormone therapy.
If hormone therapy is not effective in treating prostate cancer that has spread beyond the prostate gland, doctors may recommend chemotherapy, which uses high doses of powerful anticancer drugs to destroy cancer cells. The goal of chemotherapy is to slow tumor growth and relieve pain. Because chemotherapy does not kill all of the cancer cells in the prostate, it is not used to treat early stages of the disease.
Possible side effects of the various treatments for prostate cancer include:
• Sexual problems such as erection problems (see page 486)
• Urinary problems such as frequent urination, urinary incontinence (leaking of urine), obstruction of the flow of urine, blood in the urine,