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Prostate Cancer

Prostate cancer is the second most common type of cancer among American men and 10% of men develop the disease at some point in their lifetime, most after the age of 50. Nearly 250,000 American men are diagnosed with prostate cancer every year in the United States, alone, and about 2 million live with the disease at any given point.

This gland is part of the male reproductive system and should be roughly the size of a walnut. The prostate gland encircles the urethra-the tube that carries urine away from the bladder. The purpose of the prostate is to help produce seminal fluid.

Prostate cell growth is relatively common in men over the age of 50 and may be benign (non-cancerous) or malignant (cancerous). Although prostate cancer is typically slow-growing, it can spread to other parts of the body left untreated. It's crucial to detect prostate cancer early and treat it before it has a chance to spread. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free. Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high. Nearly 100% of men diagnosed at this stage will be disease-free after 5 years.

Diagnosis

In its early stages, prostate cancer causes no symptoms, meaning that diagnosis is usually made during a routine prostate exam called a digital rectal exam. A prostate-specific antigen (PSA) blood test may also be ordered to look for elevated levels of PSA which can indicate cancer as well as other prostate diseases. Depending on these results, an ultrasound or a biopsy may be ordered. Some cancers grow so slowly that treatment may not be needed at all. Others grow fast and are life-threatening so treatment is usually necessary.

Every man aged 45+ should resolve to be screened annually. African-American men or those with a family history of the disease should start annual testing at 40.

Causes

Scientists are still trying to find that cause of prostate cancer, but there are common risk factors among men who are likeliest to develop it.

Risk factors include:

  • Age: Men are at greater risk for developing prostate problems as they age. The diagnosis of prostate cancer is rare in men younger than 40. 1 in 6 men will be diagnosed in their lifetimes.
  • Family history: If your father, grandfather, brother, son, or other closely related family member has had prostate cancer, you are at an increased risk yourself.
  • Race: Black men are 60% more likely to develop prostate cancer than white or Hispanic men. The disease is rarer among Asian American and American Indian men.
  • Diet: Some studies suggest that men with diets high in fat may be at higher risk. Other research suggests that nutritional factors, like greater intake of vitamin D, lycopene, and selenium, may lower a man's risk of developing prostate cancer.

Treatment Options

Treatment depends on the stage and aggressiveness of the cancer, your risk category, age, and overall health. Chemotherapy, radiation, surgery, and other treatments are all available depending on your specific needs.

Therapeutic approaches may include:

  • Cryosurgery involves controlled freezing of the prostate gland to destroy cancer cells while the patient is under anesthesia. This treatment is for men who are not good candidates for surgery or radiotherapy.
  • Radical prostatectomy is the complete surgical removal of the prostate gland along with the pelvic lymph nodes. Radical prostatectomy may be performed by a robotic, retropubic, or perineal approach. Robotic-assisted laparoscopic radical prostatectomy (RALP) is the most common type of prostate cancer surgery done today.
  • Hormonal ablation therapy is performed either surgically or through medication. Drugs are used to block or lower testosterone and other male sex hormones that fuel cancer.
  • Observation: Active surveillance entails patients being monitored for cancer growth with regular PSA tests, DREs, and periodic biopsies. Progression of the disease would be an indication to change plans and treatment modality.
  • Radiation therapy is an effective treatment that uses ionizing radiation to destroy cancer cells.
  • High-intensity focused ultrasound (HIFU) — Uses the energy of sound waves to target and superheat the tumor to kill cells (with the help of MRI scans). Learn more about HIFU.
  • Advanced cancer therapeutics (ACT) — ACT is a term used to describe treatment for cancers that are advanced beyond their organ of origin or for high-risk cancers. Whether it’s a primary or secondary cancer, the ACT Team strives to enhance longevity and quality of life.

Recovery

During the first month or two of recovery, the body is repairing the physical trauma caused by the surgery and the incision(s) is also healing. You should refrain from physical activities that place a stress or strain on the abdominal and pelvic regions of the body. Your physician will instruct you as to when it's safe to return to your normal exercise routine.

Men usually are able to achieve partial erections about 3 to 6 months after surgery and then continue to improve as the nerves recover from the trauma of surgery. Despite expert application of the nerve-sparing prostatectomy technique, early recovery of natural erectile function is uncommon. Even when the nerve-sparing surgery is performed with meticulous technique, patients generally do not recover erectile function as quickly as they do urinary continence.

Men can typically resume sexual activity within 4 to 6 weeks after prostate cancer surgery or as soon as they feel an interest and when their urinary continence is under control. The process is gradual for men as their ability to achieve an erection returns. The stimuli for erection during the first year will also be different. Visual stimuli will be less effective, and physical stimulation will be more effective. Re-familiarize yourself with your body, and don’t wait until you have the "perfect erection" before attempting sexual activity. With orgasm, there will not be ejaculate, because the prostate and seminal vesicles have been removed.

Side Effects

It's natural for a man to feel anxious and/or depressed by their prostate cancer. However, with time, as men begin to adapt to their new life and resume the regular activities they enjoy. After total prostate removal, a man may have little or no ejaculate, although there is the sensation of climax and orgasm. Some men experience urinary incontinence after prostate removal, but if there is no return of urine control after one year, further medical intervention is needed. Treatment may include the placement of an artificial urinary sphincter (AUS) or AdVance® Male Sling to improve your quality of life.

Men become permanently sterile as a result of prostate removal, because there is no seminal fluid after the prostatectomy.

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