Prostate Cancer: What You Need to Know

According to the Prostate Cancer Foundation, a non-smoking man is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined. It is the most common non-skin cancer in America, affecting one in six men.

The Importance of Screening
It is estimated that there are more than two million men in the U.S. currently living with prostate cancer. Most men with an early stage of this disease will not experience any symptoms, which is why regular screening is so important. Having a routine prostate cancer screening can detect cancer at its earliest stages.

In some cases of prostate cancer, men will experience symptoms such as frequent, hesitant or burning urination, difficulty with erection or pain in the lower back, hips or thighs. Since other conditions can have similar symptoms, men experiencing any of these warning signs should undergo thorough testing to determine the cause.

"The 2009 recommendation from the American Urological Association is that all men with a life expectancy of more than 10 years should start prostate cancer screening at age 40," says Jeffrey Lamont, MD, Chief of Urology at Newton-Wellesley Hospital. "Many men don’t realize that prostate cancer is very common and continues to be the second leading cause of cancer death in men."

Our Cancer Program
Newton-Wellesley Hospital has a comprehensive cancer program with all the necessary resources to treat prostate cancer. The Hospital has a strong tradition of providing excellent medical care for cancer patients including medical oncology, surgery and chemotherapy. To enhance this high-quality care, the Hospital is constructing a 25,000 square foot Cancer Center scheduled to open this summer. The Joan and James Vernon Cancer Center will be located on two levels in the main Hospital. To provide the most comprehensive care for cancer patients, Newton-Wellesley will be making radiation therapy available on the Hospital campus through a collaboration with Massachusetts General Hospital.

"If a patient is diagnosed with prostate cancer, we are able to offer them the full spectrum of treatment options here in one convenient location," says Dr. Lamont. "Our program is comprehensive and we treat patients from diagnosis, through their cancer treatment and provide their follow-up care. Our patients say this is very comforting for both them and their families."

Risk Factors
According to Dr. Lamont, there are specific factors that put men at higher risk for prostate cancer including:

Age – Age is the strongest risk factor for prostate cancer. The chance of having prostate cancer increases significantly after age 50.

Family History– The risk for developing this disease increases if a man has a father or brother with prostate cancer. The risk is highest for men with several affected relatives.

Race– Prostate cancer occurs more often in African American men than other racial groups. African American men are also more likely to be diagnosed at an advanced stage of the cancer.

"It is important for men to know the risk factors of prostate cancer and begin earlier testing if they are at higher risk," says Dr. Lamont. "I recommend that men have both a PSA blood test and a digital rectal exam to screen for prostate cancer."

The prostate produces a protein called PSA that leaks into the bloodstream in small amounts. If a man has prostate cancer, the PSA levels often rise in the bloodstream and can be measured with a simple blood test. However, other prostate conditions can also cause high levels of PSA so physicians recommend undergoing a digital rectal exam in addition to the blood test. During this exam, the physician is able to examine the prostate for any irregularities in size, shape and texture.

"It important for all men over 40 to begin talking about prostate cancer screening with their physicians," says Dr. Lamont. "Together they will discuss symptoms, family history and lifestyle choices and create a plan for screening."

Treatment Options
If a patient has an abnormal prostate screening and is diagnosed with cancer, Dr. Lamont and his team at Newton-Wellesley are able to offer various treatment options.

"There is no one set plan to treat this disease," says Dr. Lamont. "It is important for each individual to learn about the various treatments and, with the help of his physician, make a decision that is best for him. Newton-Wellesley Hospital has comprehensive resources to care for patients with prostate cancer. Our specialists will provide a complete assessment and discuss the treatment options and expected outcomes."

Since the type and severity of prostate cancer varies among patients, it is important for the treatment of this disease to be tailored to meet the needs of each individual. These methods include:

Surveillance – Since prostate cancer often grows slowly, in certain instances a physician may recommend surveillance. Surveillance is an active treatment, which involves closely monitoring the cancer but without immediate intervention such as surgery or radiation therapy. This approach may be appropriate if the cancer is not causing any symptoms and is expected to grow slowly. It is also common in men who are older or have other serious health conditions.

Surgery – One of the most common treatments for prostate cancer is surgery to remove the entire prostate gland and some of the surrounding tissues. This is called a radical prostatectomy. This approach is used if the cancer has not spread outside of the gland. It currently has the highest rate of long-term, cancer-free survival. Continued advances in technology have allowed this surgery to be performed easily and with less disruption of the patient’s quality of life.

Radiation Therapy – Some patients elect radiation therapy, which can be delivered through high-energy rays from a linear accelerator or by implanting radioactive seeds called brachytherapy. Medical specialists at Newton-Wellesley trained in radiation oncology use a CT simulator to calibrate the exact location the patient will need radiation. This type of treatment can be used initially for cancer that is still limited to the prostate gland or has only spread to nearby tissue. Radiation may also be used if the cancer comes back after surgery. If a patient has a more advanced type of cancer, radiation therapy may be used to reduce the size of the tumor or to offer relief from symptoms.

Cryosurgery – Cryosurgery is a surgical method used to treat localized prostate cancer without removing the entire prostate gland. To treat the cancerous area of the prostate, the physician guides several probes to the prostate gland using transrectal ultrasound. Cold gases are passed through the needles and used to destroy the cancer. During cryosurgery, the physician uses ultrasound to monitor the freezing process. Cryosurgery can be repeated if needed and is also beneficial to treat men who cannot have surgery or radiation therapy because of their age or other medical problems.

"As technology continues to develop, we are able to diagnose and treat prostate cancer at earlier stages. These developments have allowed us to consider more minimally invasive and targeted therapies like focal cryosurgery to treat this disease," says Dr. Lamont. "This type of treatment has many potential advantages for patients because they can avoid the side effects of a more invasive surgery or radiation. It can also be a potential adjunct to those patients who elect surveillance."

Cryosurgery is being studied as a method for treating only the areas of the prostate where cancer is found and not the entire gland. This concept of "focal therapy" is actively under investigation and hopefully may lead to successful cancer treatment with less morbidity.

"We continue to look towards the future and are working to develop better ways to understand prostate cancer," says Dr. Lamont. "We are actively pursuing more focused and less invasive methods to treat this disease. We hope that more men will undergo routine screenings so we can help to ensure a long and healthy life."

For more information about physicians or services at Newton-Wellesley Hospital, contact CareFinder at 1-866-NWH-DOCS (694-3627) or visit our website at www.nwh.org.