Prostate Problems : Symptoms and Treatments, Part 2

by National Institute on Aging

(Page 2 of 2)

To figure out if these symptoms are caused by prostate cancer, your doctor will ask you questions about your past medical problems. He or she will perform a physical exam. In the exam, the doctor will put a gloved finger into your rectum to feel your prostate through the wall of the rectum. Hard or lumpy areas may be a sign of cancer.

Your doctor may also do a test to check the prostate-specific antigen (PSA) level in your blood. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. You may also need to have an ultrasound exam. In this procedure, a probe that produces sound waves is put into the rectum. Sound waves bounce off the tissues, and a computer uses the echoes to make a picture of the prostate

A biopsy is almost always needed to diagnose prostate cancer. This can be done in a doctor's office using a local anesthetic. The doctor takes out tiny pieces of the prostate and sends them to a laboratory to be checked for cancer cells under a microscope.

Prostate Cancer Treatment. There are many ways to treat prostate cancer. The choice of treatment depends on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other parts of the body). It also depends on your age and general health. How you feel about the benefits and side effects of the various treatments is also very important.

The following are three standard treatment choices for cancer that has not spread beyond the prostate:

Watchful waiting. If the cancer is growing slowly and not causing problems, you may decide not to have treatment right away. Instead, your doctor will check you regularly for changes in your condition. Older men with other medical problems often choose this option.

Surgery. The most common type of surgery is a radical prostatectomy. The surgeon takes out the whole prostate and some nearby tissues. Side effects may include loss of sexual function (impotence) or problems holding urine (incontinence). Sometimes incontinence goes away within a year of surgery. But some men continue to have problems and have to wear a pad. An operation called nerve-sparing surgery gives some men a better chance of keeping their sexual function.

Radiation therapy. This treatment uses high-energy x-rays to kill cancer cells and shrink tumors. There are two kinds of radiation therapy. External radiation therapy is beamed into the prostate from a machine outside the body. Internal radiation therapy (brachytherapy) uses radioactive "seeds" that are placed in the prostate, into or near the tumor itself.

Like surgery, radiation therapy can cause problems with impotence. Radiation is not as likely to cause urinary incontinence as surgery. But it can cause rectal problems such as pain and soreness, rectal urgency, and trouble controlling bowel movements (fecal incontinence).

In addition, after radiation therapy, some men are treated with hormone therapy. This is used when chances are high that the cancer will come back. Hormone therapy is also used for prostate cancer that has spread beyond the prostate. Side effects of hormone treatments include hot flashes, loss of sexual function, and loss of desire for sex.

PSA Testing. Some doctors think that men should have regular PSA tests, and others do not. Here's why: We know that this test can catch a cancer before it causes symptoms, but we aren't sure that PSA tests save lives. Also, PSA tests find small cancers that would never grow or spread. When that happens, a man may have surgery or other treatments that he does not need. Researchers are studying ways to improve the PSA test so that it catches only cancers that need treatment.

Protecting Yourself

The following can be signs of prostate cancer. Keep in mind that they are much more likely to be caused by benign diseases than by cancer.

• Frequent urge to urinate
• Blood in urine or semen
• Painful or burning urination
• Difficulty in urinating
• Not being able to urinate
• Painful ejaculation
• Frequent pain or stiffness in lower back, hips or upper thighs
• Dribbling of urine

If you have any of these symptoms, see your doctor right away.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.