What are the best treatment options for prostate cancer?

A very fast death (14 months) happens for 1% of those diagnosed with pure squamous cell prostate cancer. A very slow death happens for the other 99% of men. This question invites tremendous explanation.

To preview, my answer will cover:

• Normal Anatomy,
• Normal Physiology,
• Pathology of an enlarged prostate and prostate cancer,
• Treatment options for enlarged prostate and prostate cancer,
• Treatment options for complicated enlarged prostate and prostate cancer;
• Prevention;
• Symptoms.

You may only want to glean my answer. Feel free to skip ahead to the sections that interest you!

Normal Anatomy

The prostate exists only in men. The prostate is located between the base of the penis and bladder. The urethra connecting the bladder and penis runs through the prostate. Ducts on the prostate feed into the urethra. There are two main arteries which are the source of the prostate blood supply.

The prostate is rich with hormone and androgen receptors. The testicals produce both estrogen and testosterone which stimulate the prostate receptors. The prostate contains approximately 35% of the fluid in an ejacultation. The fluid serves to protect sperm from sperm-killing female cervix secretions. The prostate and seminal vesicles together contain the bulk of ejaculation fluid.

From the opening of the anus, the prostate can be palpated (felt with a finger) approximately three inches up into the rectum. After the age of 40, your healthcare practitioner will commonly perform an annual Digital Rectal Exam (DRE) to feel for prostate abnormalities.

A normal young adult prostate is both the size and shape of a walnut, approximately one inch wide. In childhood the prostate weighs about 2 grams. At puberty the prostate rapidly grows to 20 grams. From puberty onward, the prostate continues to very slowly grow throughout a man’s entire life.

Normal Physiology

The normal prostate functions dutifully during ejaculation. Fluid from the prostate enters into the ducts and flows into the urethra. Normal ejaculation requires a cascade of complex hormonal interactions. The prostate contributes to sperm protection with a gelatin-like protein. The large volume of prostate produced fluid assists in the mechanical transportation thrust. Prostate produced fluid safely delivers sperm close to the target:

Pathology of an enlarged prostate and prostate cancer

There are many underlying reasons a prostate grows too quickly or gets too large. Some of the reasons are understood. The unknown reasons are more numerous.

Starting shortly after the age of 30 that formally walnut-sized prostate starts to misbehave. A continuance of prostate growth does not have any apparent purpose. At this point in a man’s life, it might be better if the prostate could just stop its growth-shenanigans! The prostate won’t listen to our argument and continues to grow.

By the age of 100 years old, 100% of all men will have an enlarged prostate. Close to all of these men will also have prostate cancer. If you are a centurion, avoiding prostate cancer might not be possible. The good news is that you will most certainly die from something else. Prostate cancer after a certain age is ignorable.

The prostate grows with normal cells very slowly. Normal cells divide and die. The programmed death of a cell is known as apoptosis. Prostate cells which are normal divide faster than apoptosis thus increasing the size of the prostate.

The prostate can also grow with cancerous cells. There are many definitions for the word, “cancer.” A crude medical dictionary definition helps to illustrate:

Cancer is an abnormal shaped cell which continues to divide, but will not die.

Cancer of the prostate is further defined by the abnormal cell type:

1. carcinoma
1. 95% of prostate cancers are this type of cancer;
2. It is a VERY VERY slow dividing cancer;
3. Frequently, the medical advice is to leave it alone — a very slow death!
2. squamous-carcinoma mixed types
1. 4% of prostate cancers are this type of cancer;
2. It is a VERY slow dividing cancer;
3. Take reasonable time to research your best intervention — a slow death!
3. pure squamous cell carcinoma
1. 1% of prostate cancers are this type of cancer.
2. Men with this type of cancer frequently die within 14 months of the diagnosis;
3. Listen to the advice of the poet Dylan Thomas, “do not go gentle into the good night. Rage, rage, rage against the dying of the light!”
4. Act fast.

The benign (not cancer) enlarged prostate is not completely innocent. It is true that some enlarged benign prostates have no symptoms and never will have symptoms.

By the age of 50 years, 25% of all men have an enlarged prostate.

Many enlarged benign prostates have terrible symptoms. A large prostate can obstruct urination. It can obstruct ejaculation flow. It can cause erection failure.

