Prostate Cancer: What Men Need to Know

Found only in males, the prostate is a walnut-sized gland that is part of the reproductive system located below the bladder and in front of the rectum. Cancer can develop when cells in the prostate begin to grow out of control. While there are a few rare forms of prostate cancer (i.e., sarcomas, neuroendocrine tumors), almost all are diagnosed as adenocarcinomas that develop from gland cells.

Why It’s So Important to Be Aware of Prostate Cancer

Prostate cancer is the second most common form of cancer that occurs in men in the US. According to the American Cancer Society, approximately 268,490 men will be diagnosed with prostate cancer in 2022, and an estimated 34,500 deaths will occur from prostate cancer this year.

While 1 in 8 men will be diagnosed with prostate cancer at some point in their life, the rate of diagnosis goes up with age. For example, 1 in 451 males under the age of 50 will be diagnosed, 1 in 55 between the ages of 50-59, and 1 in 20 for ages 60-69. Men over the age of 65 will represent close to 60% of the diagnoses.

Prostate cancer is typically detected when the cancer is confined to the prostate and localized areas. For men diagnosed in the early stage of prostate cancer, the 5-year survival rate is greater than 99%. Despite the high percentage of positive outcomes, it’s important to recognize that it is still a deadly disease for some men and it’s important to know the signs and symptoms to catch and treat the cancer as soon as possible.

Early Signs and Symptoms of Prostate Cancer

Most men with prostate cancer will experience no symptoms at all, hence the importance of screening.  When symptoms do occur, it often indicates locally advance or advance prostate cancer.  When symptoms do occur, they may include the following:

  • Difficulty starting or holding back urination
  • Frequent urination especially at night
  • Pain or burning during urination
  • Blood or urine in semen
  • Painful ejaculation or decrease in amount of semen ejaculated
  • Incessant pain or stiffness in low back, hips, pelvis and/or thighs

Keep in mind that these symptoms may indicate conditions other than prostate cancer which may also require medical evaluation. This is why it’s so important to see a urologist if you are having any of the symptoms above, and especially if you are seeing a combination of these symptoms.

Risk Factors for Prostate Cancer

All males have some level of risk for prostate cancer, but there are contributing factors that may increase the risk of developing this disease that include:

  • Increased age – especially if you’re 65 or older
  • Having a family history of prostate cancer
  • Ethnicity – African American men are 1.7 times more likely to be diagnosed with prostate cancer.
  • Unhealthy lifestyle- being overweight or obese

There are also existing studies suggesting that a history of breast cancer in the family may increase the risk for a man to develop prostate cancer.

Prostate Cancer Screening to Determine if Treatment is Necessary

If you are at a high risk for prostate cancer, and/or are showing early signs of prostate cancer, you will want to make an appointment with a urologist for screening. Screening for prostate cancer is something to be discussed with your doctor who will review your personal risk factors, the benefits and harms of screening including the pros and cons of other tests and treatment, and if you have other medical conditions that may make it difficult to treat prostate cancer (find a urologist near you here).

If the decision is made to have a prostate screening there are two main ways in which to screen for prostate cancer.

Prostate Specific Antigen (PSA) Test

PSA is a substance made in the prostate. A blood test called a PSA test measures the levels of PSA in the blood. High levels of PSA may indicate prostate cancer or other conditions that affect the prostate.

Digital Rectal Exam (DRE)

The DRE exam is when your doctor carefully inserts a lubricated, gloved finger into your rectum to determine if your prostate feels enlarged or if a nodule, lump, asymmetry, or other irregularity is felt that may indicate an underlying prostate cancer. This procedure may feel uncomfortable but it isn’t painful.

Diagnosing Prostate Cancer

If your prostate screening detects an abnormality, your doctor may suggest more testing to determine if you have prostate cancer, including:

  • Ultrasound which uses sound waves to create an image of the prostate.
  • Magnetic Resonance Imaging (MRI) scan to get a more detailed image of the prostate.
  • Prostate biopsy to collect prostate tissue cells that are analyzed in a lab to determine if cancer cells are present.

Treatment Options for Prostate Cancer

If prostate cancer is diagnosed, you and your doctor will discuss one or more treatment options depending on certain factors such as stage of the cancer, age, PSA test results, type of cancer, urinary symptoms, medical co-morbidities and other important considerations. Some treatment options consist of the following:

Active Surveillance

Certain prostate cancers can be slow growing, and if localized (hasn’t grown outside the prostate), it may not be a significant threat. In this case, the doctor may discuss ‘active surveillance’ as an option.

You will be regularly tested and closely monitored to see if the cancer progresses. Rather than going directly into treatment, active surveillance may avoid treatment-related side effects.

