Better Understand Developing Treatments of Prostate Cancer
Raise awareness of prostate cancer in September by knowing its symptoms, risks, screening, and treatment options.
The prostate is a small gland of the male reproductive system resting below the bladder in front of the rectum and surrounding part of the urethra. It helps to produce the fluid in semen and is normally the size of a walnut.
Besides skin cancer, prostate cancer is the most common malignancy in men. Statistics show that annually, worldwide, approximately 1.1 million men are diagnosed with prostate cancer and more than 300,000 die from it. Although prostate cancer can potentially grow and spread quickly, it usually grows slowly or not at all.
There May Be Symptoms, or Not
According to the Prostate Cancer Treatment Research Foundation (PCTRF), many men have no symptoms related to their prostate cancer. If there are symptoms, they may include:
- Urinary problems such as weak urine stream; difficulty initiating urination; stopping and starting during urination; urinating frequently, especially at night; and pain or burning with urination
- Blood in the urine and semen
- Discomfort or pain during ejaculation
- Pain in the hips, pelvis, back, or upper legs
Urinary symptoms often are associated with noncancerous enlargement of the prostate, referred to as benign prostatic hypertrophy (BPH).
Who Is at a Higher Risk?
Certain men are at a higher risk of developing prostate cancer. PCTRF said higher risk factors include:
- Over 65 years of age – The older a man gets, the higher his risk of developing prostate cancer. It’s rare in men under 45 years of age.
- Family History – Men who have a father, brother, or son with prostate cancer are at higher risk for developing it, too.
- Race – It’s more common among African American men and less common among Asian/Pacific Islanders, Native American, and Native Alaskan men.
- Certain Prostate Changes – Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk for prostate cancer.
- Certain Genome Changes – Research suggests that the risk for prostate cancer may be linked to specific changes on particular chromosomes.
These risk factors do not mean a person will develop prostate cancer. Many men with risk factors never develop this disease.
Common Screening and Controversy
It’s best to screen for and detect cancer early before there are symptoms. According to the Centers for Disease Control and Prevention (CDC), two tests are commonly used to screen for prostate cancer:
- Digital rectal exam (DRE): A gloved, lubricated finger is inserted into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
- Prostate-specific antigen (PSA) test: The PSA level is measured in the blood. PSA is made by the prostate, and the levels of PSA in blood can be higher in men who have prostate cancer or other conditions affecting the prostate.
Generally, the higher the PSA level in the blood, the more likely a prostate problem is present. Besides prostate cancer, other factors that can affect the PSA level are certain medical procedures, some medications, an enlarged prostate, and prostate infection. The PSA test may have false positive or false negative results, which means men may think they have cancer when they do not, or they may have cancer and the PSA test missed it.
The U.S. Preventive Services Task Force recommends against PSA-based screening 1 for prostate cancer, reasoning that more men will be harmed by PSA screening than will benefit. The expected harm is greater than the small potential benefit.
The American Cancer Society (ACS) advises men 50 and older to talk with their physician about whether to test for prostate cancer. Men with one or more risk factors should consult a doctor about whether to begin screenings earlier. When having a screening discussion, decision aids and provisions should be documented in the medical record, particularly when the patient decides against screening.
Codes for reporting prostate cancer screening using HCPCS Level II codes are:
G0102 Prostate cancer screening; digital rectal exam
G0103 Prostate cancer screening; prostate specific antigen test (PSA)
The ICD-10 diagnosis code to support either screening is:
Z12.5 Encounter for screening for malignant neoplasm of prostate
According to the Medicare Intermediary Manual, Transmittal 1801, Change Request (CR) 1098, both screening digital rectal examinations and PSA tests are covered once every 12 months for men beginning at age 50 (at least 11 months must have passed since the last Medicare-covered screening was performed).
Although screening may help detect prostate cancer early, only a biopsy can diagnose prostate cancer, for sure.
Treatment Options Are Based on Stages
There are plenty of treatment options for prostate cancer. Many factors weigh into treatment, including the stage of the disease (stages 1-4), age, and health. Tests to help determine the stage of prostate cancer include:
- Transrectal ultrasound
- Magnetic resonance imaging (MRI) of the prostate using a rectal probe
- Computed tomography scan of the abdomen and pelvis to look for prostate cancer metastasis to other organs
- MRI of the skeleton or a nuclear medicine bone scan to look for bone metastasis
- Surgery to examine the lymph nodes in the pelvis for spread prostate cancer
Prostate options for treatment are dependent on the stage, and may include:
- Active Surveillance – When the cancer grows slowly, some men may never need treatment, so doctors will just watch to keep an eye on the cancer to make sure it doesn’t get worse.
- Advanced Prostate Cancer Treatment – Among advanced prostate cancer treatment options are endocrine therapy, chemotherapy, and Provenge.
- Alternative Treatments – Some patients look to remedies, such as herbs and dietary supplements, to help treat or slow the progression of prostate cancer. More research is needed to determine effectiveness.
- Cryotherapy – This involves freezing the abnormal cells to destroy the cancerous tissue.
- High-intensity Focused Ultrasound – High-energy sound waves (ultrasound) are directed to destroy the cancer cells.
- Hormone Therapy – This is also called androgen deprivation therapy or androgen suppression therapy, which removes, blocks, or adds hormones to treat prostate cancer.
- Laparoscopic Surgery – A camera or scope is inserted into the abdomen for a minimally invasive surgery to remove the cancerous tissue.
- Radical Prostatectomy – An operation to remove the prostate gland and tissues surrounding it.
- Radiation Therapy – High doses of radiation, such as X-rays, are used to destroy cancer cells. Proton beam therapy is a radiation treatment that focuses a ray of protons to eliminate the cancer. Another method is the placement of radioactive seeds around the tumor.
Websites providing decision support tools are: American Cancer Society (www.cancer.org), American Society of Clinical Oncology (www.asco.org), Centers for Disease Control and Prevention (www.cdc.gov), and Mayo Clinic (www.mayoclinic.org)
WebMD, What Is the Prostate? What’s Normal?
WebMD, Treatment & Care:
CDC, What Screening Tests Are There for Prostate Cancer?
U.S. Preventive Services Task Force screening recommendations:
Medicare Intermediary Manual: Transmittal 1801, CR 1098: