Prostate cancer is the most commonly diagnosed cancer in men and is the second leading cause of cancer deaths after lung cancer. Approximately 220,000 new cases of prostate cancer will be diagnosed in 2007. The increase in detection is largely due to better screening by using a simple blood test and physical exam. Early detection is leading to improved treatment outcomes.

Prostate cancer is seen most commonly in older men and in men with a family history of the disease. African American men carry a higher risk of the disease and may have a more aggressive pattern. Other risk factors include obesity, high dietary fat intake, excessive alcohol usage and possibly a lack of exercise. There is some data to suggest that diets rich in lycopenes, powerful antioxidants found in tomatoes and other fruits, may decrease the risk of developing prostate cancer. Several large studies are currently underway to assess whether other vitamins or minerals may be of benefit in reducing the risk of developing prostate cancer.

The American Cancer Society believes that health care professionals should offer the prostate–specific antigen (PSA) blood test and digital rectal exam (DRE) yearly beginning at age 50. Men at high risk, such as African Americans and men who have a first–degree relative with prostate cancer at an early age should begin testing at age 45. Men at even higher risk (because they have several first–degree relatives who had prostate cancer at an early age) could begin testing at age 40. Prostate cancer can be detected by digital rectal exam or an elevation of the prostate specific antigen.

This simple blood test can also help physicians assess the severity of the cancer. Once an abnormality is discovered then the next step is to obtain a biopsy of the prostate to confirm a diagnosis. The biopsy specimen will also provide a scoring system which is used to identify appropriate treatment strategies. Complete staging workup may include a bone scan, CT scan, MRI or a PET scan to look for disease extension outside of the prostate.

This evaluation is critical in patients suspected as having cancer because signs and symptoms related to the tumor may not be seen until disease is no longer confined to the prostate. Signs may include blood in the urine, pelvic pain or problems with sexual function. Symptoms of advanced disease depend on the organs involved. Bone pain is the most common symptom of widespread disease.

The ability to cure prostate cancer is dependent on finding it early when disease is limited to the prostate itself and for which there are excellent treatment options. Because there are several options for many patients a multi–disciplinary team approach should be instituted. Patients should consult with a Urologist (surgeon) and a Radiation Oncologist prior to making any decision.

Standard treatment options available for curable patients include prostatectomy and radiation therapy. A radical prostatectomy involves an open surgical technique in which the prostate and surrounding tissues are completely removed. Newer, less invasive surgical techniques utilize robot assisted technology and claim less complications. Radiation therapy can be performed using therapeutic x–rays to kill the cancer cells. Radiation can be given in two ways. External beam radiation is a non–invasive therapy given from outside the body using computer targeted 3–D treatment planning. Brachytherapy involves placing seeds or sources directly into the prostate. This procedure is performed with the Radiation Oncologist and Urologist working together. Depending on a patientÂ’s stage a physician may prescribe one form of radiation or another. Significant technological advances in Radiation Oncology have resulted in the ability to pinpoint radiation directly at the tumor and avoid over treatment of healthy surrounding tissues.

Complications of surgery may include bleeding, urinary leakage and sexual dysfunction. Nerve–sparing surgeries can reduce this latter risk. External radiation can result in diarrhea and sexual dysfunction. Incontinence is less commonly seen following radiation. Some studies suggest that brachytherapy may carry the lowest risk of sexual dysfunction however a higher risk of bladder symptoms.

Hormone therapy is often used in addition to radiation or surgery but is not curative. It is also very useful in delaying the spread of more advanced disease. It is important to remember that aggressive therapy options can sometimes be avoided especially in very old men whose life expectancy is limited. Here an approach of watchful waiting can be more prudent.

Contemporary medical data suggests that surgery, external radiation and brachytherapy radiation have comparable cure rates for early stage prostate cancer patients. Therefore, it is important for patients to understand that their decision must take into account what potential side effects of therapy they feel most comfortable with. Of course, other factors such as their age, general health and overall well being must also be considered in their decision. By discussing with their medical team of Urologists and Radiation Oncologists patients can make a more informed and comprehensive decision regarding their treatment choice.

Simple healthy habits such as eating a diet rich in fruits, vegetables and antioxidants such as lycopene may help reduce the risk of prostate cancer. The importance of regular cardiovascular exercise can not be underscored and may also have a positive benefit in reducing the development of prostate cancer. Of course regular medical screening for men at risk is key in the early detection of prostate cancer and can definitely increase the chance of cure