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About The Prostate  The prostate is a male endocrine organ that is normally the size of a golf ball. The primary function of the prostate is in male fertility by secreting enzymes and nutrients that promote sperm motility and enhance fertilization of the female egg. Without a prostate a man is not fertile. The prostate does not secrete male hormones and does not play a role in sexual function. Thus men can maintain normal sexual function even after the prostate has been removed. As men age the prostate frequently grows in size and can often block the flow of urine. The condition of “enlarged prostate” is called benign prostatic hyperplasia or BPH. In other words for most men an “enlarged prostate” is not caused by prostate cancer, but rather a non-cancerous condition. Prostatitis is another common benign condition that affects the prostate. Men affected by prostatitis often complain of pain in the perineal or rectal area as well as urinary frequency.
About Prostate Cancer Overview:  Microscopic picture of prostatic adenocarcinoma 2006 Estimated US Cancer Deaths* Lung & bronchus Colon & rectum Prostate Pancreas Leukemia Liver & intrahepaticbile duct Esophagus Non-Hodgkin lymphoma Urinary bladder Kidney All other sites | 31% 10% 9% 6% 4% 4% 4% 3% 3% 3% 23% | Men
291,270
| Women
273,560
| 26% 15% 10% 6% 6% 4% 3% 3% 2% 2% 23% | Lung & bronchus Breast Colon & rectum Pancreas Ovary Leukemia Non-Hodgkin lymphoma Uterine corpus Multiple myeloma Brain/ONS All other sites |
ONS=Other nervous system. Source: American Cancer Society, 2006. 2006 Estimated US Cancer Cases Prostate Lung & bronchus Colon & rectum Urinary bladder Melanoma of skin Non-Hodgkin lymphoma Kidney Oral cavity Leukemia Pancreas All other site | 33% 13% 10% 6% 5% 4% 3% 3% 3% 2% 18% | Men
720,280
 | Women
679,510
| 31% 12% 11% 6% 4% 4% 3% 3% 2% 2% 22% | Lung & bronchus Breast Colon & rectum Pancreas Ovary Leukemia Non-Hodgkin lymphoma Uterine corpus Multiple myeloma Brain/ONS All other sites |
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2006. Detection and diagnosis: Currently most men are diagnosed with prostate cancer because of an elevation in the PSA blood test or an abnormality on the digital rectal exam. PSA (aka Prostate Specific Antigen) is a protein made by normal, as well as cancerous prostate cells. The primary function of PSA is to aid in fertility. Thus a very high level of PSA can be found in the ejaculate. Normally only a low level of PSA is detected in the blood, and elevated levels of PSA in the blood may be indicative of a problem. The most concerning cause of for an elevation in blood PSA levels (>2.5 ng/ml) is prostate cancer, but levels can also be elevated from non-cancerous conditions such as prostatic enlargement (BPH) and prostatic inflammation (prostatitis). Bike riding and sexual activity can also cause small transient elevations in blood PSA levels. Nearly 70 – 75% of men with prostate cancer have an elevation in the blood PSA level but some men with prostate cancer can have a normal PSA level. These men are typically diagnosed because a doctor feels a firm area or nodule on the prostate. For this reason it is important for men to be screened with both a PSA blood test and digital rectal exam. The American Urology Association recommend screening men year with a PSA blood test and digital rectal exam beginning at the age of 50 (40 for men at a high risk for prostate cancer). The PSA and digital exam merely identify men that are at a particularly high risk for prostate cancer, but diagnosis of prostate cancer is always made by a biopsy. In other words, a man should not be treated for until he has undergone a biopsy that demonstrates prostate cancer. Treatment options: A man diagnosed with prostate cancer and his health care team must first decide whether watchful waiting or active treatment is most appropriate. Choosing the most appropriate approach involves understanding the extent and aggressiveness of the cancer and balancing the risk of dying from or suffering from complications related to prostate cancer with the risk of treatment-related side effects. The options for initial prostate cancer treatments are influenced by these factors as well as the desires of the patient and his family.
