Prostate cancer is the most common cancer in men, striking one in every six men during their lifetime. The Prostate gland is located under the base of the bladder and is part of the male reproductive system. In cancer, there is an uncontrolled division of cells thus forming an abnormal growth or mass and causing destruction of adjacent tissue. This is then followed by spread:
– to the lymph nodes, and
– to the blood stream.
CAUSES
The cause of prostate cancer is unknown.
Some studies have shown a relationship between
– high dietary fat intake and
– increased testosterone levels.
RISK FACTORS
- There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH).
Prostate cancer is rarely found in men younger than 40 years. But it is the most common cause of death from cancer in men over age 75.
People at higher risk include: - African-American men
- Men over 60 years
- Men working in tire plants
- Men with exposure to cadmium and to paints.
- The lowest number of cases occurs in Japanese men and vegetarians.
SYMPTOMS
Today with PSA (Prostate Specific Antigen) testing, most prostate cancers are now found before they cause symptoms. The symptoms listed below can occur with prostate cancer, but they are more often associated with benign prostate hyperplasia (BPH) or enlargement.
- Urinary hesitancy (a delay or slow start of urination)
- Urinary dribbling, especially just after urinating
- Urinary retention
- Pain with urination
- Pain with bowel movement
- Lower back pain
- Other symptoms may include:
- Excess urination at night
- Urinary leaking (incontinence)
- Blood in the urine (hematuria)
- Abdominal pain
- Bone pain or tenderness
- Low red blood cell count (anemia)
- Lethargy
- Loss of weight
TESTS & DIAGNOSTICS
A digital rectal exam (DRE) will often show an enlarged, hard, irregular prostate.
Tests to diagnose prostate cancer:
– PSA (Prostate Specific Antigen) test may be high, but benign enlargement of the prostate can also increase PSA levels.
– Free PSA (may help tell the difference between BPH and prostate cancer).
– AMACR (Alpha-methylacyl-CoA racemase- a newer test that is more sensitive than the PSA test for determining prostate cancer).
– Urinalysis (may show blood in the urine).
– Urine or prostatic fluid testing (may reveal unusual cells).
– Prostate biopsy. This is the definitive test to confirm the diagnosis of prostate cancer.
Tests tests done to determine if the cancer has spread:
– CT scan
– Bone scan
– Chest x-ray
STAGING
Health care providers use a system called staging to describe how far the cancer has grown ( tumor size), and how far the cancer has spread outside of the prostate to determine the stage. Identifying the correct stage helps the doctor determine the best treatment.
Different ways to stage tumors, include:
-The TNM ( tumor, node, metastasis) staging system. This uses stages l, ll, lll and lV.
-The A-B-C-D staging system, also known as the Whitmore-Jewett system.
Stages A and B- are both confined to the prostate. A= small and B = larger tumor.
Stage C- is spread through prostate capsule to adjacent tissue but not to lymph nodes.
Stage D- is spread to lymph nodes or by blood stream to other tissues.
The TNM stages l, ll, lll and lV correspond to the Whitmore- Jewett A, B, C and D stages.
GRADE
The grade of a tumor describes how aggressive a cancer might be. The more the tumor cells differ from normal tissue, is the faster these cells are likely to grow. The grading system for prostate cancer is called the GLEASON grade or score. It is a 5 point scoring system G1 to G5. The higher scores usually indicate faster growing and more aggressive cancers.
TREATMENT OPTIONS
Treatment options vary based on the stage of the tumor, and include (1) surgery, (2) radiation therapy, and (3) chemotherapy. Older patients, may have monitoring of the cancer without active treatment.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire and /or performance on either a temporary or permanent basis. These are concerns for discussion between the health care provider and patient.
SURGERY
Surgery is usually only recommended after a thorough evaluation and discussion of all treatment options. The patient must be aware of the benefits as well as risks of the procedure.
– Prostatectomy (surgery to remove the prostate gland) is often recommended for treating the earlier stages of prostate cancers. Surgery is lengthy and complications are possible. There are different surgical approaches including:
– Abdominal retropubic. Incision from the umbilicus to pubic bone.
– Abdominal laparoscopic. A thin tube with a video camera (laparoscope) is inserted through a small incision. The view of prostate is projected on to a screen which the surgeon watches while working with instruments through other small incisions.
