Prostate Cancer

Overview + Risk Factors + Detection

Impalpable prostate cancer is not infrequently diagnosed at the time of transurethral resection of the prostate (TURP). If the cancer is well differentiated and involves less than 5% of the resected material, it is classed as a T1A and carries a good prognosis. If, on the other hand, the lesion is moderately or poorly differentiated and involves more than 5% of the resected chips, then it is termed a T1B lesion. These lesions are associated with a poorer prognosis and a higher probability that residual cancer will persist in the prostate remnant after resection and require further therapy.

Because many prostate cancers develop posteriorly in the peripheral zone of the gland, it is not surprising that tumor cells are often able to escape the confines of the gland through the veins and lymphatics that accompany the neurovascualar bundles of Walsh.

Treatment
Surgery, or Radical Prostatectomy, can effectively cure prostate cancer when diagnosed early by PSA testing. It offers the best 15 year cancer-free survival rates for prostate cancer patients by removing the entire gland. Newer techniques for sparing the nerve(s) necessary for normal sexual function and urinary control have reduced the side effects associated with this procedure in years past.

Radiation Seed Implantation (Brachytherapy) is an alternative treatment for localized prostate cancer with excellent success rates when used alone, in selected cases, or more commonly today, in combination with external radiation (EBRT). Cure rates at 10 years approach those seen with radical prostatectomy with fewer reported side effects. In more advanced cases, hormonal therapy is often used in concert with EBRT and Brachytherapy to achieve the derived results.

Prevention
While the key to cure is early detection via PSA testing, efforts have recently been made to identify ways to prevent prostate cancer development and limit risk factors. Dietary changes limiting ingested fats, increasing antioxidant rich vegetables and lycopenes found in tomatoes, and limiting smoking are encouraged. Promising results in arresting prostate cancer cells using selenium and possibly vitamin E have been observed in clinical trials. Vaccines and gene-specific therapies hold out the promise of non-surgical therapies with minimal side effects in the future.