Factors that Help Determine the Most Appropriate Treatment
 | Gleason Sum | < 6 3 + 4 = 7 4 + 3 = 7 8 - 10 | Low grade Low intermediate grade High intermediate grade High grade |
Stage I
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- Tumor not detectable by imaging or clinical exam
- Low-grade tumor
- Less than 5% of tissue specimen
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- Cannot be felt
- T1a - cancer found in TURP specimen
- T1c - cancer found as a result of PSA elevation only
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Stage II
 | - Tumor not detectable by imaging or clinical exam
- May be found in one or more lobes by neele biopsy - Moderate/High grade tumor
- Less than 5% of tissue specimen
| - Can be felt during DRE (digital rectal exam)
- T2a - felt on one side of prostate
- T2b - felt on both sides of prostate
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The expected risk of recurrence can be determined by a man’s staging information, Gleason score, and PSA level. The staging information refers to the result of the digital rectal exam. T1c means that the prostate feels benign (i.e. no nodules or firm areas) and T2 means that a nodule or rough area on the prostate is felt. The Gleason score is based on the pathologist determination of how cancerous cells found on the biopsy appear under the microscope.
Clinical Stage | Gleason Score | Blood PSA Level | Risk of Recurrence | T1c or T2 T1c or T2 T1, T2a T1c or T2 T1c or T2 T2 T2 Any | < 6 < 6 Any 7 7 < 7 < 7 8 - 10 | < 10 10 - 20 > 20 < 20 > 20 < 20 > 20 Any | Low Intermediate High Intermediate High Intermediate High High |
Source: Based on Prostate Cancer Treatment Guidelines for Patients, Version III/October 2002, the American Cancer Society and National Comprehensive Cancer Network.
Recurrence Risk | Life Expectancy (Years) | Recommended Initial Treatment Options | Low | Less than 10 | - Active surveillance
- Radiation therapy
| Low | 10 or more | - Radical prostatectomy
- Radiation therapy
- Active surveillance
| Intermediate | Less than 10 | - Active surveillance
- Radiation therapy
- Radical prostatectomy
| Intermediate | 10 or more | - Radical prostatectomy + lymph node dissection
- Radiation therapy
| | High | Any | - Hormonal therapy + radiation therapy
- Radical prostatectomy + lymph node dissection
- Hormonal therapy alone
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Source: Based on Prostate Cancer Treatment Guidelines for Patients, Version III/October 2002, the American Cancer Society and National Comprehensive Cancer Network. Treatment Options for Clinically Localized Prostate Cancer Early Diagnosis - Active Surveillance External
- Beam Radiation Therapy
- Brachytherapy (Radioactive seeds)
- Cryosurgery (Freezing prostate)
- Surgery (Radical Prostatectomy)
- Open Surgery
- Conventional Laparoscopic Surgery
- da Vinci™ Prostatectomy (Robotic-Assisted Surgery)
The treatment options for men with prostate cancer that appears to be contained within the prostate include: - Radical prostatectomy (surgical removal of the entire prostate by an open laparoscopic or robotic technique).
- Radiation therapy (treatment of the entire prostate with external beam and/or seed implantation)
- Active surveillance or observation (“watchful waiting”
- Cryotherapy (freezing the prostate) is an investigational procedure that may be appropriate for some men.
Goals of Radical Prostatectomy
- §Cure cancer
- Safely remove the entire prostate and seminal vesicles
- Remove all of the cancer
- Preserve urinary function
- Do not damage urinary sphincter
- Reconnect bladder and urethra
- Preserve erectile function
- Do not damage or remove neurovascular bundles
- “Nerve sparing”
Options for men with more advanced cancer and high risk of recurrence may include hormonal therapy, hormonal therapy plus radiation, or radical prostatectomy with lymph node biopsy. Treatment Options for Metastatic Prostate Cancer Patients with prostate cancer that has spread beyond the prostate to the lymph nodes and/or bones should be treated with some form of hormonal therapy: orchiectomy (surgical removal of the testicles), LHRH agents (injections that are given regularly, whether monthly, every three to four months, or at other intervals) that block the secretion of testosterone), or a combination of an LHRH agent and oral anti-androgen (pills that block the action of testosterone). If the PSA begins to rise, indicating that the hormonal therapy is not working, or if the patient develops symptoms while receiving a combination of LHRH agents and oral anti-androgens, the oral anti-androgen should be discontinued. Treatment Options for Cancer that Returns or Grows after Treatment The treatment that is most appropriate for a man’s recurrent prostate cancer depends upon where in the body the recurrence occurs and if it has responded to hormone therapy. Treatment options may include active surveillance, radiation therapy (for patients with failure after radical prostatectomy, radical prostatectomy (for patients with failure after radiation therapy) and hormonal therapy. Prostate Cancer Nomograms Sources for more information on prostate cancer. American Cancer Society
National Cancer Institute
Prostate Cancer Foundation |