– Perineal. Incision between the anus and base of scrotum.
– Orchidectomy is removal of one or both testes. The testes produce testosterone and this promotes the growth of prostate tumors. Orchidectomy changes the hormonal environment, thus preventing further growth and spread of cancer cells.
But then, the loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.
RADIATION THERAPY
Radiation therapy is used to treat different stages of prostate cancers. When a patient’s health makes surgery too risky, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:
– External beam radiation (EBR) therapy is done in a radiation oncology center by specially trained radiation oncologists. The part of the body to be treated is marked with a with a special pen. The radiation is delivered painlessly to the prostate gland using a special machine. This EBR therapy is usually done 5 days a week for about 6 – 8 weeks.
– Internal radiation or Prostate brachytherapy involves placing radioactive seeds, directly into the prostate. A surgeon inserts small needles through the skin behind scrotum to inject the seeds. The seeds are so small they are not felt. They can be temporary or permanent. Internal radiation therapy may be given for early and slow-growing prostate cancers. It also may be given with external beam radiation therapy for some patients with more advanced cancers.
– ProstRecision. This technique uses a combination of pinpoint radiation by seed implants and a conformal beam radiation to destroy the prostate cancer. Cure rates are high and side effects are few.
– Radiation is sometimes used for pain relief when cancer has spread to the bone.
Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, inflamed bladder (cystitis), and blood in urine.
MEDICATION THERAPY / CHEMOTHERAPY
Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Because prostate tumors require testosterone to grow, reducing the testosterone level often works very well at preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread beyond the prostate.
The drugs Lupron and Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, unlike surgery, it is reversible. The drugs must be given by injection, usually every 3 – 6 months.
Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and impotence.
Other medications used for hormonal therapy include androgen-blocking drugs (such as flutamide), which prevent testosterone from attaching to prostate cells.
Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include:
- Adriamycin
- Estramustine
- Mitoxantrone
- Docetaxel
- Paclitaxel
- Prednisone
After the first round of chemotherapy, most men receive further doses on an outpatient basis at a clinic or physician’s office. Side effects depend on the drug, how often you take it, and for how long. Some of the side effects for the most commonly used prostate cancer chemotherapy drugs include:
- Bruising
- Blood clots
- Dry skin
- Fatigue
- Hair loss
- Low blood cell count ( white cells, red cells, or platelets)
- Mouth sores
- Nausea
- Upset stomach
- Weight gain
- Tingling or numbness in hands and feet
- Fluid retention
PROSTATE CANCER VACCINE
Aims to treat, not prevent, prostate cancer by spurring the immune defenses to attack prostate cancer cells. Immune cells are removed from the patients blood, then they activated to fight cancer, and finally, re-infused into the blood. Three cycles occur in 1 month. Used for advanced prostate cancer that is no longer responding to hormone therapy.
COMPLICATIONS
Impotence is a potential complication after prostate removal or radiation therapy. Recent improvements in surgical procedures have made this complication less common. Urinary incontinence is another possible complication. Medications can have side effects, including hot flashes and loss of sexual desire.
PREVENTION
There is no known way to prevent prostate cancer. Following a vegetarian, low-fat diet or one that is similar to the traditional Japanese diet may lower your risk. Early identification (as opposed to prevention) is now possible by screening men over age 40 each year with a digital rectal examination (DRE) and PSA blood test.
There is a debate, however, as to whether PSA testing should be done in all men. There are some potential downsides to PSA testing. The first is that a high PSA level does not always mean that a patient has prostate cancer. The second is that health care providers are detecting and treating some very early-stage prostate cancers that may never have caused the patient any harm.
COPING
– Keep educating yourself, so you know what to expect.
– Find a support group of individuals with similar diagnosis or experience.
– Avoid stress, pace yourself, rest when you need to do so.
– Get involved in meaningful activities like helping others.
– Have some fun and laughter, spend time interacting with the grand children.
– Use a diet of good proteins especially fish, moderate in carbohydrates , rich in fruits , vegetables and essential fatty acids, plus a multivitamin supplement.
– Develop and maintain a regular daily exercise program.
– Have faith in God; prayer, meditation, and scripture reading are of great value in completing “a holistic approach” to coping with prostate cancer.
