Prostate Cancer
Written by Shabir
All men over the age of 50 are at a risk for prostate cancer. More than 70% of men over the age of 65 are annually diagnosed with prostate cancer. Prostate cancer is the most common cancer of men in the United States. Each year close to 200,000 new cases of prostate cancer are discovered and 30,000 men die from the cancer annually.
Prostate cancer is generally a slow growing tumor and typically starts off in the periphery of the gland. In the early stages, prostate cancer causes no symptoms. However, if left untreated, it can grow, invade adjacent organs and spread to other parts of the body. What causes prostate cancer and why some subtypes behave differently remains unknown. It is believed that a multitude of factors such as heredity, ethnicity, hormones, diet and environment may play a role in the cause of prostate cancer.
Risk factors
Knowing the risk factors may help to prevent or delay the onset of prostate cancer. The risk factors identified to cause prostate cancer include:
Age. As one gets old, the chances of having prostate cancer increase. It is recommended that after age 50, men should have regular prostate evaluation.
Ethnicity. Of all ethnic groups, blacks have the highest risk of prostate cancer.
Hereditary. If anyone in the family has prostate cancer, the chance of a family member developing the cancer are greatly increased
Nutrition. A high-fat diet and obesity have been associated with an increase in prostate cancer. It is believed that fat stores are important for production of testosterone, and thus reduction in a fatty diet may reduce the risk of developing prostate cancer.
Vasectomy: Although it has been suggested that vasectomy may be a risk factor for prostate cancer, there is no conclusive evidence to substantiate this fact.
High levels of testosterone. Men who have high levels of testosterone are at high risk for prostate cancer. Long term testosterone treatment has been linked to benign prostate hypertrophy and there is a concern that these individuals should undergo regular screening for prostate cancer.
Symptoms
In the early stage of prostate cancer, most individuals have no symptoms. However, when the cancer grows or spreads, the following symptoms may occur:
- weak urine flow
- frequent urination (especially at night)
- difficulty starting urination
- inability to urinate
- pain or burning sensation when urinating
- blood in the urine
- persistent pain in lower back, hips, or thighs (bone pain)
- painful ejaculation
- difficulty having an erection
Who should seek medical advice
Unfortunately there are no early signs or symptoms of prostate cancer. The general advice is that if one is 50 or older, one should undergo prostate cancer screening. A blood test is also recommended to check for prostate-specific antigen (PSA) beginning at age 50, or earlier if one has risk factors for cancer. A digital rectal exam as early as age 40 is also advised in individuals with risk factors.
Screening tests
Since Prostate cancer does not cause symptoms in the early stage, the following screening tests are recommended and include:
Digital rectal exam (DRE): A digital rectal exam is not fun but essential in examining the prostate. The digital exam can discover the presence of any abnormalities in the texture, shape or size of your gland.
Prostate-specific antigen (PSA) test: This blood test analyzes the levels of a chemical released from the prostate. Higher levels are not always specific for prostate cancer because infection, inflammation or prostate enlargement may also cause an increase in this chemical.
Transrectal ultrasound: If the above tests raise any suspicion of prostate cancer, a small probe is placed through the rectum and the gland is analyzed. The images can reveal the presence of any mass or deformity of the gland.
Prostate biopsy
If there is suspicion that a mass may be present, a prostate biopsy is the next step. The biopsy is done under ultrasound guidance. The ultrasound probe is placed through the rectum and will identify any abnormal areas. A fine needle is then inserted for a biopsy. There is minimal pain associated with the test. The tissue specimen is analyzed by the pathologist and the grade of the tumor is determined. Once prostate cancer has been diagnosed, further testing is done to determine if spread has occurred. The majority of men do not require these additional investigations if no other symptoms are present. Treatment of the prostate cancer is then based on the needle biopsy results.
Grading
Whenever a cancer is diagnosed, the next step is to define the grade-which allows one to determine it aggressiveness. The degree of aggressiveness can be evaluated by looking at the degree of differentiation of the prostate cells. The degree of differentiation is then graded. With prostate cancer, a grading scale known as the Gleason score is used to define the degree of differentiation. The Gleason grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer. The Gleason scores may be helpful in determining which is the best treatment option.
Prognosis of prostate cancer
When prostate cancer is not treated, a whole host of complications can occur. The typical complications of untreated prostate cancer include:
- Spread of cancer
- Pain
- Urinary incontinence
- Erectile dysfunction (ED) or impotence
- Depression
Observation
The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose observation as a treatment option. With observation, one has to have regular follow-ups, frequent blood tests, repeat rectal exams and possibly biopsies to monitor the progression of the early cancer.
