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What is Prostate Cancer?

Prostate cancer is the second most common cause of cancer deaths in men of all ages and is the most common cause of death from cancer in men over 75 years old. Men at higher risk include African-American men and men with a family history of prostate cancer.

While one in six men will be diagnosed in their lifetime, prostate cancer is very treatable when caught early with a death rate of only one in 34 men.

Recent studies have suggested a link between a diet high in processed meats or dairy foods and obesity appears to increase the risk of aggressive prostate cancer. Prostate cancer is a tumor in the prostate gland, a small walnut-sized gland in men that makes seminal fluid, which helps carry sperm out of the body.

The prostate is located beneath the bladder and surrounds the urethra, the tube that carries urine out through the penis. Prostate tumors can be benign or cancerous. With benign tumors, the prostate enlarges and squeezes the urethra, interrupting the normal flow of urine. This condition, benign prostate hyperplasia, is common and rarely life threatening.
Prostate cancer can spread beyond the prostate gland and be life threatening.

When caught early, prostate cancer can be treated successfully in more than 90% of cases. Men 50 years old and older should talk to their doctors about being screened for prostate cancer. Men at higher risk should have this discussion with their provider at age 40.

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The Provision Center for Proton Therapy will be the first of its kind in Tennessee and only the second in the southeast. It will open in early 2014 and provide the most advanced cancer treatment in the world to patients in the region. Currently under construction on the campus of the Provision Health Alliance at Dowell Springs in Knoxville, TN, Provision Center for Proton Therapy will have three treatment units and will be able to treat up to 1,500 cancer patients annually, and will bring in many patients from outside the area.

The Provision Center for Proton Therapy will be open to all credentialed physicians and health systems in the region. The Provision Center for Proton Therapy brings to Knoxville an advanced cancer treatment capability that presently is available in only a handful of cities. When completed, it will be one of only 14 in the nation.

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Prostate Cancer Symptoms
Early prostate cancer usually causes no symptoms. Some advanced prostate cancers can slow or weaken your urinary stream or make you need to urinate more often, especially at night.

If the prostate cancer is advanced, you might have blood in your urine (hematuria) or trouble getting an erection (impotence).

Advanced prostate cancer commonly spreads to the bones, which can cause pain in the hips, back (spine), chest (ribs), or other areas. Cancer that has spread to the spine can also press on the spinal nerves, causing weakness or numbness in the legs or feet, or even loss of bladder or bowel control.

Other diseases can also cause many of these same symptoms. It is important to tell your doctor if you have any of these problems so that the cause can be found and treated, if needed:


- Frequent, urgent need to urinate
- Painful or burning urination
- Inability to empty bladder
- Inability to urinate or difficulty in starting urine stream
- Blood in urine
- Continual pain in the lower back, pelvis or upper thighs

Screening for prostate cancer
Whether to test healthy men with no prostate symptoms for prostate cancer is controversial. Medical organizations don't agree on the issue of screening and whether it has benefits.

Some medical organizations recommend men consider prostate cancer screening in their 40s, or sooner for men who have risk factors for prostate cancer. Other organizations advise against screening.

Discuss your particular situation and the benefits and risks of screening with your doctor. Together you can decide whether prostate cancer screening is appropriate for you.

Prostate screening tests might include:
Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

Prostate Cancer Treatments

Prostate cancer treatments may vary based on age, stage and grade of the cancer. Cancer treatments may include proton therapy, hormone therapy, radiation therapy, chemotherapy or surgery.

Men may experience some side effect or complications from treatment that will impact their quality of life. In older men with less aggressive tumors evidence suggest that careful observation rather than immediate treatment can be an appropriate option.

Many men find it helpful to get a second opinion about the best treatment options based on their situation, especially if there are several choices available. Prostate cancer is a complex disease, and doctors may differ in their opinions regarding the best treatment options.

Speaking with doctors who specialize in different kinds of treatment may help you sort through your options. You will want to weigh the benefits of each treatment against its possible outcomes, side effects, and risks. It is important to discuss all of your treatment options, including goals and possible side effects, with your doctors to help make the decision that best fits your needs.

Once you decide on a treatment plan, many other specialists may be involved in your care as well, including nurse practitioners, nurses, nutrition specialists, social workers, and other health professionals.

Monitoring

Patient with prostate cancer are monitored closely to make sure the cancer does not spread. This involves routine doctor's checkups.

