Updated on June 15, 2022
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SUNDAY, July 7, 2002 (HealthDayNews) -- No wonder the mention of prostate cancer makes many men shudder. It's the second leading cause of cancer deaths in American men, exceeded only by lung cancer.
However, if detected early, it's a very treatable cancer, even though the exact cause isn't known and the side effects of some therapies can diminish a man's quality of life.
About 189,000 new cases of prostate cancer will be diagnosed in American men this year, the American Cancer Society says.
Upon diagnosis, most men have a range of treatment options, from surgery to radiation to hormone therapy. The best choice depends on their age, health and concerns about side effects.
In general, surgery or radiation treatment continue to be the best options, says Dr. Arnold Kwart, chairman of the urology department at the Washington Hospital Center in Washington, D.C.
"Drug or hormone treatments are, by and large, palliatives," Kwart says. "If they're curative, they're curative maybe in about 10 percent of patients."
The prostate is a walnut-sized gland located just below a man's bladder, and its function is to produce fluids for semen.
Although men of any age can get prostate cancer, it's most often found in those over 50, and more than 70 percent of all cases are diagnosed in men over age 65. It's about twice as common among black men as it is among white men. It's most common in North America and western Europe, less so in Asia, Africa and South America, the cancer society says.
The best way to survive prostate cancer is to detect it early. Although some 30,200 men in the United States are expected to die of the disease this year, most cases are survivable with early detection, doctors say.
Men should begin regular screenings for prostate cancer at age 50, says Dr. Judd Moul, a clinical urologist at Walter Reed Army Medical Center in Bethesda, Md., and director of the Center for Prostate Disease Research.
If men belong to high-risk groups -- for example, if they're black or have a history of prostate cancer in their family -- they should start screenings as young as age 40, Moul says.
"The secret is picking it up early," he says.
The National Comprehensive Cancer Network says that once prostate cancer is detected, the treatment options are:
- Radical prostatectomy: This is the removal of the entire prostate gland. Surgeons enter through an incision in either the lower abdomen or between the scrotum and anus to remove the gland, along with any apparently nearby cancerous tissue.
The main side effects of such surgery are incontinence and impotence. While bladder control usually returns within a few weeks of surgery, up to 35 percent of men report passing a small amount of urine while sneezing, coughing, laughing or exercising. Between 2 percent and 5 percent of men report more severe incontinence.
Impotence is a more common side effect of the surgery. For up to a year, most men will not be able to maintain an erection. Moul says impotence can be limited if the surgeon is able to perform a nerve-sparing prostatectomy, which leaves the nerves on either side of the gland intact.
"It's the gold standard, as far as treatments go," he says.
Under a normal prostatectomy, between 65 percent and 90 percent of men will become impotent, depending on their age. Nerve-sparing surgery reduces the impotence rate to between 25 percent and 30 percent for men under 60.
- Radiation therapy: Two options exist for this type of therapy, either external beam radiation or internal radiation treatment.
External beam radiation is much like getting a standard X-ray, only for a longer time. Patients usually receive treatment five days a week in an outpatient center for seven or eight weeks, with each treatment lasting a few minutes.
Internal radiation therapy uses radioactive pellets the size of a grain of rice that are implanted into the prostate. The radioactive materials are placed inside thin needles, which are inserted through the area between the scrotum and anus, into the prostate.
The side effects of external beam radiation therapy include diarrhea, colitis, frequent urination, a feeling of fatigue and impotence, which can be temporary or permanent. Internal radiation therapy can cause impotence, incontinence and bowel problems. Rectal problems such as burning, pain and diarrhea may occur in up to 5 percent of patients and are difficult to treat once they develop.
- Hormone therapy: This involves lowering male hormones, also known as androgens. The main androgen is testosterone. Produced primarily in the testicles, androgens cause prostate cancer cells to grow. Prostate cancers can shrink or grow more slowly when androgen levels are lowered, but hormone therapy doesn't cure the cancer.
Male hormone levels can be lowered through orchiectomy -- an operation to remove the testicles -- or through the use of drugs to decrease testosterone. The drugs include luteinizing hormone-releasing hormone (LHRH) analogs like leuprolide (Lupron) and goserelin (Zoladex), which reduce the amount of testosterone in the body. There are also anti-androgens like flutamide (Eulexin), bicalutamide (Casodex), and nilutamide (Nilandron), which stop the body's ability to use androgens.
Hormone therapy can cause impotence, hot flashes and growth of breast tissue. A recent study by the National Cancer Institute found men who had the therapy were more than twice as likely to suffer impotence than men who didn't undergo the treatment, and five times more likely to suffer hot flashes and breast swelling.
In the end, all these therapies might work best when combined together. Moul says that over the last couple of years, more consideration has been given to treatments that blend the available options.
"It may make more sense to attack the cancer through different means than relying solely on one form of therapy," he says.
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