Observation is a viable option when the individual has:
- no symptoms
- the tumor is localized
- the grade of the tumor is low
- tumor growth is very slow
- individual is reliable and informed
- elderly male in poor health
- can accept the risks and understand the benefits
Various Treatment for Prostate Cancer
Prostate cancer can be treated in more than one way. Depending on the rate of growth, age, life expectancy, stage and spread, combination therapy is often used. The most common treatments for prostate cancer include the following:
Radiation
One may either receive direct radiation therapy to the prostate or the surgeon may place small radioactive implants in the prostate. They both work by killing the cancer cells. Today, radiation therapy is applied in a very sophisticated way to prevent toxicity. With precise focusing of radiation beams, greater doses of radiation can be given to decrease the frequency of complications. During the radiation therapy, all individuals are protected by custom-designed shields.
Radiation treatments are generally given over a 6-8 week period. The treatment is not painful and does not require anesthesia. The side effects of radiation therapy are not instant and one may gradually develop the following:
- Frequent urination
- impotence more common in elderly
- loose stools
- rectal bleeding
- urgency to defecate
- rectal ulcers
- rectal pain upon defecation
Once the radiation treatment course is complete, the majority of these side effects gradually disappear. However, a few unlucky men may continue to experience rectal pain/bleeding/ulcers. If these do not resolve with medical therapy, surgery may be required.
Hormone therapy
Because testosterone is know to stimulate growth of prostate cancer cells, anti hormonal therapy is frequently used to treat prostate cancer. Hormone therapy either uses drugs to stop the production of the male sex hormones or the entire source of the hormone is surgically stopped by removing the testicle (orchidectomy).
Hormonal therapy is most effective in men with advanced prostate cancer. The treatment does help to slow the growth and frequently shrinks the tumor. Because this therapy is effective in shrinking tumors, hormonal therapy is frequently used in the early stage of prostate cancer — often in combination with radiation and surgery. Once the tumor size is downsizes, surgery or radiation therapy can be used to destroy whatever tumor is left behind.
Most men develop side effects from these hormonal based drug therapies. These include nausea, diarrhea, breast enlargement, decreased libido, impotence, hot flashes, weight gain and loss of muscle and bone mass. The liver function has to be regularly monitored because all these drugs have the potential to cause liver damage.
Orchidectomy
A few men elect to undergo an orchidectomy. The testes are a major source of testosterone and surgical removal of the testes eliminates the hormone. This mode of therapy is usually for individuals with advanced prostate cancer and is quite effective. The procedure is not as painful as it sounds.
Radical prostatectomy
Surgical removal of the prostate gland is another option for patients with prostate cancer. This is a major surgical procedure which removes the entire prostate and adjacent lymph nodes. The surgeon tries to preserve the nerves and muscles which control urination and sexual function. Two surgical approaches are available to remove the prostate. – Retropubic and perineal. Both have been designed to prevent the complication to the adjacent organs, however, a fair number of individuals continue to have complications
Chemotherapy
Chemotherapy drugs are frequently used to treat prostate cancer. These toxic drugs kill the rapidly growing cancer cells. This form of therapy is not curative but can help control the spread. However, chemotherapy is associated with more side effects and is generally given to men who have prostate cancer which did not respond to hormonal therapy. Today, various combinations of chemotherapeutic drugs are used and may even be combined with hormones. Early results are positive but long term resulting are not available.
Alternative Medical Therapy for Prostate Cancer
Alternative medicine is fast catching on as a treatment for all cancers. This is mainly because of the dissatisfaction of individuals with conventional medicine. The problem is that many individuals cannot accept that life is not eternal and conventional medicine is not a cure for all diseases. Before seeking alternative medicine, one should know that the majority of the products have never been proven scientifically and the field is full of charlatans who prey on desperately ill people.
There are numerous nutrition supplements and herbs which are found in every store all over the country- all of them claiming great success in treating prostate disease and cure all other cancers. Most of the success of these products is claimed by the industry and the sellers.
The question remains, are these therapies effective? Anecdotal data always suggests that these products are effective but no large controlled trials are available on the majority of these products. Even though these products are widely used, there is absolutely no regulation or control of these products. The ingredients, their content or their purity is not assessed and their long term safety remains unknown. In addition, fake supplements are on the increase and buyer better beware
Herbal Supplements
There are a number of nutritional herbs claiming to be effective in the treatment of prostate cancer but there is not an iota of medical evidence that any of these substances work. The herbs postulated to have activity against prostate cancer include chaparral, PC SPES and shark cartilage. The majority of these products have not been shown to have any benefit in humans and yet they are sold in all herbal stores. But there are a few exceptions
Saw palmetto
Saw palmetto (Serenoa repens) has been widely tested, and the results show promise. However, it is important to know that saw palmetto is recommended to treat the symptoms associated with benign prostate hypertrophy and not prostate cancer.
