Each year, 30,000 men die from prostate cancer; it's the second leading cause of cancer death in men. But thanks to better methods of early detection and a variety of treatment options, all of which are available at Rush, today more men are surviving this deadly disease.

Although instances do occur at earlier ages, prostate cancer is rarely seen in men under the age of 40. But as a man ages, the prostate starts to be a troublemaker. It can become obstructed, affecting urinary habits, and can eventually becomes cancerous. "If a man lives long enough, the question isn't whether he will get prostate cancer," says Jerome Hoeksema, MD, a urologist at Rush, "it's when he'll get prostate cancer."

Why, then, can't the prostate be removed at an early age to prevent cancer from developing? "What many don't realize is that the prostate gland is essential for reproduction; it produces nearly half of the fluid the body uses to deliver sperm during sexual intercourse," says Lawrence Levine, MD, a urologist at Rush, "and because of its location, removing it affects bladder and penile function."

The good news is that unlike other types of cancer, prostate cancer tends to grow slowly. So when it is diagnosed in the early stages, there is usually time to treat it before it becomes life-threatening. However, since prostate cancer causes symptoms, such as pain and difficulty urinating, only when the disease has advanced beyond the point where it is curable, doctors like Hoeksema and Levine encourage patients to get their prostates screened as part of a routine physical.

Men who benefit from screening are those in their 50s and 60s, who have a life expectancy of 10 or more years and will likely live long enough to be affected by the cancer, and those at greatest risk for prostate cancer. Those at greatest risk include African-American men and men with a family history of the disease (a father or brother).

The best way to screen is with a digital rectal exam and a serum blood test, which detects elevated PSA levels, starting around age 50. These simple evaluations can be done by a primary care physician or a urologist. If the PSA is elevated, a follow-up biopsy may be done to determine whether cancer is the cause.

After a diagnosis of prostate cancer, patients and physicians work together to select the best course of action. "Do we take steps now to avoid problems down the road, or do we take a watch-and-see approach? The answer depends on how aggressive the cancer is, the man's age and his priorities for quality of life," Hoeksema says.

As president of the Board of Directors of the Illinois Division of the American Cancer Society, Hoeksema is a well-respected clinician who, along with his colleagues at Rush, offers his patients all of the most up-to-date treatments. Radical prostatectomy, a surgical procedure in which the entire prostate is removed, is often recommended when the cancer is confined to the prostate and for younger men who are better able to tolerate surgery. Localized external or internal radiation therapy can be used for most slow-growing cancers, whether or not they have spread beyond the prostate. And men who have more advanced disease may benefit from hormone therapy.

Another option is cryosurgery, in which the prostate is frozen, wiping out the prostate and, with it, the cancer. Rush was the first hospital in the city to offer cryosurgery. "It's a highly effective therapy," says Charles McKiel, MD, chairman of the Department of Urology at Rush. "The benefits are that it's noninvasive and can be used as the only therapy regardless of how aggressive the cancer is, whereas radiation alone isn't effective for the most aggressive cancers, and surgery can't eliminate cancers that have spread beyond the prostate.

At Rush, possible side effects of treatment, such as erectile dysfunction and incontinence, are addressed by renowned experts in urological disorders. For example, although treatments for prostate cancer cause erectile dysfunction in a large percentage of men, those in their 40s, 50s and 60s can often regain at least some of their potency with medications or other more aggressive forms of therapy. Full bladder control can usually be preserved in younger patients and those who are fully continent before treatment, or it can be restored with surgery.

"In choosing a treatment each patients brings his own concerns and values into the decision-making process," McKiel says. "They must weigh the potential risks of each option against their priorities."