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Doctor's Order: Prostate Cancer Treatable
Q. My older brother has been diagnosed with prostate cancer. How can I find out about the latest treatment options, and what should I be doing for myself in terms of screenings and prevention? A. The prostate is walnut-sized gland that sits at the base of the bladder and serves as a reproductive organ, which produces seminal fluid. As men age the prostate commonly develops cancer. Prostate cancer is now the most commonly diagnosed cancer among American men. One of every 10 men will develop this cancer in the course of his life. This year about 189,000 new cases will be diagnosed in this country. Fortunately, there is a simple blood test that can detect prostate cancer early, while it is confined to the prostate, in most cases. This test, known as PSA (Prostate Specific Antigen), is recommended for men over age 50 and for men over age 40 with a family history of prostate cancer. The test should be performed annually and is usually, although not always, included in your blood tests performed with your annual physical. Many community screening programs are also available. In addition to PSA test, patients should have their prostate examined by a physician. This is called a DRE or Digital Rectal Exam. If either the DRE or PSA is abnormal the patient will be referred to a urologist, who is a physician who specializes in prostate problems. The urologist will likely recommend a prostate biopsy. The biopsy is a simple procedure performed with local anesthesia in the doctor's office. The urologist will obtain several tissue core samples for analysis. If the biopsy is positive for prostate cancer, there are several good treatment options. In most cases, the urologist may also order bone scans and CAT scans to determine if the cancer has spread beyond the prostate. Prostate cancer can be diagnosed in many different stages. Localized prostate cancer refers to cancer, which develops within the prostate and has not yet shown evidence of spread. Treatment options for localized cancer include removal of the prostate (radical prostatectomy), radiation treatment and surveillance. The doctor will take into account the aggressiveness of the particular cancer, as well as the patient's age and health, when making recommendations. Because prostate cancer is generally slow growing, the less invasive options are often chosen for older or ill patients with shorter life expectancies. Most younger patients will opt for surgical removal of the prostate. This surgery requires a small incision below the navel, generally takes two to three hours and requires two to three days in the hospital. Following successful surgery, the PSA should fall to zero. All men will have temporary incontinence after the procedure, but nearly all eventually regain excellent urinary control. Impotence can be a side effect but this can generally be corrected with the use of medication. Radiation is available in two forms. External beam radiation is delivered by a computer assisted machine, which focuses radiation energy at the prostate. The radiation passes through surrounding tissues to get to the prostate and destroys the cancer cells. Treatments are usually given daily for seven to eight weeks. Another form of radiation involves the implantation of radioactive "seeds" directly into the prostate. This requires a short anesthetic and is performed as an outpatient. Sometimes both forms of radiation are recommended in combination. Although incontinence is rare, patients can have problems with impotence, which usually can be corrected with medication. In certain patients, watchful waiting or "surveillance" may be a good choice. Surveillance involves regular DRE and PSA checks. If either of these change significantly, the decision can be made to then treat the patient. This usually is appropriate for patients with limited life expectancies because of advanced age or illness. It may also be appropriate for younger patients with "good risk" cancers. Choosing the correct treatment depends not only on the cancer, but also on the state of health and preferences of the patient. I would suggest you talk to a urologist who offers all of the treatments I have discussed. Some hospitals such as Morristown Memorial offer specialized programs for treatment of prostate cancer, which allow for review of the biopsies and x-rays and can arrange for the patient to discuss the treatment options with both qualified urologists and radiation oncologists.
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