Prostate cancer is the most common cancer (other than skin cancer) diagnosed in men in the United States, with approximately 180,000 cases diagnosed annually. The blood test for prostate specific antigen (PSA), used routinely since 1988, has been the reason for the great increase in detection as well as the trend toward detection at earlier stages. The cause of prostate cancer is unknown; it may be more frequent in some families, suggesting a genetic predisposition in these cases.
Despite the high
incidence of prostate cancer, there is little agreement on how the disease should be
treated in various age groups. In general, prostate cancer is a slowly
progressive disease that is highly curable when diagnosed in its early
stages. Treatment options include radiation therapy, surgery
(prostatectomy), hormonal therapy, observation, or some combination of
these. In early-stage prostate cancer, the longest follow-up is available
for patients treated with surgery; nevertheless, the available data for external
beam radiation therapy and seed implant show outcomes equivalent to those for
surgery. For this reason, Emory Radiation Oncology advises patients with
early prostate cancer to choose their treatment based on other factors such as
the side effect profiles, their desire for an immediate pathologic diagnosis and
staging, their desire to avoid surgery, their ability to visit the clinic daily
for several weeks of outpatient radiation therapy, and similar
considerations.
In-depth
Information
Prostate cancer now is most commonly diagnosed after an elevation in the PSA. Another common presentation is the detection of a nodule on a digital rectal examination (DRE). Patients also may present with urinary obstructive symptoms such as a weak stream, hesitancy, dribbling and incomplete emptying or a sense of retention. Symptoms of bladder dysfunction such as urgency, discomfort with urination, and straining are less common. Blood in the urine is not a common presenting symptom of prostate cancer. Patients with advanced or metastatic disease may present with weight loss, fever, fatigue, kidney failure, anemia, edema (swelling) of the legs and genitalia, or bone pain, but this is very rare.
If a PSA test is elevated or there is a significant change over in a short period of time, or a nodule is felt on DRE, this prompts an evaluation by a urologist. Ultimately this evaluation may lead to a transrectal ultrasound and biopsy of the prostate gland. The biopsy is the gold standard for diagnosing the disease.
The three most important pieces of information for determining the treatment and prognosis are the DRE findings, the pathologic grade (given as the Gleason score) and the PSA. Other tests may be used to determine the extent of disease. A bone scan is often used to evaluate for spread to bone, but it is rarely positive for a PSA less than 20. An endorectal coil MRI may be helpful in looking for disease spread outside the capsule of the prostate gland. A CT scan of the pelvis may be used to look for spread to lymph nodes. The surgical sampling of pelvic lymph nodes either using a standard or laparoscopic approach is the definitive procedure for determining lymph node involvement. Prostascint, a nuclear imaging technique, is also being used to search for lymph node spread or residual cancer in the prostate bed. Many times, depending upon the DRE, PSA and Gleason score, these tests are used sparingly based on the judgment of the evaluating physicians.
At Emory University, we participate in a number of new methods to treat prostate cancer including radioactive seed implants and external beam therapy with IMRT. Click here to learn more about our IMRT Research and Treatment Center. In addition, we participate in a number of clinical trials. Click here to visit our clinical trials center.