PROSTATE CANCER

There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:

• A frequent need to urinate, especially at night.
• Difficulty starting or stopping a stream of urine.
• A weak or interrupted urinary stream.
• Leaking of urine when laughing or coughing.
• Inability to urinate standing up.
• A painful or burning sensation during urination or ejaculation.
• Bone pain.
• Blood in urine or semen.
• Erectile dysfunction.

Symptoms of advanced prostate cancer include:

• Dull, deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs; pain in the bones of those areas.
• Loss of weight and appetite, fatigue, nausea, or vomiting.
• Swelling of the lower extremities.
• Weakness or paralysis in the lower limbs, often with constipation.

DIAGNOSIS

It is recommended for men to have their prostate screened by their 50s.  To screen for prostate cancer, the doctor performs the following:

• Digital rectal exam (DRE). The doctor looks for any abnormalities in the texture, shape or size of your gland, by inserting a gloved finger in the rectum.
• Prostate-specific antigen (PSA) test. PSA, is a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream, but if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

Diagnosing prostate cancer

If an abnormality is detected on a DRE or PSA test, your doctor may recommend tests to determine whether you have prostate cancer, such as:

• Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate.
• Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy).

RECOMMENDED MEDICATIONS

Conventional medical treatment options for prostate cancer include:

• Watchful waiting. For men diagnosed with very early-stage prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance.
• Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes.
• Radiation therapy. Radiation therapy uses high-powered energy to kill cancer cells.
• Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. Initial attempts to use cryosurgery for prostate cancer resulted in high complication rates and unacceptable side effects. However, newer technologies have lowered complication rates, improved cancer control and made the procedure easier to tolerate. Cryosurgery may be an option for men who haven’t been helped by radiation therapy.
• Hormonal therapy. Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly.
• Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy.
• Immunotherapy and other targeted therapies. This treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer, then injects the cells back into your body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple treatments.
• Bisphosphonates and denosumab.
• Radiopharmaceuticals (radioactive substances used as drugs).
• Research techniques including high-intensity focused ultrasound (HIFU).