Prostate Cancer

Early-Stage Prostate Cancer: Diagnosis and Treatment

Receiving a cancer diagnosis can be both difficult and scary. You will probably have many questions and may feel overwhelmed and confused. This is a normal response, and it is okay to feel many different emotions.

One of the best ways to understand how to fight early prostate cancer is to understand the disease and the options for treatment better.

This will help manage your expectations and anxiety, as well as mentally prepare for you for your cancer journey.

The good news is that prostate cancer can be treated, especially if it is caught early. Let’s learn more about how to understand early prostate cancer.

What is Prostate Cancer?

Prostate cancer is a type of cancer found only in men. Cancer develops in the prostate gland, which is responsible for producing semen. It is located below your bladder and near your urethra. The prostate is about the size of a walnut, but it often grows larger with age.

Prostate cancer is the most common cancer among men. Most cases are found in men ages 65 and older, but men as young as 50 can be diagnosed with this disease. The best way to treat prostate cancer is to find it early before cancer can spread to other parts of the body.

What is early Prostate Cancer?

Cancer is divided into four different stages, based on far it has spread. If you have early stage prostate cancer, then your cancer is either Stage I or II. This means cancer has not spread outside the prostate gland. Since it is contained, it is easier to treat and does not require common types of cancer treatment, like chemotherapy.

Risk factors for Prostate Cancer

You are at risk of prostate cancer if:

  • You are aged 40 and are at a high risk of contracting the disease. Those at high risk are people with more than one first-degree relative that also had prostate cancer at a young age.

  • You are aged 45 and are at a high risk of contracting the disease. In this instance, men of African-American heritage are at risk, as well as men with a first-degree relative such as a father, son, or brother, that also had prostate cancer below the age of 65.

  • You are aged 50 or older and are considered to be at average risk of the disease.

What are the symptoms of early Prostate Cancer?

Early prostate cancer often does not have any symptoms. You may have been diagnosed after a routine prostate exam, or it was found while seeking treatment for a different ailment.

Many times, the symptoms of early prostate cancer mimic those of the swelling of the prostate gland, which is a common, benign condition in most men.

If you do have any symptoms from early prostate cancer, they could include: trouble urinating, needing to urinate more often, blood in your urine or semen, and a frequent urge to urinate. You may also feel like you cannot completely empty your bladder after urinating.

If you are experiencing these symptoms, you should notify your Doctor. He will recommend prostate cancer screening, which will involve tests, including:

  • PSA screeningThe PSA test is a simple blood test which is carried out to detect levels of a protein known as a prostate-specific antigen. This analysis is performed to test for prostate cancer and irregularities with the prostate gland that could result in cancer later in life.

  • DRE– Digital rectal exam-A Doctor will insert a gloved finger up the rectum of the patient and will feel the prostate. If they detect any lymph nodes or irregularities, this could be a warning sign of cancer.

  • Prostate biopsy-A prostate biopsy is a procedure used to detect prostate cancer. Small samples of the prostate are removed and then observed under the microscope.

  • MRI– A multi-parametric MRI or a color Doppler ultrasound has a 95 to 98% chance of determining the location and grade of prostate cancer cells.

Gleason Score

Named after its creator, Dr. Donald Gleason, The Gleason score is a measurement that is given to indicate the aggressiveness of prostate cancer.

Aggressiveness is a medical term used to describe the likelihood of cancer spreading outside the prostate.

The Gleason scoring system was developed at a VA hospital in the 1960s and was quickly adopted all over the world as an effective predictor of the pace of prostate cancer growth.

When he created this measurement, Dr. Gleason assigned a number between 1 and 5 to the different patterns of prostate cancer cell growth. Prostate cancer cells display different patterns of growth, which reveal their aggressiveness.

When your pathologist checks your biopsy samples, they examine your prostate cells under the microscope and will look at the different patterns.

They will then choose the two most commonly appearing patterns and give you a score. The first number indicates the most common pattern in all the samples. The second is the second most common pattern. When these two scores are added together, the total is called the Gleason score.


For more information on the Gleason Score click here.


What are the treatment options for early Prostate Cancer?

There are a number of options for treating men with prostate cancer.

Your doctor will discuss the different options with you so you can make the best decision for your body. Let’s take a closer look at some of these treatments.

Watchful waiting

Watchful waiting is usually used by men experiencing other health problems, who may be unable to handle surgery or radiotherapy.

It can be used in men with both low-risk cancer or men whose cancer has spread (advanced prostate cancer).

It involves fewer tests than active surveillance and is less intensive, more often than not taking place at the GP surgery than a hospital. If you do have treatment in the future, it will aim to control the cancer and manage any symptoms, rather than to cure it.

Active surveillance

Active surveillance includes grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate (localized prostate cancer).

It can be a good option for those with slow-growing cancer who may not be able to recover from surgery or radiation quickly. If you are older, your doctor may recommend this treatment as well.

Some people find that the side effects of cancer treatments are worse than the treatment itself. In fact, one of the main benefits of monitoring low-risk cancer is that you might avoid having unnecessary surgery.