Prostatectomy

A prostatectomy is a surgical procedure to remove the prostate and surrounding tissue. The vast majority of prostatectomies for prostate cancer are done using a robotic-assisted laparoscopic technique.

Hormone Therapy

Hormone therapy treatments stop the body from creating the male hormone testosterone. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly.

Medication

There are a variety of different medications available at the urologist’s disposal to help fight prostate cancer.

Radiation Therapy

Radiation therapy uses high-powered beams of intense energy to kill cancer cells.

Freezing or Heating the Prostate

Cryotherapy or cryoablation is the repeated cycle of using very cold gas to freeze and then thaw prostate tissue which kills cancer cells and some surrounding tissue.

Heating the prostate tissue uses concentrated ultrasound energy called high-intensity focused ultrasound (HIFU) to cause the prostate tissue to die.

Chemotherapy

Chemotherapy is an option for treating prostate cancer that has spread to other areas of the body. It uses drugs to target cells that grow and divide quickly such as cancer cells.

Immunotherapy

Immunotherapy is used to stimulate or boost a person’s own natural immune system defenses.

Make an Appointment with a Urologist

If you find yourself experiencing any signs or symptoms of concern, or think your symptoms warrant a more in-depth evaluation, contact one of our urology specialists.

 

Written by Dr. Andrew Siegel

10 Treatment Options for Menopause

More than 50 million women in the United States will are over the age of 51, the average age that menopause occurs. Yet in some ways, menopause is the last taboo subject among women, many of whom are hesitant to talk about hot flashes, hormone imbalances, and a type of thinning hair that’s different from that of women in their 20s and 30s. But times are changing.

Menopause is defined as having gone 12 months without a menstrual period. The years leading up to that time may include irregular periods which may or may not be quite heavy, moodiness, fatigue, and weight gain. Most of these changes occur because of changes to the body’s production of both estrogen and progesterone, both of which are produced by the ovaries. In addition, many begin to suffer with urinary incontinence, which, while being common, is not a normal part of aging.

Fortunately, there are a multitude of effective treatment options that are both hormonal and non-hormonal. However, only about 10% of women seek medical advice during the menopausal period. Many women require no treatment, however, if symptoms are affecting a woman’s daily life she should see her doctor. The treatment options available will depend on the symptoms, medical history, and preferences of the patient.

Available treatment options include:

  1. Herbal Remedies – Soy, Black Cohosh, Relizen. These are non-estrogen compounds that while have not been specifically FDA-approved for the treatment of peri-menopausal symptoms, research studies suggest an improvement in symptoms with minimal side-effects.
  2. Paroxetine (Brisdelle) – This is the only non-hormonal FDA approved treatment for peri-menopausal symptoms.
  3. Hormone Replacement Therapy (HRT) – This is considered to be the most effective treatment to treat the above symptoms. Hormone therapy can be received by a simple patch on the skin that releases estrogen and progestin. In addition to treating many troublesome menopausal symptoms, HRT also helps to prevent osteoporosis, and lowers colorectal cancer risk. While most formulations of HRT are safe, some may raise the risk of breast, ovarian or uterine cancer, as well as raise the risk of coronary heart disease, stroke, and memory loss.
  4. Low-dose Antidepressants – Effexor, Prozac, Paxil, Celexa or Zoloft.
  5. Omega 3s – May ease psychological distress and depressive symptoms often suffered by menopausal and peri-menopausal women.
  6. Gabapentin (Neurontin) – This is effective in treating hot flashes. It is commonly used for treating seizures.
  7. Vaginal Estrogen – Vaginal estrogen may be applied locally using a tablet, ring or cream. This medication effectively treats vaginal dryness, discomfort during intercourse, as well as some urinary problems. A small amount of estrogen is released and absorbed by the vaginal tissue.
  8. Ristela – A novel herbal therapy functions to increase nitric oxide concentrations in the vagina. This leads to the increased blood supply to the vagina which results in increased libido and improved sexual function.
  9. Exercise.
  10. Hypnosis and Acupuncture – May prove effective for the treatment of hot flashes. Researchers reported in the Journal of Menopause, in October 2012, that hypnosis can reduce the symptoms of menopausal hot flashes by up to 74%.

Written by Dr. Paul Littman

Dr. Littman became the first urogynecologist to practice in Sussex, Warren, and Morris counties. He has brought a multitude of novel, minimally-invasive outpatient procedures to northwestern New Jersey including single-incision vaginal approaches to correct both urinary incontinence and pelvic organ prolapse, robotic surgery, sacral neuromodulation, botox-injections, and acupuncture-based treatments.

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