A.
rostate cancer is an abnormal (malignant) growth of the
prostate, a walnut-sized gland at the base of the urinary bladder in men.
2.
Q. How common is prostate cancer?
A.
Prostate cancer is the most common form of cancer in men
(except for skin cancer) and a leading cause of cancer death worldwide. In
2007, close to 218,890 men will be diagnosed with prostate cancer and 27,050
men will die from prostate cancer in the U.S.
3.
Q. How is
prostate cancer diagnosed?
A.
Prostate cancer is most often diagnosed by needle biopsy of
the prostate gland. Biopsies are usually advised for men found to have either
an abnormal digital rectal exam (DRE) or elevated PSA blood level. (The medical
term for PSA is prostate-specific antigen.) Some, but not all men with an
abnormal DRE or PSA have prostate cancer.
Digital rectal exam (DRE) — is a procedure in which a
gloved finger is put into the rectum to check the prostate gland.
Prostate-specific antigen
(PSA) — is
a protein produced by the prostate gland. Its level goes up in the blood of
some men who have prostate cancer. It can also go up with other conditions that
affect the prostate. These include infections (prostatitis) and a non-cancerous
growth that comes with aging, benign prostatic hyperplasia (BPH).
4. Q. What are the risk factors for prostate cancer?
A.
Risk for
prostate cancer increases with age. More than 90% of men diagnosed with
prostate cancer are older than 50 years. African-American men have a higher
risk for prostate cancer than men of other races. A family history of prostate
cancer increases prostate cancer risk. About 10% of prostate cancers appear to
run in families although little is known about how or why this happens. Some
environmental factors, including high intake of dietary fat, appear to increase
prostate cancer risk.
4.
Q. How is
early-stage prostate cancer treated?
A.
There are several treatment choices for men with
early-stage prostate cancer (tumors that appear confined to the prostate gland):
Prostatectomy:
surgical removal of the prostate gland.
External
beam radiation therapy: the most frequently used form of radiotherapy
involving delivery of radiation to a tumor from a source (machine) outside the
body.
Brachytherapy:
placement of radioactive seeds in the prostate gland. In some cases, hormone therapy is given along
with other treatments (See Question # 10).
Not all prostate cancers need to be treated. Some men with
favorable prostate cancers may undergo what is called watchful waiting or
active surveillance, where the physician monitors the patients’ condition to
determine whether treatment is needed.
Bone
Metastases
6. Q. Where in the body does prostate cancer spread?
A. Cancers may spread or metastasize to other organs
in the body. Some cancers have distinct patterns of metastases. Prostate
cancer, for example, tends to spread to either lymph nodes or bone.
The
spine, pelvis, ribs, and bones of the arm and thigh are the most common sites
if cancer spreads to the bone. Prostate cancer that has spread to the bone is
called metastatic prostate cancer – it is not bone cancer, which is treated
differently.
7. Q. What are the symptoms of bone metastases?
A.
Pain is the most common symptom of metastatic prostate
cancer. It may be caused by pinched nerves due to metastases in the bones. Less
often, pain is caused by fractures. Cancer can cause bones to weaken and break.
Not all bone metastases result in pain.
8. Q. How are bone metastases detected?
A.Bone metastases from prostate cancer can be found by a
number of tests. Bone scan is the standard method for detecting bone metastases
from prostate cancer. It is highly sensitive. A bone scan often detects bone
metastases before they cause symptoms or before they can be seen by plain
x-rays. In some cases, more tests may be needed to diagnose bone metastases.
These tests include computed tomography (CT) scan, magnetic resonance imaging
(MRI) scan, or bone biopsy.
Treatment of Men with
Prostate Cancer and Bone Metastases
9. Q. What types of
physicians and other health professionals treat patients with prostate cancer
affecting the bone?
A. Most
often more than one health care specialist will take part in the care of men
with bone
metastases from prostate cancer. Urologists, radiation oncologists, and medical
oncologists
may provide care depending on the medical condition. Orthopedic surgeons
provide care for bone fractures or impending fractures. Treatment by a
neurosurgeon may be needed for metastases that press on the spinal cord or
nerves. Physical medicine physicians may help in prescribing physical therapy. Oncology
nurses, orthopedic nurses, and physical therapists will often be called upon to
assist with the use of medications and rehabilitation so that patients are able
to return to their usual daily activities. Because of the emotional and social impact of
prostate cancer in bone, many patients may consult mental health professionals
(e.g., psychologists, social workers, or psychiatrists). Psychotherapy,
medication for depression, and/or support groups may help some patients.
10. Q. What treatments are available for men with
metastastic prostate cancer?
