Introduction

Cancer of the prostate is the most common form of cancer that affects men. About 240,000 American men are diagnosed with prostate cancer every year.

The earlier prostate cancer is found, the better are the chances of a successful treatment.

This reference summary will help you understand what prostate cancer is and how it can be diagnosed and treated.

Cancer and Its Causes

The body is made up of very small cells. Normal cells in the body grow and die in a controlled way as the body needs them. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor.

If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are rarely life threatening.

If the tumor invades and destroys nearby cells, it is called a malignant tumor or cancer.

Cancer may threaten a person’s life. Cancerous cells may also spread to different parts of the body through blood vessels and lymph channels.

Lymph is a nearly clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes.

Cancer treatments are used to kill or control abnormally growing, cancerous cells.

Cancers in the body are given names depending on where the cancer originates.

Cancer that begins in the lungs will always be called a lung cancer, even if it has spread to another place such as the liver, bones, or brain. Although doctors can locate where a cancer begins, the cause of a cancer in a patient cannot usually be identified.

Cells contain hereditary or genetic materials called chromosomes. This genetic material controls the growth of the cell. Cancer always arises from changes that occur in these genetic materials.

When the genetic material in a cell becomes abnormal, it can lose its ability to control its growth. These sudden changes in genetic material can occur for a variety of reasons. This tendency may be inherited from parents. Changes in genetic materials may also occur because of exposure to infections, drugs, tobacco, chemicals, or other factors.

Prostate Cancer – Diagnosis

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Often early cancer of the prostate has no symptoms. To examine the prostate, usually your doctor will insert a gloved finger into the rectum to feel for lumps in the prostate.

This is called digital rectal examination. Sometimes the tumor may be too small for the doctor to feel during a rectal examination. As the cancer grows, it squeezes the urethra. Urine passes through the urethra when a man empties his bladder.

That is why the first symptom of prostate cancer is usually difficulty urinating. Note, however, that other diseases can also cause difficulty in urination.

The speed at which cancer grows varies from person to person.

The earlier the prostate cancer is detected, the better are the chances of a successful treatment. That is why doctors recommend a blood test called a PSA test to help find prostate cancer during its early stages.

PSA (Prostatic Specific Antigen) is a substance in the blood that may indicate prostate cancer. If the amount of PSA in the blood is higher than normal or if the doctor feels a lump during a rectal examination, the doctor will consider further prostate cancer testing. High levels of PSA do NOT always mean that the patient has prostate cancer; there are other causes for elevated PSA levels.

Some tests help the doctor see the prostate and other parts of the body where the cancer may spread. Examples of such tests are

• Ultrasound

 • X-ray

• IVP

• Bone scan, and

• MRI.

Your doctor may take cells from your prostate and look at them under the microscope.

Your doctor will usually do this by putting a needle into the prostate to remove some cells. This is called fine needle biopsy.

Once cancer of the prostate has been diagnosed, more tests will be done to find out if cancer cells have spread from the prostate to tissues surrounding it or to other parts of the body.

This is called staging. To plan treatment, your doctor needs to know the stage of the cancer.

Staging

If the patient has cancer, it is important to determine

• How much the cancer has grown and

• If the cancer has spread to other parts of the body.

These two pieces of information help your doctor determine the stage of a cancer.

Knowing the stage of the cancer helps the doctor determine the best treatment options.

A pathologist carefully analyzes cells and tissues taken from the prostate cancer.

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A pathologist is a doctor who examines a sample of your cancer under the microscope.

Doctors group prostate cancer into four stages. The higher the stage, the more advanced is the cancer.

Stage 1 or A

The prostate cancer at this stage cannot be felt and causes no symptoms.

The cancer is only in the prostate and usually is found accidentally when surgery is done for other reasons. It is too small to be felt during a rectal examination.

Stage 2 or B

The tumor is still located within the prostate but is large enough to be felt during rectal examination. There are often no symptoms.

Stage 3 or C

Cancer cells have spread outside the prostate to surrounding tissues, but not to the lymph nodes. Difficulty in urinating is common.

Stage 4 or D

Cancer cells have spread to lymph nodes near or far from the prostate or to organs and tissues far away from the prostate, such as a bone, the liver, or lungs. The patient may experience difficulty urinating, bone pain, weight loss, and tiredness.

Treatment Options

Treatment of cancer of the prostate depends on the stage of the cancer, as well as the patient’s age and his overall health.

Your doctor may follow your condition more closely rather than starting treatment immediately. This decision depends on whether

• you have symptoms

• are elderly

• have another more serious illness, or

• have only slightly abnormal tumor cells.

New advances in medical technology and knowledge make it possible to treat all patients who have cancer of the prostate. Thousands of men with prostate cancer are living longer with less discomfort and fewer treatment side effects.

Four kinds of treatment are commonly used :

1. Surgery.

2. Radiation therapy using high dose x-rays or other high-energy rays to kill cancer cells.

3. Hormonal therapy using hormones to stop cancer cells from growing.

4. A combination of radiation and hormonal therapy. Sometimes chemotherapy is given when the hormonal therapy isn’t working.

