Prostate cancer treatment

Prostate cancer is a condition where there are cancerous cells in the prostatic tissue.  Signs of prostate cancer can include a weak urinary flow or an increase in urination.  There are tests the patient can take to see if they have prostate cancer, including a prostatic ultrasound, a digital rectal examination, and a prostate specific antigen (PSA) test.  Prostate cancer is most common among elderly men.  In the United States, about one out of every 5 men will have this type of cancer.

Other conditions may result in the same symptoms.  The patient may not have prostate cancer at all and will have benign prostatic hypertrophy (BPH) instead.  The doctor will be able to tell the difference between the two by doing a biopsy of the prostate gland.  If prostate cancer is present, the patient will start treatment by having surgery on the prostate gland.

The following procedures and tests may be used to make the diagnosis of prostate cancer:

• A medical history and physical examination. The doctor will take a complete history and physical examination, looking for evidence of metastatic prostate cancer.  A history of the patient’s habits, such as alcohol intake and tobacco use, will be taken as well.
• Digital rectal examination.  This is an examination of the rectum.  The doctor will use a lubricated glove and will insert a finger into the rectum, checking for abnormalities that might indicate the presence of a cancer. 
• PSA.  This is a blood test that measures the amount of prostate specific antigen in the blood.  It can tell if the patient has an elevation in an antigen only found in the prostate gland.  It is often elevated in prostate cancer but can be seen in benign prostatic hypertrophy as well.
• Transrectal ultrasound.  This is a test where the doctor inserts an ultrasound probe into the rectum and evaluates the prostate gland for any abnormalities, such as lumps suspicious for prostate cancer.
• Transrectal MRI.  This is a test that uses a strong magnet, a computer, and radio waves that can provide cross-sectional and 3 dimensional images of the prostate gland. 
• Biopsy. This involves taking a sample of the prostate gland tissue and looking at it under the microscope.  The biopsy can tell the grade of the cancer, which is a measurement of the degree of virulence in the cancer cells.

Besides eating well, getting plenty of rest, and remaining physically active, there are essential steps the patient may need to take prior to prostate cancer surgery to make sure the patient is healthy enough for surgery. 

The patient may be taking aspirin, anti-inflammatory medications, or blood thinners that must be stopped at least two weeks before having prostate cancer surgery.  These can cause bleeding before surgery so as not to have bleeding complications during the procedure.  The doctor will tell the patient when it is okay to restart the medications. 

The patient will need to be cleared for surgery by the primary care physician prior to surgery.  If the patient doesn’t have a primary care physician, the oncologist may be able to recommend one.  The patient may undergo tests prior to surgery, including bloodwork, an EKG, and possibly a chest x-ray.  A bone scan may need to be performed to see if the patient has metastatic disease, which may change the treatment outcome.

It is recommended that the patient engage in moderate activity and exercise before surgery.  This helps promote healing and keeps the patient healthy prior to having the procedure.  If the patient is already exercising on a regular basis, they need to continue this up until the day before surgery.  If the patient is sedentary, they should start by taking walks up to a mile every day.  After surgery, the doctor will recommend walking up to three miles per day so it pays to exercise before surgery. 

The patient will have a bowel prep before surgery.  This involves drinking a bottle of magnesium citrate the morning prior to the procedure. This helps clean out the bowels before surgery. The patient will also need to take a Fleet enema in the evening prior to the procedure.  They need to also drink plenty of fluids before the surgery as the bowel preparation will cause a significant loss of fluid.

Even though there is very little blood loss in the surgery for prostate cancer, the patient may also donate some of their own blood in case they need it at the time of surgery.  If the blood isn’t used for surgery, it will go back into circulation for some other patient.

After surgery, the patient can expect that the cancer has been destroyed.  Finally getting over treatment can be both exciting and stressful.  The patient may continue to worry that the cancer is going to come back. Fortunately, this is rarely the case and, even if the patient has recurrence of the cancer, there are treatments that can keep the cancer in check. 

In some cases, the patient may have recurrence of the cancer.  If this happens, the cancer can spread to the bone, resulting in painful bone lesions.  This is when hormone treatment is started in order to prevent further growth of the cancer. Some patients will be castrated to prevent male hormones from making the cancer worse. This is when hormone treatment is started in order to prevent further growth of the cancer. Some patients will be castrated to prevent male hormones from making the cancer worse.

After surgery, the patient needs to talk with their doctor about which tests need to be done postoperatively.  This may involve tests that screen for other types of diseases the patient might come down with.  The doctors will need to follow the patient closely after the procedure to make sure the cancer does not return. 

Postoperative doctor’s visits generally include repeating the PSA exam and doing repeat digital rectal examinations (if the prostate gland hasn’t been removed at the time of surgery).  Such postoperative visits usually start a couple of months after treatment for prostate cancer.  Repeat prostate specific antigen tests are generally done every six months in order to make sure the cancer has not come back. 

Prostate cancer treatment is often done when the patient has had documented evidence through a positive biopsy that indicates the patient has prostate cancer.  Most patients receive prostate cancer surgery as a first-line therapy for the treatment of prostate cancer.  Chemotherapy and hormonal therapy are done after the surgery is completed.

After surgery, the patient generally is cured of their cancer.  The chances of recovery from prostate cancer treatment depend on whether or not the cancer has just been diagnosed, the patient’s age, and the stage of the cancer at the time of diagnosis.