The prostate. It’s probably the body part men least like to think anything could be wrong with. Yet prostate cancer is the second leading cause of cancer death for men in the United States. More than 29,000 men die of the disease each year.
Yet while more than 200,000 men are diagnosed with prostate cancer every year, it’s also one of the most treatable cancers—if it’s caught and treated early. More than 2 million men count themselves as prostate cancer survivors, according to the American Cancer Society.
September is Prostate Cancer Awareness Month—no better time to learn about the disease and the most up-to-date ways to treat it.
First, the biology: The prostate is a walnut-sized organ located just below the bladder and in front of the rectum in men. It produces fluid that is part of semen. The prostate gland surrounds the urethra, which is the tube that carries urine and semen through the penis and out of the body.
There’s no way to really know who will get prostate cancer, although it’s more common in men over age 50. About two out of three prostate cancers occur in men over 65, according to the American Cancer Society. If you have a father, brother or son who has had prostate cancer, you’re more likely to get it. And studies show that black men, for some reason, seem to have a greater chance of developing the disease.
There isn’t, however, a set time when men should get screened for prostate cancer. Not all medical experts agree that screening will save lives, because of the risks of false positives and negatives, and the potential for harsh treatments that aren’t always needed just yet. The best way to decide whether you should get screened is to talk with your doctor.
There are two types of screenings:
- The prostate specific antigen (PSA) test measures the level of PSA, a substance made by the prostate, in the blood. The level is typically higher in men who have prostate cancer. Other conditions, including prostate infections, may also increase PSA levels, however.
- A digital rectum exam is performed to feel the size, shape and hardness of the prostate gland.
Some men don’t show symptoms of prostate cancer. Others can have very different symptoms, including difficulty starting to urinate, weak or interrupted flow of urine, blood in the urine or semen, or frequent urination—especially at night, according to the Centers for Disease Control. Any symptoms are reason enough to seek out a doctor.
Not all prostate cancers are the same—some grow more quickly than others. So it makes sense that treatment is different. Over the past five or so years, the trend has been active surveillance, which basically means what it implies—simply keeping an eye on things if PSA numbers are the slightest bit elevated.
The first step after a prostate cancer diagnosis—or after having a PSA test with high numbers—is a conversation about what treatment route to take, says Dr. Bradley Prestidge, a radiation oncologist and medical director at the Bon Secours Cancer Institute at DePaul Medical Center in Norfolk, Virginia
“Sometimes I spend an hour, to an hour and a half with a new patient going over all the treatments,” Prestidge says. “Most of the time, I prefer the patient to decide what he wants to do.”
If the cancer is a little more advanced, treatment options range from removing the prostate to performing radiation treatments. One type of treatment, called brachytherapy, involves placing tiny radioactive pellets in the prostate that radiate from the inside out.
There are up to nine-week courses of external beam radiation treatments, as well as a newer external therapy called stereotactic body radiation therapy, or SBRT, which shortens the therapy into only five days of treatments with very precise, high doses of radiation.
Doctors around the Hampton Roads region more recently began using a new device when performing radiation treatments called SpaceOAR hydrogel. It’s a gel that’s injected between the prostate and rectum before treatment in order to protect the rectum from radiation.
“Radiation isn’t an exact science, so radiation hits organs around the prostate”—mainly the bladder and rectum, according to Dr. Geoffrey B. Kostiner, a urologist with Tidewater Physicians Multispecialty Group in Williamsburg, Virginia. And damage to the rectum can be a devastating complication.
Patients can’t feel the gel, which is inserted a few weeks before starting radiation and dissolves after three months. Kostiner compares it to the heavy drape used to protect the pelvis during an X-ray. The gel essentially pushes the rectum out of the way.
SpaceOAR was approved by the FDA in May, and both Prestidge and Kostiner say they expect to see its use spread. Kostiner says the gel could potentially be used in treating other cancers also.
Technology has gotten better especially in the past 10 years as far as prostate cancer treatment goes, Prestidge says. The quality of imaging and ultrasound has meant more precise methods of delivering radiation. Software helps doctors better figure out doses.
“Everything has grown by leaps and bounds,” Prestidge says. “And a lot of men are really excited about choice.”
Chesapeake, Virginia, resident Dennis Jones carefully weighed his options after his diagnosis. At first, doctors kept an eye on his PSA numbers, and then it got to the point to talk options. After a biopsy, Jones chose brachytherapy—and had the seed implants put in last summer.
His PSA numbers have been low ever since. He says he’s glad he had the chance to make the treatment choice that felt right for him.
“There are a lot of things out there,” says Jones, a 69-year-old businessman and minister. “Some are better than others, and it’s not one-size-fits-all, either. The best thing to do is to check them all out and make an informed decision.”