Prostrate growth pinches-off the urethra opening. An enlarged prostate can interfere with nerves necessary for erections. Monitoring enlarged prostates until symptoms emerge is a common course of treatment.

Treatment options for enlarged prostate and prostate cancer

Aggressively treating symptoms is paramount.

The starting point is frequently urination retention. The kidneys produce approximately 30 mls of urine every hour of your life. The urine made by the kidney is stored in the bladder. When the bladder expands with approximately 600 mls of urine, receptors signal your brain to desire urination. An inability to drain the bladder results in urinary retention.

Urinary retention can very quickly progress to bladder malfunction, bacterial infection, or back-up causing kidney failure. Temporarily — almost always temporary — you will need to immediately use a catheter to urinate property. Please don’t complain, “…but I do urinate.” The quantity of urine retained in the bladder is the problem. There are three types of catheters used for urination retention caused by an enlarged prostate:

Straight catheters: Single-use

Foley catheters: Stays in-place

Suprapubic catheters: Stays in-place.

Registered Nurses are the professional experts in teaching catheter use. RNs will instruct you how to properly use a straight catheter. RNs will insert/change Foley and Suprapubic catheters.

Urinary retention requiring catheters is frequently temporary. For example, enlarged benign prostates and slow-cancer prostate can be the result of inflammation or infection. Treating those conditions curtails the problem quickly —back to normal urination.

Erection problems are sometime relieved with common erectile dysfunction medications. Again, the cause is frequently temporary. In other words, you wont likely need to take medications forever.

For uncomplicated enlarged prostates or very very slow-growing cancers which happen later in life, monitoring for changes is the common treatment choice.

Treatments for complicated enlarged prostate or prostate cancer.

Medications: Anti-androgen and anti-estrogen medications are available intended to prevent the prostate receptors from triggering growth. For many years, testosterone was the suspected culprit of prostate enlargement. Researchers are now pointing the finger at estrogen.

Prostate Arterial Ablation: This procedure is done by an interventional radiologist (not a urologist). It is quick and minimally invasive. The two arteries which feed the prostate are blocked. After ablation the prostate shrinks. See video.

TURP (Transurethral Resection of the Prostate): This procedure is performed by a urologist (not a radiologist). It is less invasive than a prostatectomy. See video.

Partial Prostatectomy: This might be the selected procedure for a contained tumor.

Total Prostatectomy: This procedure frequently involves removing the whole prostate as well as other tissue including the lymph glands and seminal vesicles. See video.

Castration: Surgical in combination with other treatments is an option for advanced cancer. See video.

Chemotherapy and Radiation: As with many cancers, prostate cancer and complex benign enlarged prostate are at times treated by oncologists and radiologists with chemotherapy and radiation therapy.

——Treatments are often guided by these tests:

1. PSA scoring: Some researchers have found that a prostate-specific antigen score of over 10 is a strong indicatication for cancer monitoring. The velocity of upward-change (speed of increase) from one PSA score to the next PSA score is very relevant.
2. Prostate biopsy: Provides tissue for cell examination. See video
3. Gleason Score: Describes the biopsy results in a 1–5 graded system.
4. C-Reactive Protein: This test measures inflammation. Prostatitis (inflamed prostates) will often have high c-reactive protein scores.
5. TNM cancer grading: T is tumor in-place. N is nodes —spread to near node. M is metastasis which means the cancer has spread to more locations.

Prevention:

1. Be sexually active! Ejaculate often. Increased sex and ejaculations is protective against prostate cancer.
2. Frequently participating in all forms of exercise, good nutrition, no smoking, and decreased stress reduce all forms of cancer.
3. Resistance training and prostate massage reduces PSA according to some researchers.

See your healthcare provider for an exam if you have any of these symptoms:

1. unexplained abdomen pain;
2. unexplained rectal pain;
3. difficulty urinating;
4. painful urinating;
5. blood in urine, semen, or rectal bleeding;

Thank you for the question. Hope this helps!

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All Images: Sourced from google search in public domain.

Disclaimer: See your primary care health provider for medical advice. The content herein is not intended to diagnose or treat. Information is not complete and modalities of care not mentioned herein are presumed to exist.