One study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease.

Surgery

In some instances, your Doctor may recommend surgery and removing your prostate gland, thereby removing all of the cancer. This surgery is called a prostatectomy and can be done with cuts in either your lower belly or in your perineum.

Laparoscopic surgery may also be an option, depending on the type of technology available at your treatment center. Robotic surgery is becoming more popular and can help control the precision of the cuts needed for this delicate surgery.

However, it is essential to note that in cases of prostate problems or even cancer, this gland is there for a purpose. Our bodies don’t have extraneous parts. Once the surgery is performed, the prostate cannot be put back.

The same sexual and urinary function of the area may never return to normal. A prostatectomy can sometimes result in nerve damage around your penis so it may affect your ability to control your bladder or get an erection. Talk to your doctor about these possible side effects before opting for surgery.  

A study that compared radical prostatectomy with active surveillance drew some interesting conclusions. It found that while radical prostatectomy improved the cancer survival rate of men under the age of 65, active surveillance remained an effective management protocol for early-stage prostate cancer.

A further study supported this result, concluding that for most men ages 65 and older with localized, early-stage prostate cancer, observation might be the preferred treatment.


For more information on prostate surgery click here.


Radiation

Radiation is a form of high energy x-rays that can be produced through external beams or brachytherapy. With external beam radiation therapy, a machine focuses x-rays on your prostate to target the cancer. Brachytherapy involves inserting small pellets of radiation into your prostate.

This usually involves either being put under or numbed so that the pellets can be placed via thin needles.

Low doses can be relatively safe, but high doses can cause long term side effects such as urinary dysfunction, bowel dysfunction, and erectile dysfunction.

Another form of radiation treatment is proton therapy. A large-scale study treated prostate cancer patients with proton therapy and found it to be an effective treatment for low-risk prostate cancer.

The cohort of 1,327 men was treated at the University of Florida Health Proton Therapy Institute between 2006 and 2010, with a median follow-up of five-and-a-half years. The researchers reported that 99%, 94%, and 74% with low, intermediate, and high-risk cancer have no signs of cancer recurrence after five years of follow up.

Nerve-sparing surgery

Radical retropubic prostatectomy most effective to preserve a man’s erectile nerves. It can substantially limit the duration of post-surgical ED but requires a surgeon to be highly skilled and trained in the process.

In this type of procedure, the surgeon takes care not to damage the erectile nerves that surround the prostate as it is removed. However, if cancer has infiltrated these nerves, it may not be possible to save them.

Preventing injury with nerve-sparing surgery signficantly improves the chances of a man recovering erectile function within two years of the surgery.

Minimally invasive surgery

Minimally invasive procedures are claimed to work better than drugs in easing the symptoms of an enlarged prostate.

Prostate artery embolization is the only truly minimally invasive procedure which does not damage the prostate.

Prostate artery embolization involves inserting a catheter into an artery in the groin or wrist. Using an X-ray, it is passed into the blood vessels, and plastic particles are injected into the vessels to reduce the prostate gland’s blood supply. The aim is to shrink the prostate gland.

The UroLift system is another minimally invasive procedure. It is the first permanent implant for an enlarged prostate and works by pulling back the prostate tissue that is pressing on the urethra.

The Rezūm System uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms.

Conclusion

A prostate cancer diagnosis is scary, but it does not have to be confusing. Early detection is key, and when you are fully informed about the type of cancer you have and the risks involved with each treatment, you can work with your doctor to create the best treatment plan.

If you are diagnosed with prostate cancer is very important to be open and honest with your doctor and ask lots of questions about treatments and their side effects.

Surgery is a final decision. There’s no going back. While sometimes (arguably) necessary, it is often performed in moments of desperation and distress.

Do your homework before diving headfirst into this life-changing decision. Remember, catching prostate cancer in its early stages is the best time. You can beat this cancer and live a healthy, happy life.

Sources

  1. Holmberg, L, Bill-Axelson, A, Helgesen, F, Salo,J. (2002). A Randomized Trial Comparing Radical Prostatectomy with Watchful Waiting in Early Prostate Cancer. The New England Journal of Medicine. 347 (1), p781-789.
  2. Osman SO, Horn S, Brady D, et al. Prostate cancer treated with brachytherapy; an exploratory study of dose-dependent biomarkers and quality of life. Radiat Oncol. 2017;12(1):53. Published 2017 Mar 14. doi:10.1186/s13014-017-0792-1
  3. Patel P, Young JG, Mautner V, et al. A phase I/II clinical trial in localized prostate cancer of an adenovirus expressing nitroreductase with CB1954 [correction of CB1984] [published correction appears in Mol Ther. 2009 Jul;17(7):1302]. Mol Ther. 2009;17(7):1292–1299. doi:10.1038/mt.2009.80
  4. Prado K, Chin AI. How nerve-sparing technique has been applied to radiotherapy?. Asian J Androl. 2016;18(6):898–899. doi:10.4103/1008-682X.184995
  5. https://www.health.harvard.edu/blog/early-stage-prostate-cancer-treat-or-wait-2009031010

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