Prostate Cancer

Cancer is a disease in which the body’s cells grow out of control. Almost any cell in any body part can become a cancer cell. Cancer that starts in the prostate ( the gland under a man’s bladder that produces seminal fluid) is called prostate cancer. Prostate cancer is the most common type of cancer among men, not including skin cancer.

Risks

There is no known cause for prostate cancer, but there are certain factors that can increase a man’s risk of getting prostate cancer, including:

• Age: The risk of getting prostate cancer increases with age.
• Ethnicity: African-American men are more likely to get the disease and they are more likely to have more aggressive tumors.
• Family History: Men who have a history of prostate cancer in the family are more likely to get it themselves.
• Testosterone Levels: Higher levels of testosterone are associated with increased rate of prostate cancer growth and spread. This is why men on testosterone replacement must have prostate cancer screening every 6 months. 
• Smoking: Some studies have shown that the risk of developing cancer of the prostate can double in heavy smokers. Quitting can bring your risk down.
• Lifestyle and Location: Diet and lifestyle may increase the risk of developing the disease. Also, people in North America and Northern Europe have higher incidences of the disease.

Symptoms

Most prostate cancers do not cause symptoms until they are very large or have spread to other places, often at points when they are incurable. This is why early detection and screening in asymptomatic men is so important. When symptoms do occur they include blood in urine, difficulty urinating, or pain in bones.  

Diagnosis

A biopsy is the standard way to definitively diagnose prostate cancer. A biopsy is a procedure in which a small piece of tissue is removed from the prostate and examined under a microscope to check for cancer cells. The doctor may use tests like MRI or a transrectal ultrasound to guide them in selecting where in the prostate the sample should be taken.

Management

Management of prostate cancer depends on the cancer’s stage, how high the risk is, your age, your general health, and your own preferences. The different types of treatment all have their own risks and side effects, so those should be discussed with your doctor and weighed when making a decision about treatment. There are a variety of common treatments for cancer in the prostate as well as some new and experimental treatments.

• Watchful waiting/active surveillance – appropriate for smaller or less aggressive cancers or in men of very advanced age or who have other major health problems
• Surgery – This is the most aggressive form of treatment with highest chances of cure for cancers that have not already spread. This is most commonly done robotically by a surgeon with dedicated training in the technique. The entire prostate is removed, sometimes with lymph nodes for more aggressive cancers. The urinary tract is then reconstructed. With current techniques, hospital stay is usually only 1-2 nights. Surgery is most appropriate for younger men of good health and for more aggressive cancers. Side effects include decline in erections and changes to urinary control which are worst immediately after surgery, then improve with time.
• Radiation – This is also a very good therapy for curing prostate cancer that is still contained to the prostate. Treatment is provided in conjunction with a radiation oncologist who works with the urologist together. Radiation may be delivered by radiation pellets (brachytherapy), external beam, or a combination. Radiation tends to be most appropriate for older men, those with smaller prostates, or those who seek minimal downtime for their treatment. Side effects include decline in erections and changes to urinary control which are usually minimal at first, but progress with time. Sometimes radiation is used in after surgery for the most aggressive cancers or those that recur. 
• Hormone Therapy – The goal of hormone therapy with prostate cancer is to lower testosterone. Testosterone is a key growth signal for prostate cancer growth. Hormones are sometimes used in conjunction with radiation to treat cancers that have not already spread. Hormones are more commonly used to slow down and shrink prostate cancers that have spread to other places.  Hormone therapy may be managed by the urologist or sometimes by a medical oncologist.
• Chemotherapy – Chemotherapy is not curative but can help shrink cancers and slow their growth. Chemo is most appropriate for cancers that have already spread beyond the prostate. The strongest chemotherapy is given through the veins in conjuction with a medical oncologist who is an expert in the drugs and their potential side effects. Other forms of chemotherapy include oral medications which can be managed by the urologist or a medical oncologist. 

Testicular Cancer

An estimated 1 in 250 males will develop testicular cancer at some point during their lifetime. Although testicular cancer is not considered common, the incidence rate has continued to increase in recent decades, so it’s important to be familiar with the signs and symptoms of the disease. 

What is Testicular Cancer?

Testicular cancer is just as it sounds–cancer that starts in the male gland known as a testicle or testis. 

Testicular cancer is most often diagnosed in men ages 15 to 44 years old. As mentioned previously, this type of cancer is considered rare. It is also very treatable and when detected early, testicular cancer may be cured.

Risk Factors

Factors that increase testicular cancer risk include a family history of testicular cancer and having undescended testicles or other abnormal testicle growth and development. Other risk factors include race and age. White males are 4 to 5 times more at risk than other races and males between the ages of 15 to 35 are most at risk.

Symptoms

One of the most effective ways to discover a lump is during a testicular self-examination. Discovering a lump or swelling in a testicle is one of the symptoms that young men should be aware of. Others include:

• A heavy, dull or achy feeling in the scrotum or lower belly
• Rarely, individuals may notice soreness or growth in their breasts.
• Signs of early puberty in boys, such as a deeper voice or facial and body hair at a very early age.

In cases where cancer has spread, individuals may experience:

• Lower back or stomach pain
• Difficulty breathing or shortness of breath

Diagnosis 

With treatment, the risk of death from testicular cancer is small. Since this type of cancer is seldom painful, men should always see a healthcare provider for an evaluation if they notice a mass or nodule in their testicles. 

A urologist will start by evaluating your personal and family medical history followed by a physical examination. The provider may request blood work to screen for certain proteins and hormones made by the cancer. 

Treatment

If testicular cancer is diagnosed, imaging will be ordered including a CT scan of the abdomen/pelvis and a chest X-ray. This imaging will help the urologist determine the spread of the disease and the best treatment plan. 

Treatment options for testicular cancer include surgery, radiation or chemotherapy. Prompt evaluation is warranted as some forms can be very fast growing.

Lance Armstrong

A very good modern day example of testis cancer is professional cyclist Lance Armstrong. He was diagnosed at age 25 and had already developed spread to his brain, lungs, and abdomen. Through a combination of treatments he was cured of the cancer and went on to continue a very successful athletic career. He was also able to father several children after cancer treatment by saving sperm that was collected before his treatment began.