Surgery can be used to remove cancer from the prostate and from nearby tissues into which the cancer has spread. Surgery is generally recommended during the early stages of the cancer. If prostate cancer is found in its early stages, surgery may cure the disease.

Several surgical options are available to remove prostate cancer. One procedure involves removing the prostate through the perineum, the area between the scrotum and the anus. This procedure is called radical perineal prostatectomy. The entire prostate and nearby cancerous tissue are removed.

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Another radical prostatectomy procedure for removing the prostate cancer and nearby lymph nodes is done through an incision through the lower abdomen. This procedure is called radical retropubic prostatectomy.

The radical prostatectomy can be done with the help of a robot, the Da Vinci system ®.

Another procedure, called cryosurgery, involves killing the cancer by freezing.

Radiation therapy is the use of high-energy radiation to kill cancer cells and shrink tumors.

Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation in the area where the cancer cells are found (internal radiation therapy or brachytherapy).

Because the rays cannot be directed perfectly, they may damage both cancerous and healthy cells nearby. If the dose of radiation is small and spread over time, the cancer cells die while the healthy cells are able to recover and survive.

Radiation therapy usually is given for prostate cancer that has not spread to other parts of the body, such as lungs and bones. It may also help stop the cancer from spreading further. Radiation therapy may cure the disease if the cancer is in its early stages. It may also relieve pain if the prostate cancer has spread to the bones.

Proton Therapy for Prostate Cancer Treatment

Traditional prostate cancer treatment involving surgery or radiation carries the risk of serious toxicity and side effects. The potential long-term impact of these side effects on quality of life forces men to make a difficult choice during a stressful time. Proton radiation for prostate cancer treatment, however, offers an innovative method of radiation treatment intended to lower the risk of prostate cancer treatments and side effects.

For treating cancer of the prostate, proton therapy offers multiple benefits:

    • Excellent control of tumors, thanks to more precise targeting of radiation
    • Lower risk of damage to healthy tissue surrounding the prostate cancer
    • Better quality of life for patients undergoing prostate proton therapy treatments

An alternative to traditional prostate cancer treatment, proton radiation for prostate cancer delivers precise doses of radiation with a lower risk of side effects.

For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.

The difference is in the protons themselves. Since physicians have greater control over the distribution of the proton radiation dose, higher, more effective doses can be used.

And since proton therapy lacks an “exit dose,” and has a lower entrance dose than conventional X-rays, damage to critical tissue near the prostate is reduced, potentially lessening the likelihood of prostate cancer side effects like impotence, incontinence and gastrointestinal disorders.

The figure below demonstrates the difference in radiation dose distribution between a conventional IMRT plan on the right and a proton plan on the left.

As apparent, much less of the pelvis is exposed to radiation with the proton plan, likely leading to a lower risk of secondary cancers in prostate cancer survivors.

Also apparent is a lower dose of radiation to the rectum, which may lead to a lower risk of rectal injury with proton therapy.

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Proton therapy improves the quality of life for prostate cancer patients and survivors.

Reduced risk of incontinence

Radiation to the bladder and surrounding areas caused by conventional prostate cancer treatments can cause incontinence. Because proton therapy limits the radiation to the tumor itself, patients have a greater chance of avoiding urinary complications such as involuntary leakage.

Reduced risk of erectile dysfunction

Treating prostate cancer with surgery can result in erectile dysfunction is one of the most common side effects. Due to proton therapy’s targeted approach, studies have found that patients treated using this method have a significantly reduced risk of impotence, with 94% of men reporting that they remain sexually active after treatment.

Fewer gastrointestinal side effects

Multiple peer-reviewed prospective studies have found that proton therapy reduces the risk of gastrointestinal side effects in comparison to other prostate cancer treatments such as IMRT and conformal radiation therapy. This attributes to the fact that proton therapy decreases the radiation dose to gastrointestinal structures by at least 59% compared to X-rays.

Painless treatment and recovery

Proton therapy is a relatively painless, non-invasive outpatient procedure. It does not require recovery time and has little to no impact on a patient’s energy level. At Andalus Proton Therapy Center, the once-daily therapy sessions last only about 15 minutes total, leaving you plenty of time to continue leading an active lifestyle.

What to expect

Each patient’s therapy is precisely tailored to their needs. Patients and clinicians collaborate closely to create a personalized treatment plan. The number and length of treatments will vary, based on the cancer. How patients respond depends on many factors, including the types of breast cancer treatments they are receiving. Many people tolerate proton therapy well and continue to perform normal activities. However, individual responses vary.

Benefits of proton prostate cancer treatment

Proton therapy improves the quality of life for prostate cancer patients and survivors by offering a number of compelling benefits:

    • It is non-invasive and therefore painless
    • It is more accurate than other kinds of radiation
    • Full or higher doses of radiation can be used for treatment without damaging healthy tissues and organs
    • Treatment is provided in an outpatient setting
    • Proton radiation therapy does not require recovery time
    • The treatment has little to no impact on a patient’s energy level
    • Proton therapy poses minimal risk of impotency
    • The treatment has lower risk of side effects compared with conventional treatment.