A. Hormone therapy is the cornerstone of treatment for
men with metastatic prostate cancer. At first, prostate cancer cells need the
male hormone testosterone in order to grow. In almost all men with metastatic
prostate cancer, treatments to reduce testosterone levels are helpful but they
are not cures. Testosterone levels can be lowered by surgical removal of both
testes (bilateral orchiectomies) or treatment with medicines termed
gonadotropin-releasing hormone (GnRH) agonists. The names of some of these GnRH
drugs are leuprolide (Lupron®, Eligard®, Viadur®) or goserelin (Zoladex®). In
some cases, men who had both testes removed or are receiving a GnRH agonist are
also treated with antiandrogens such as bicalutamide (Casodex®) or flutamide
(Eulexin®). Chemotherapy may provide extra help in men with metastatic prostate
cancer that has grown despite hormone therapy. Docetaxel (Taxotere®) and
mitoxantrone(Novantrone®), are the most commonly used chemotherapy drugs for
prostate cancer. Because of potential side-effects, chemotherapy may not be
suitable for all of these men.
11. Q. What other therapies are available to treat
bone metastases?
A. Along with hormone and chemotherapy treatments for
prostate cancer, there are other therapies designed to treat or prevent the
problems that are due to spread of prostate cancer to bone.
External
Beam Radiation Therapy (similar to that used to treat early stage prostate cancer) can
be aimed at sites of painful bone metastases. External beam radiation relieves
pain in the majority of men and is most useful for treatment of one or two
sites of pain.
Radiopharmaceuticals
are drugs
given by IV (intravenous infusion), such as strontium-89 (Metastron®) or
samarium-153 (Quadramet®). These drugs target radiation to bone metastases.
They relieve pain in most men. Because radiopharmaceuticals travel throughout
the
skeleton, this therapy may be most helpful for men
with a number of painful bone metastases.
Bisphosphonates
are a class
of drugs that keep bone from breaking down or becoming resorbed. Zoledronic
acid (Zometa®) is a bisphosphonate given by intravenous infusion. It reduces
the risk of bone complications, including pain and fractures, in men with
metastatic prostate cancer. Surgery may be needed to treat bone
fractures or to relieve pressure on the spinal cord by bone metastases.
Pain
medications are
an important part of care for most men with metastatic prostate cancer. They
are used in combination with other treatments for prostate cancer.
Drugs Approved to Treat
Prostate Cancer In The United States
Hormone Therapy
Gonadotropin-releasing
hormone (GnRH) agonists:
Zoladex® (goserelin
acetate)
Lupron® (leuprolide
acetate)
Eligard® (leuprolide
acetate)
Viadur® (leuprolide
acetate implant)
Antiandrogens:
Casodex® (bicalutamide)
Eulexin® (flutamide)
Chemotherapy:
Taxotere® (docetaxel)
Novantrone® (mitoxantrone)
Bisphosphonates:
Zometa® (zoledronic
acid)
Radiopharmaceuticals:
Metastron® (strontium-89)
Quadramet® (samarium-153)
12. Q. Can bone metastases
be prevented?
A. The best ways to prevent the spread of prostate
cancer to bone are early diagnosis and treatment. In men whose cancer comes
back after treatment for early-stage prostate cancer, hormone therapy may delay
or prevent the spread of cancer to the bone. Ongoing and future clinical trials
will examine new ways to prevent bone metastases.
13. Q. What are the emerging
therapies to prevent or treat bone metastases?
A.
Several drugs are in development for the prevention and treatment of bone
metastases in men
with prostate cancer.
Denosumab, is a drug currently under evaluation as a
treatment to help prevent bone complications, including pain and fractures in
men with metastatic prostate cancer. It is also being evaluated in clinical
trials to prevent bone metastases in men with high risk prostate cancer.
Alpharadin
(Radium-223) is a new radiopharmaceutical (a drug that targets radiation to
bone metastases) in development for the treatment of men with bone metastases.
Osteoporosis
in Men with Prostate Cancer
14. Q. What is osteoporosis?
A.
Osteoporosis is a condition of general loss of bone mass that can lead to
fractures.
Although osteoporosis is usually thought of as a
disease of older women, it is also common in men. About two million American
men have osteoporosis. Another twelve million men are at risk. Hormone therapy
increases risk of osteoporosis and fractures in men with prostate cancer.
15. Q. What are the symptoms of osteoporosis?
16. Q. How is osteoporosis diagnosed?
A.
Osteoporosis is
diagnosed by testing the density of the bone called bone mineral density (BMD).
There are several ways to measure BMD; all are convenient, safe and painless.
