and Treatment of Prostate Cancer
rectal examination (DRE)
- A physician performs this physical examination to
determine the consistency of prostate. Healthy prostate
tissue is soft while malignant tissue is firm, hard, and
often asymmetrical or stony. It is an initial evaluation
only as nearly one-third of patients diagnosed with
prostate cancer have a normal DRE.
specific antigen (PSA) and Prostatic acid phosphatase (PAP)Tests -
and total PSA
- Malignant prostate cells produce more bound PSA;
therefore, a low level of free PSA in relation to total
PSA might indicate a cancerous prostate, and a high level
of free PSA compared to total PSA might indicate a normal
prostate, BPH, or prostatitis. A PSA of 4 ng/mL or lower
is considered normal; 4 -10 ng/mL, slightly elevated; 10 -
20, moderately elevated; and 20 - 35, highly elevated.
Most men with slightly elevated PSA levels do not have
prostate cancer, and many men with prostate cancer have
normal PSA levels. A highly elevated level may indicate
the presence of cancer. A false positive result occurs
when the PSA level is elevated and there is no cancer. A
false negative result occurs when the PSA level is normal
and there is cancer. Because of this, a biopsy is usually
performed to confirm or rule out cancer when the PSA level
acid phosphatase (PAP) test Prostatic acid phosphatase is
an enzyme produced by prostate tissue. The level of PAP
increases as prostate disease progresses.
Biopsy - If
a tumor is found, a TRUS guided biopsy is usually
performed to determine the type of cancer, its location,
and stage of development. Pathologist gives Gleason score
to the tissue depending on differentiation of the tumor.
Gleason scores of 2 to 4 indicate that the cells are well
differentiated, meaning the tissue is not too abnormal; 5
to 7 moderately differentiated; 8 to 10 poorly
differentiated. Higher scores suggest aggressive tumors
that likely require aggressive treatment.
tomography (CT scan) - Computer-assisted tomography (CAT
scan or CT scan) is used to determine the involvement of
pelvic lymph nodes.
scan - A bone
scan is a nuclear imaging procedure that is used to detect
metastasis to bones. It is not used in patients with small
cancers and low PSA levels.
for prostate cancer depends on the stage of the disease and
the patient's age and overall health. Elderly patients with
minor symptoms, early stage cancer, or coexisting illness may
be treated conservatively. Watchful waiting is a reasonable
course of action for patients who are elderly, in poor
health, or with early stage cancer. Untreated prostate cancer
may take years to become problematic. Patient stays under
careful observation of physician who monitors his signs and
symptoms periodically investigates him.
therapy for prostate cancer involves the use of antiandrogens
to block production of testosterone, which prostate cancer
cells use to grow. Drugs used for hormone therapy include
leuprolid acetate (Viadur), goserelin acetate implant (Zoladex),
bicalutamide (Casodex), and flutamide (Eulexin). This
prostate cancer treatment suppresses androgen (e.g.,
testosterone, estrogen) production, causing the tumor to
shrink or stop growing and reducing symptoms (e.g., pain,
urinary retention, urinary frequency). Hormone therapy may
often have undesirable side effects for which patient is
for Bone Metastases - Zoledronic acid (Zometa) is a
bisphosphonate prescribed to treat hypercalcemia (excess
calcium in the blood) in prostate cancer patients who have
bone metastases (secondary tumors in bone).
types of radiation therapy are used to treat prostate cancer:
brachytherapy and external radiation therapy (XRT).
This treatment involves implanting tiny, radioactive capsules
into the cancerous prostate gland. The capsule emit radiation
that kills the malignant tumor. Men with small tumors
confined to the prostate (stage T1 or T2) are candidates for
Radiation Treatment (XRT)
External Radiation Treatment is recommended when the tumor
has spread through the prostate capsule to surrounding
tissues. XRT usually is given on an outpatient basis for 7 to
of stage T1, 66% of stage T2, 55% of stage T3, and 22% of
stage T4 prostate cancer patients survived 10 years after
External Radiation Treatment.
- Good candidates for surgery to treat prostate
cancer have one or more of the following characteristics:
Good health ; No spread of cancer to bone ;Tumor confined to
the prostate gland (stage T1 and T2); Under the age of 70
;Expected to live another 10 years or longer ;
on the extent of the disease, there are several surgical
options for prostate cancer-
This is a minimally invasive outpatient
procedure and it destroys cancer cells by twice rapidly
freezing and thawing cancerous tissue. It is recommended
for patients who cannot tolerate surgery or radiation,
have prostate-confined tumors (stage T3 or lower), do not
respond to radiation (both external-beam and brachytherapy),
and are elderly.
Radical Prostatectomy -Laparoscopic
radical prostatectomy causes less bleeding and less
postoperative pain and results in a shorter hospital stay
and recovery period.
prostatectomy is the surgical removal of the prostate
gland and surrounding tissues, including the seminal
vesicles and the pelvic lymph nodes.