Saw palmetto is thought to work by preventing testosterone from breaking down into another form of the hormone associated with prostate tissue growth. Studies have shown that saw palmetto appears to be as effective as the medication Finasteride (Proscar) in reducing the size of an enlarged prostate. It also appears to produce fewer side effects.
Saw palmetto works slowly or not at all. Most men begin to see an improvement in their urinary symptoms after 1-3 months. It appears safe to take saw palmetto indefinitely, but possible effects from long-term use are unknown.
Other Herbs lacking scientific evidence
A few other herbal products have been claimed to cure prostate cancer. There is little scientific data to support these products but many anecdotal reports are available. These products include:
Chaparral
Chaparral (Larrea tridentata) is derived from a desert shrub found in the southwestern United States and Mexico. Research hasn't shown that the herb effectively treats cancer, and it can lead to irreversible liver failure.
PC-SPES
This is an herbal mixture that has been marketed for treatment of prostate cancer. It contains a mixture of eight herbs: da qing ye (Isatis indigotica), licorice (Glycyrrhiza glabra), san qi (Panax pseudoginseng), reishi mushroom (Ganoderma lucidum), Baikal skullcap (Scutellaria baicalensis), chrysanthemum (Dendranthema morifolium), dong ling cao (Rabdosia rubescens) and saw palmetto (Serenoa repens). Studies indicate that the PC SPES can act like a female sex hormone and block the effects of testosterone on the prostate.
However, the product commonly produces impotence and breast tenderness. It can also cause blood clots in the leg veins and, if taken in large amounts, can be toxic. Another concern with this product is that it can mask progression of your cancer. It reduces PSA levels, even when the cancer is advancing.
Prevention of Prostate Cancer with Nutritional Therapy
Unfortunately prostate cancer can’t be prevented but one can take measures to decrease the risks or slow its progression. The most important steps one can take to maintain good health is to well, be physically active and get regular check up from the doctor.
Epidemiological studies from different geographic regions have helped to identify dietary differences between different regions of the world. This information has led to recommendation regarding dietary changes to reduce the risk of prostate cancer.
Selenium
This element is a strong antioxidant. Studies reveal that the prevalence of prostate cancer is higher in those areas where the soil is lower in selenium content than where the content of selenium is higher. Another study reported a significantly lower incidence of prostate cancer and 50% reduction in mortality for men who received daily selenium supplementation versus placebo. Others have found an inverse relationship between plasma selenium levels before diagnosis and the subsequent development of advanced prostate cancer. A third study revealed that there was a significant inverse relationship between toenail selenium level and risk of advanced prostate cancer compared with age-matched controls.
Soy
Data indicate that Asian men are much less likely to get prostate cancer than North American men but there when these Asian men immigrate to the US; they lose these protective benefits and adopt the same higher prostate cancer risk within one generation. Studies reveal that the Asian diet is rich in soy, which is a major source of Genistein and other isoflavonoids. The beneficial effects of the isoflavonoids are thought to be related to its estrogen like effects.
Lycopene
Data from the Health Professionals Follow-Up Study indicates that increased consumption of tomatoes (which are rich in lycopene) confers a significant reduction in the risk of prostate cancer. Other anecdotal data indicate that even eating tomato sauces may also decrease the risk of prostate cancer. However, the latest NIH study refutes this claim in their latest pilot study.
Vitamin E
Vitamin E is known to act like an antioxidant and has the ability to arrest the division of rapidly dividing cells. In one study called the ATBC Trial (alpha-tocopherol and beta carotene), it was observed that men who took vitamin E had a significantly lower risk of prostate cancer compared to those who took placebo. Other studies are currently underway to determine how and which cancers may respond to Vitamin E.
Others Nutrients
Other nutrients that may diminish the risk of prostate cancer include folic acid, vitamin D, vitamin A derivatives and unsaturated fatty acids. Numerous anecdotal reports exist about the benefits of these nutrients and the NIH will be undertaking controlled trials in the near future.
Future therapy
Current trials are evaluating use of stem cells, gene therapy and immune therapy in the treatment of prostate cancer which has already spread. These newer treatments are currently only available at major cancer centers.
Coping skills
Once a diagnosis of prostate cancer is made, the news is always devastating and depressing. Many individuals may not be able to cope with such news. To cope with a prostate cancer, the best way is to educate oneself. One should maintain a normal routine of lifestyle and work. One should not suffer the burden of a cancer diagnosis on their own and seek counseling from family members friends and help is even available by calling the National Cancer Organization(s). The best way to deal with the cancer is by being well informed with the cancer.
Because it's not always easy to tell which products may be unsafe, the best advice is to seek advice from your physician. These products are by no means cheap and by having blind faith in these products, one not only tends to lose their money but also their life.
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