Prostate Cancer: Surgery vs. Watchful Waiting

What is prostate cancer?

Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. The tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs (abnormalities on physical examination). As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.

Why is prostate cancer important?

Prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer. Most experts in this field, therefore, recommend that beginning at age 40, all men should undergo yearly screening for prostate cancer.

Risk factors have been linked with development of this condition: -

* Age: – There is a strong correlation between increasing age and developing prostate cancer. The incidence of prostate cancer increases steadily from fewer than 1 in 100,000 for men aged 40 years to 1146 per 100,000 in men aged 85 years. The median age at diagnosis of prostate cancer is 70.5 years. More than 80% of prostate cancers are diagnosed in men older than 65 years. Autopsy records indicate that 70% of men older than 90 years have at least one region of cancer in their prostate.

* Race: – African American men are 1.5-2 times more likely than white men to develop prostate cancer. African American men also appear to develop prostate cancer at an earlier age.

* Genetic factors: – Men who have a history of prostate cancer in their family, especially if it was a first-degree relative such as a father or brother, are at an increased risk. This risk may be 2-3 times greater than the risk for men without a family history of the disease.

* Diet: – A diet high in fat has been associated with an increased risk of prostate cancer.

Prostate Cancer Symptoms

Most men with prostate cancer have no symptoms. This is particularly true of early prostate cancer.

* Most prostate cancers are discovered incidentally when a digital rectal exam is performed.

* A digital rectal exam is part of a thorough regular health examination. Digital refers to finger.

* During the digital rectal exam, the examiner inserts a gloved and lubricated finger in the rectum to feel the prostate for abnormalities.

Symptoms usually appear when the tumor causes some degree of urinary blockage at the bladder neck or the urethra.

How is prostate cancer diagnosed?

Prostate cancer is diagnosed from the results of a biopsy of the prostate gland. If the digital rectal exam of the prostate or the PSA blood test is abnormal, a prostate cancer is suspected. A biopsy of the prostate is usually then recommended. The biopsy is done from the rectum (trans-rectally) and is guided by ultrasound images of the area. A small piece of prostate tissue is withdrawn through a cutting needle. The TRUS-guided Tru-Cut biopsy is currently the standard method to diagnose prostate cancer. Classically a 6-core set is taken by sampling the base, apex and mid gland on each side of the gland. More cores may be sampled to increase the yield, especially in larger glands. A pathologist then examines the tissue under a microscope for signs of cancer in the cells of the tissue.

Prostate Cancer Treatment

Treatments for prostate cancer are effective in most men.

* They cause both short- and long-term side effects that may be difficult to accept.

* You and your life partner or family members should discuss your treatment options in detail with your urologist and other physicians.

* Make sure you understand which treatments are available, how effective each is likely to be, and what side effects can be expected.

* You must weigh all these choices carefully before making a decision about which course to pursue.

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