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Prostate Cancer is expected to strike 234,000 men in 2007. One in six American men are diagnosed with prostate cancer during their lifetime, usually after 60 years of age. Of these newly diagnosed cases, only one in 16 will die from the disease. These excellent survival rates are largely a reflection of improved screening, which has resulted in cancers being diagnosed at earlier stages, and improvements in treatments, which yield better cure rates and fewer complications.
If the cancer is caught in its earliest stages, says the Prostate Cancer Foundation, most men won’t experience any symptoms. An elevated blood test known as PSA is typically the first and only sign that there might be a problem. Some men, however, will experience symptoms such as frequent, hesitant, or burning urination, difficulty in having an erection, or pain or stiffness in the lower back, hips or upper thighs.
In addition to these symptoms, as the cancer progresses, there is an increased risk that it has left the prostate and spread to the immediate vicinity of the gland, the lymph nodes or the bones, according to Dr. Daniel Shasha, Director of Genital Urinary Oncology at Beth Israel Medical Center. Although at this stage the cancer is incurable, it is still treatable, resulting in long-term remission and prolonged life. Once that cancer has left the prostate, more than one form of treatment may be required, including radiation, surgery, and/or hormonal therapy.
However, this high-risk stage is only one of three stages in the disease progression. The other two are early and intermediate. The level of risk spread, the prognosis, and the treatments recommended will primarily be dictated by three tests:
- PSA (prostate specific antigen) is an enzyme produced by the prostate cells. PSA levels are checked by means of a blood test, and they can be used to measure the amount of cancer.
- DRE (digital rectal exam) - During the examination, the doctor gently inserts a lubricated, gloved finger of one hand into the rectum. This is a way of checking for growths in, or an enlargement of, the prostate gland.
- Biopsy - When a biopsy confirms the presence of cancer, it must then be determined how quickly the cancer is growing. This evaluation process, called grading, compares prostate cancer cells with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer. The scale used to determine growth rate is known as a Gleason score. Dr. Shasha said that a Gleason score of between two and six indicates early stage prostate cancer, a score of seven is intermediate, and a score of eight to ten is the most threatening type of prostate cancer.
A concern during the surgical removal of a prostate is to prevent the patient from remaining incontinent. On rare occasions, damage can occur during surgery to the urinary sphincter, which controls flow and leakage. To avoid this, some cancerous cells may be left behind in the periphery of the prostate gland. Radiation removes those cells.
As Dr. Shasha noted, “The goal of radiation therapy is to deliver as much radiation as we safely can. Higher doses translate into improved cure rates.” That’s one way in which the implantation of radioactive seeds offers a distinct advantage over surgery. They are directly injected into the prostate, delivering a high dose of radiation safely and effectively, while minimizing damage to the bladder or rectum. They can be used alone or in conjunction with radiation. Dr. Shasha said, “Radioactive seeds have as good cure rates as surgery in men with 15 or more years of follow-up.”
The implantation procedure is done on an outpatient basis in a hospital or ambulatory surgical facility under general or spinal anesthesia. The procedure itself lasts between 30-40 minutes, and the patient spends between one to two hours in recovery. The patient is discharged, without a catheter, as soon as he urinates.
There are certain side effects. The patient will see blood in his urine for a few days, and blood in his ejaculate for a few weeks. He will also experience a mild burning when urinating, a weakness of stream, and frequent urination at night. However, there is no pain associated with the procedure, and within six to 12 weeks the side effects will be gone and the patient will be back to normal. He may require medication to help return him to normal, but the medication is temporary and will be stopped within several months of the implant.
Dr. Shasha said radioactive seeds are a “drive through treatment for patients.” But despite his humorous analogy, Dr. Shasha noted some serious advantages to radioactive seeds:
- Better potency rates – Only one-third of the patients with seed implants experience erectile dysfunction as opposed to half of the men treated with radiation.
- Less chance of incontinence – Only two percent or less of the men treated with radioactive seeds experienced incontinence.
- Less treatment time – Radiation therapy requires eight to ten weeks of daily treatments, while the total time spent at the hospital for the implantation procedure is about 2 to 3 hours.
If you’ve been diagnosed with prostate cancer, time is of the essence. Talk to your doctor as soon as possible about the benefits, risks and side effects associated with each type of treatment. Dr. Shasha said, "For those men diagnosed with high-grade prostate cancer, even if it remains localized in the prostate, I would encourage them to talk with their doctors about commencing treatment immediately. Barring any medical condition that precludes assertive treatment, it is imperative to attack the faster-growing grade of prostate cancer as quickly as possible."
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