The Elusive Danger of Prostate Cancer

June 15, 2019

Prostate cancer is a significant health problem in the United States with about one in nine men diagnosed with prostate cancer in his lifetime. Prostate cancer is the most common cancer in men (not including skin cancer) and is one of the leading causes of cancer death among men. Prostate cancer develops mainly in older men and in African-American men. About six cases in ten are diagnosed in men aged 65 or older.

Prostate cancer is a cancer that occurs in the prostate (a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm). It begins when cells in the prostate gland start to grow uncontrollably. Prostate cancer symptoms oftentimes do not show during the early stages, which makes it even more of an elusive disease.

This type of cancer can be small and slow-growing whereas other times it can be fast growing and progress rapidly. Prostate cancer treatment is most successful when detected early — when it’s still confined to the prostate gland.

Prostate Cancer Symptoms

It often goes undetected as there are typically no real indicative prostate cancer symptoms. As it spreads, oftentimes symptoms may develop such as:

Problems urinating, including a slow or weak urinary stream or the need to urinate more often

– Blood in the urine or semen

– Erectile Dysfunction

– Pain in the hips, back, chest, or other areas from cancer that has spread to bones

– Weakness or numbness in the legs or feet

– Loss of bladder or bowel control from cancer pressing on the spinal cord

Most of these problems are more likely to be caused by something other than prostate cancer. However, in advanced prostate cancer, they could be possible.

Prostate Cancer Risk Factors

Risk factors for prostate cancer are still being researched, however, known links to an increased risk in prostate cancer include:

-Family history: Prostate cancer tends to run in some families. This suggests that there
may be an inherited or genetic factor involved. Having a father or brother with prostate
Cancer more than doubles a man’s risk. The risk is much higher for men with multiple affected relatives, particularly if young when the cancer was detected.

-Age: Prostate cancer is very rare in men younger than 40, but the chance of having prostate cancer rises after age 50. About six in ten cases of prostate cancer are found in men older than 65.

-Race: Prostate cancer occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races.

-Gene Changes: A few inherited gene changes are linked to higher prostate cancer risk. Inherited mutation of the BRCA1 or BRCA2 genes linked to the risk of breast cancer may also increase the risk of prostate cancer in some men. Men with Lynch syndrome (known as hereditary non-polyposis colorectal cancer, or HNPCC), have an increased risk for prostate cancer. Additionally, other inherited gene changes can also raise a man’s risk of prostate cancer

-Geography: Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands.

-Obesity: Although not as direct of a link to prostate cancer, some studies have found that obese men have a lower risk of getting a low-grade (less dangerous) form of prostate cancer, but are at higher risk of getting more aggressive prostate cancer. The reasons for this are not clear.

-Other Factors: Potential prostate cancer risk factors that are being studied or have weak links and still need further research that may increase the risk of prostate cancer include: a diet in high dairy fat, calcium or red meat and low in fruits and vegetables, smoking, chemical exposure, STDs and inflammation or infection of the prostate

Prostate Cancer Diagnosis

Screening for prostate cancer is the best way to detect it early and treat it in its early stages. Annual screening starts for most men at age 50 with a prostate exam (DRE) and a blood test called a PSA (prostate specific antigen) which looks at the “health” of the prostate and helps to rule out prostate cancer.
If cancer is suspected, further blood work, ultrasounds, MRIs and prostate biopsies may be indicated in order to make the diagnosis. The easiest way to detect prostate cancer and catch it early, is to be diligent about getting screened.

Types of Prostate Cancer Treatment

Treatment for prostate cancer depends on the type of cancer (slow growing or aggressive), if it is confined to the prostate only and has not metastasized outside the prostate tissue (the grade and stage of the cancer), age and general health of the patient. Prostate Cancer treatment can include active surveillance (watchful waiting), hormone therapy, chemotherapy, surgery, radiation or a combination of methods.

Oftentimes, a radical prostatectomy (surgery) is the most effective, curative prostate cancer treatment method. A radical prostatectomy is a surgical treatment option for localized prostate cancer. The surgery involves removing the entire prostate gland and seminal vesicles, as well as the surrounding tissue, often including lymph nodes.

For patients with prostate cancer confined to the prostate, the chance of cure with surgery alone at 10 years (with an undetectable PSA) is more than 90 percent. Surgery may be used as the only treatment option, but it also may be part of a broader treatment plan that may include radiation, chemotherapy and hormone therapy.

Types of Prostate Cancer Surgery

There are three different surgical techniques commonly used to perform a radical
Prostatectomy:

• Robot-assisted surgery or Robotics (da Vinci System): A surgeon makes five
incisions, less than the size of a dime, in the lower abdomen. These incisions allow for
instruments attached to a “robot” to precisely target the prostate and surrounding
tissue with minimal invasion. The surgeon is ten feet away controlling the
movements of the robot using a 3D, HD system allowing for a more exact precision
and greater dexterity.

• Open surgery: Typically, the surgeon makes an incision in the lower abdomen to
remove the prostate (retropubic surgery) and any surrounding tissues.

• Laparoscopic surgery: The surgeon makes several small incisions in the lower
abdomen and inserts special tools to assist the removal of the prostate and
surrounding tissues.

Of the three surgical techniques, robotics (da Vinci system) seems to have the best cancer free outcomes with the least potential for risks and complications. Oftentimes, erectile dysfunction and urinary incontinence is temporary and often is restored to normal function within a year of surgery. Pelvic floor physical therapy prior to and after surgery and certain medications can help minimize these risks. As of 2011, 90,000 radical prostatectomies were performed each year in the U.S. Approximately 70,000 of those were done robotically.

Know Where to Go

Dr. Shaw at the Austin Urology Institute is amongst the first surgeons in the Central Texas area to offer da Vinci Robotic Prostatectomy. Trained at Tulane in New Orleans in 2000, he has been performing the Robotic-Assisted Prostatectomy procedures in Austin since 2004.

For more information about prostate cancer or for prostate cancer screening, contact Austin Urology Institute at (512) 694-8888 to make an appointment with a provider.

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