Dr. David Samadi Answers Prostate Cancer Questions

I would like to take a moment to answer some common prostate cancer-related questions and remind you about early screening and treatment options.

What is prostate cancer?
Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. The prostate is a gland in the male reproductive system located just below the bladder (surrounding the urethra) and in front of the rectum. The prostate gland produces fluid which makes up part of the semen.

What causes prostate cancer?
It is unclear as to the exact cause of prostate cancer, whether it’s genetic or environmental. Prostate cancer, similar to other cancers, begins when prostate gland cells become abnormal, usually through DNA mutations. These mutations cause the cells to continuously divide and grow more rapidly than other cells.

How common is prostate cancer?
According to the National Cancer Institute, prostate cancer is the second most common form of cancer affecting men in the United States. An estimated 241,000 men will be diagnosed with prostate cancer in 2012; this translates into about 1 in every 6 men. More than seventy percent of men diagnosed with prostate cancer each year are over the age of 65.

If prostate cancer isn’t treated, does it always progress?
It is difficult to make a definitive statement about whether prostate cancer will “always” progress. Whether or not it spreads is dependent on the nature/stage of the disease in the individual.

What screening methods exist and should I be screened?
In light of the recent United States Preventative Services Task Force (USPSTF) recommendations against PSA screening, PSA, in combination with DRE, are the only screening tools we currently have for prostate cancer. Researchers are actively studying to develop alternative screening methods. Depending on your risk factors for the disease (e.g. familial history, race, age, etc.), you and your physician will determine the best course of action.

What is a Gleason score?
A Gleason score is the most commonly used grading system in the U.S. It is based on the appearance of prostate cells under a microscope. In assigning a grade to a tumor, a pathologist will assign a primary grade to the pattern of cancer that is most commonly observed and a secondary grade to the second most commonly observed pattern in the specimen. Gleason scores are always a combination of these 2 numbers. Grades range from 1-5, so scores range from 2-10.

What tests help determine the best treatment for prostate cancer?
There is not one best treatment for all prostate cancer patients. The best treatment option for you depends on your age, comorbidities, past medical history and your expectations. You should speak with your doctor about all possible treatment options and make a decision based on what is best for you.

What are the treatment options for prostate cancer?
• Prostatectomy – removes the cancerous gland, surrounding tissue and a few lymph nodes
• Hormone therapy – eliminates androgens (male hormones) from the body which the prostate cancer cells thrive on
• Radiation therapy – there are 2 types: 1- external beam radiation, which involves a machine delivering high-powered energy beams to your cancer and 2- brachytherapy, which involves the placement of radioactive seeds into your prostate which deliver a low dose of radiation over a long period of time
• Cryosurgery or cryoablation – involves freezing the prostate tissue to kill cancer cells
• Chemotherapy – uses drugs to kill rapidly growing cells, including cancer cells
• Watchful waiting – is the decision not to treat prostate cancer at the time of diagnosis. Instead, the prostate cancer is monitored until it shows signs of causing harm

Will I be incontinent or impotent after treatment for prostate cancer?
Every effort is made to spare the nerves that control these two functions and to securely reconnect the bladder neck to the base of the bladder. Unfortunately, these nerves surround the prostate and must be carefully removed from the gland during surgery. One of the main advantages of this procedure is the fact that the nerves and vessels are all magnified and it is much easier to save them. Return of potency could take up to six months and, in some cases, medications have helped patients.

What are the biggest misconceptions about prostate cancer?
Because of the prostate’s proximity to the delicate nerves that control urinary and sexual function, a lot of men believe that any sort of prostate cancer treatment will render them incontinent and/or impotent. This is why robotic surgery is superior to open surgery; the robot provides a 3-D view of the surgical field which translates to a much better visual field and better depth perception. The high definition video cameras give a 10X to 15X magnification – a view the surgeon could never get with traditional surgery.

What are the biggest mistakes men make regarding prostate cancer?
One of the biggest mistakes men can make regarding prostate cancer is going through it alone. Keep your friends and family close – they can provide support during and after your treatment. Connect with other cancer survivors. Friends and family can’t always understand what it’s like to face cancer. Other cancer survivors provide a unique network of support. You should also learn enough about prostate cancer to feel comfortable making treatment decisions. Finally, understand that your sex life will be different after prostate cancer treatment. Your body takes time to heal, and accordingly, your sexual and urinary function need time to heal also.

How is PSA testing used after treatment of prostate cancer?
PSA is used as an indicator of recurrence after treatment for prostate cancer. Typically a cut of off >0.2ng/mL is indicative of the cancer having spread or returned. The timing of recurrence and the rate of rise in PSA can be used in combination with pathologic stage and grade to help predict where the cancer recurred.

Can lifestyle changes slow the progression of prostate cancer?
There is no conclusive evidence for or against supplementation or dietary changes affecting the progression or prevention of prostate cancer.

If I have prostate cancer, are my family members at higher risk for getting it, too?
Men with a father or brother with prostate cancer are two times as likely to get the disease. Men with three relatives diagnosed with prostate cancer are nearly certain to develop prostate cancer.

Prostate cancer is often referred to as “The Silent Killer.” This month, urge the men important in your life to get screened – “the silent killer” doesn’t always have to kill.

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