The most common method is a DXA (dual energy x-ray absorptiometry) scan.
17. Q. How can osteoporosis
be treated or prevented?
A. There are several approaches most men with prostate
cancer can take to treat and prevent osteoporosis:
Change
unhealthy habits including smoking and excessive use of alcohol.
Take
adequate calcium and vitamin D. Daily calcium (1000-1500 mg daily) and vitamin
D (800-1200 IU) from diet and supplements are advised for most men who receive
hormone therapy.
Exercise
regularly.
Prescription
medications including bisphosphonates may be suitable for some men.
Denosumab, the drug discussed in Question 13, has been shown
in clinical trials to increase bone density and prevent fractures in men who
develop osteoporosis as a result of androgen deprivation therapy.
Glossary
Anemia Having too few red blood cells. Symptoms
include tiredness, weakness, and
shortness of breath.
Anus Opening at the lower end of the rectum through
which solid waste leaves the body.
Benign prostatic hypertrophy (BPH) Enlargement of the
prostate, blocking urine flow. BPH is not cancer, but can cause some of the
symptoms. Also called benign prostatic
hyperplasia.
Biopsy Removal of a sample of tissue, examined under a
microscope to check for cancer cells.
Bisphosphonate Drug used to prevent breakdown of bone.
Brachytherapy Implanting radioactive material into the
tumor or close to it. Also called internal radiation therapy, interstitial
radiation therapy, or seed implant therapy.
Calcium Major mineral component of bone, important for
normal function of nerves and other organs.
Clinical trial Research study involving volunteers,
designed to answer medical questions and find better ways to prevent or treat
disease.
CT scan (computerized tomography or CAT scan) Series
of detailed pictures of areas inside the body, created by a computer linked to
an x-ray machine.
Digital rectal examination (DRE) Procedure in which
the doctor inserts a gloved finger into the rectum to examine the rectum and
prostate.
External beam radiation therapy Use of a machine to
aim high-energy rays at cancer.
Hormones Body chemicals secreted by glands. Male
hormones include androgen and
testosterone (produced mainly by the testes) plays important
role in a man’s sexuality and fuels the growth of prostate cancer). Estrogen is
a female sex hormone. These hormones circulate in the blood-stream, and control
the actions of certain cells or organs.
Hormone therapy Use of medications or surgical removal
of the testes to prevent male hormones from stimulating further growth of
prostate cancer.
Intravenous Into a vein.
Lymph nodes Small, bean-shaped organs that are part of
the body’s immune system. They are located throughout the body along the
channels of the lymphatic system. Also called lymph glands.
Medical oncologist Doctor trained in the diagnosis and
treatment of cancer.
Metastasis (pl., metastases; v. metastasize) Spread of
cancer cells throughout the body. Cells that have metastasized are the same as
those in the original tumor.
Monoclonal antibodies A type of protein made in the
laboratory that targets and attaches to a specific substance in the body, such
as a tumor cell. Each monoclonal antibody is made to find only one substance.
Monoclonal antibodies are currently being used to treat some types of cancer,
and are being investigated as a treatment in several others.
MRI (magnetic resonance imaging) Imaging technique
that produces detailed pictures of areas inside the body by linking a computer
with a powerful magnet.
Multiple myeloma Disease of the bone marrow in which
certain cells grow out of control and break down bone.
Oncology Branch of medicine dealing with cancer.
Pituitary gland Master gland in the brain that makes
hormones that control hormone production in other glands such as the testes.
Prostate A walnut-sized gland at the base of the
bladder in men. The prostate produces fluid that forms part of the semen.
Prostate-specific antigen (PSA) Protein produced by
the prostate gland. PSA circulates in the blood and can be measured with a
blood test. PSA levels go up in some men who have prostate enlargement,
inflammation, infection, or prostate cancer.
Radiation oncologist Doctor who specializes in using
radiation to treat cancer.
Radiation therapy Treatment with high-energy rays to
kill cancer cells.
Radiopharmaceuticals Drugs given by intravenous
infusion to target radiation to bone metastases
Prostatectomy Surgery to remove the prostate gland.
Scrotum External skin pouch containing the testes.
Testes Pair of egg-shaped glands contained in the
scrotum that produce sperm and male hormones. Also called testicles.
Total androgen blockade Complete blockage of androgen
production. Also called combination hormone therapy.
Tumor Abnormal growth of tissue. A tumor can be
malignant (cancerous) or benign (noncancerous).
Urologist Doctor who specializes in disorders of the
urinary and male reproductive systems.
Watchful waiting Following the patient closely,
postponing aggressive therapy unless signs of disease progress.
