Clinical manifestations and pathology of prostate cancer

2.1.3 Clinical manifestations and pathology of prostate cancer

The diagnosis and treatment of prostate cancer continue to evolve. With the development of prostate-specific antigen (PSA) screening, prostate cancer is being diagnosed earlier in the disease course. Although prostate cancer can be a slow-growing cancer, hundreds of men die of the disease each year in Taiwan. Education is important to help men understand the concepts of progression and the various treatment options. This part provided a current overview of the biology, pathology, diagnostic techniques, and screening of this disorder.

2.1.3.1 Signs and symptoms

Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup2, 56, 61, 107-109

. It is highly advised to avoid sexual intercourse for 3 days prior to a PSA test because that affects the outcome of the test. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hyperplasia. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra.

Changes within the gland, therefore, directly affect urinary function. Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content,

prostate cancer may also cause problems with sexual function and performance, such as difficulty achieving erection or painful ejaculation¹⁰⁶.

Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis, or ribs¹⁴. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone.

Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence¹⁰⁷.

2.1.3.2 Treatments

Prostate cancer treatment options depend on several factors, such as how fast cancer growing, how much it has spread, overall health, as well as the benefits and the potential side effects of the treatment. Different treatment policies such as watchful waiting, radiation therapy, chemotherapy hormone therapy, and radical prostatectomy are introduced as follows41, 47-53, 108-112

. For men diagnosed with a very early stage prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend watchful waiting, which is sometimes called active surveillance. In watchful waiting, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation. Watchful waiting may be an option for cancer that isn’t causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Watchful waiting may also be considered for a man who has another serious health condition or an advanced age that makes cancer treatment more difficult. Watchful waiting carries a risk that the cancer may grow and spread between checkups, making it more difficult to treat.

Radiation therapy uses high-powered energy to kill cancer cells. Prostate

cancer radiation therapy can be delivered in two ways: Radiation that comes from outside of body (external beam radiation)⁴⁴. During external beam radiation therapy, directing high-powered energy beams, such as X-rays, to prostate cancer. Typically undergo external beam radiation treatments five days a week for several weeks. Radiation placed inside body (brachytherapy).

Brachytherapy involves placing many rice-sized radioactive seeds in prostate tissue¹⁰⁹. The radioactive seeds deliver a low dose of radiation over a long period of time. Physician implants the radioactive seeds in prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don’t need to be removed. Side effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools.

Erectile dysfunction can also occur. Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy84, 110, 113

.

Hormone therapy is treatment to stop your body from producing the male hormone testosterone¹¹⁴. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of muscle and bone mass, reduced sex drive, and weight gain. Hormone therapy also increases the risk of heart disease and heart attack. Physicians believed long-term use of hormone therapy and the low hormone levels that result may lead to cardiovascular problems.

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. There were four ways of radical prostatectomy procedure, which included making an

incision in your abdomen, making an incision between your anus and scrotum, laparoscopic prostatectomy, and using a robot to assist with surgery. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction42-43, 47, 50, 108, 115-117

. Communicating with physician to discuss any possible risks of each way of procedure was suggested. The risk factors included patients’ disease stage of prostate cancer, age, body type and overall health.