Monitoring will include the following.
- Serial PSA blood test (usually every 3 months to 1 year)
- Bone scan or CT scan to check for spreading of the cancers
- Complete blood count (CBC) to monitor for signs and symptoms of anemia
- Monitoring for other signs and symptoms, such as fatigue, weight loss, increased pain, decreased bowel and bladder function and weakness

Proton Therapy
There is a significant difference between standard (x-ray) radiation treatment and proton therapy. Both techniques treat tumors by beaming radiation into the tumor site where it deposits radiation doses that destroy cancerous cells, but traditional radiation therapy also irradiates nearby healthy tissue as the beam enters and exits the tumor, as a result, can cause collateral damage.

The power of protons is that higher doses of radiation can be used to control and manage cancer while significantly reducing damage to healthy tissue and vital organs. The patient feels nothing during treatment. The minimized normal-tissue injury results in the potential for fewer effects following treatment, such as nausea, vomiting, or diarrhea. The patient experiences a better quality of life during and after proton treatment.

According to a recent survey commissioned by the National Association for Proton Therapy to investigate outcomes and patient satisfaction associated with the use of proton therapy, ninety-nine percent of proton therapy patients believe they made the best treatment decision for themselves.

Close to 2,000 patients who were treated for prostate cancer with proton therapy from 1991 to 2010 completed the survey, which examined satisfaction with care, quality of life, emotional and physical health limitations, urinary function, sexual function, bladder function, and bowel function.

Ninety-two percent of patients reported that their quality of life was better or the same today than it was before their treatment and 98 percent reported that they had recommended proton therapy to others.

Click here for a list of frequently asked questions about proton therapy.

In Knoxville, the Provision Center for Proton Therapy located at Dowell Springs is scheduled to begin treating patients with proton therapy in 2014. The only treatment center of its kind in Tennessee, the Provision Center for Proton Therapy will be only the 14th proton therapy center in the United States to offer proton therapy, the most advanced cancer treatment in the world.

Radiation Therapy
Radiation therapy is also used to treat prostate cancers. Radiation therapy to the prostate gland is either external or internal. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy.

External beam radiation therapy is performed by specially trained radiation oncologists, usually on an outpatient basis. Prior to treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that resembles a normal x-ray machine.

The treatment itself is generally painless. Side effects may include loss of appetite, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, cystitis (inflamed bladder), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.

Internal radiation therapy places radioactive seeds directly in or near the tumor. This is called brachytherapy. The radiation oncologist uses small needles to inject the radioactive seeds into the prostate. The seeds are very small and the patient cannot feel them. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues surrounding the prostate. Side effects may include pain, swelling or bruising, red-brown urine or semen, impotence, incontinence, and diarrhea.

Provision Radiation Therapy located at Dowell Springs treats all major types of cancer and provides leading-edge treatments with care, understanding and hope. Led by 2012 'Top Doctor' Allen Meek, M.D., the facility is designed with the needs of the patient in mind, offering convenient access to superior care which is delivered in a compassionate and efficient way.

Clinical care is delivered by a team of experienced oncology-trained professionals, working together to ensure that every aspect of your experience is coordinated and delivered in a timely and thoughtful way. In addition, the Provision Radiation Therapy support services team is committed to addressing the educational, emotional, financial, and nutritional needs of patients.

Medications

Medicines can be used to adjust the levels of testosterone. This is called hormone therapy. Prostate cancer cells rely on testosterone to help them grow.

Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. This can make it more likely that radiation therapy will be successful.

Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind. Side effects may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Hormone therapy also increases the risk of heart disease and heart attack.

Surgery

Surgery is usually only recommended after thorough evaluation and discussion of all treatment options. A man considering surgery should be aware of the benefits and risks of the procedure. Radical prostatectomy is an operation to remove the prostate gland and tissues surrounding it.

This usually includes the seminal vesicles and some nearby lymph nodes. Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate.
This procedure is done under general or spinal anesthesia. A surgical cut is made through the abdomen or perineal area and may be done using an open technique, minimally invasive approach or robotically. Patients may remain in the hospital for 5 - 7 days after surgery.

Possible complications include impotence and urinary incontinence, although nerve-sparing procedures may reduce the risk of these complications. Orchiectomy (removal of the testes) alters hormone production and may be recommended for metastatic cancer. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.



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