Prostate Cancer

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What is prostate cancer?

Prostate cancer has become the most common malignancy among males, especially in America. After lung cancer, this is the second common form of cancer. Therefore, the experts feel the need to educate people about this fatal disease. In the adults the prostate is quite similar to the size of a walnut and plays the major role in reproduction. The prostate ejaculates a sticky, milky fluid of acids and enzymes on contraction that constitutes near about 15% of the total volume of semen and plays a huge role to sustain the sperm cells produced in the testicles. Now the question is what is actually meant by PROSTATE CANCER? To answer it simply, it is a cancer of Prostate Gland which is found only in males under the bladder in front of the rectum. The prostate cancer occurs due to the malignant growth of cells around the neck of the bladder and the Urethra. It denotes cancerous growth of tumor consisting of the cells of the prostate gland. The tumor grows slowly and is not easy to detect as it remains confined to the gland for many years and exhibits little or no symptom at all. The cancer can spread beyond the prostate covering the surrounding local tissues in future and can also make its advancement to bones, lungs, and liver. Physicians are suggesting going for Screening Test after the age of 40.

Steps to be taken after diagnosis:

  • The percentage of the malignancy.
  • Location of the cancer.
  • The rate of development.
  • If it has affected the surrounding areas.

The causes of Prostate Cancer: Even though the exact causes of prostate cancer are still not known research is going on to understand the process of development of cancer cells and how it spreads. They aim at detecting the role of the following factors to cause the disease:

  • Testosterone
  • Age
  • Heredity
  • Diet

Testosterone:Testosterone is a male hormone which does not cause prostate cancer but encourages its growth. Therefore, the physicians aim at blocking the system of the production of this hormone after diagnosis.

Age:Generally the disease is common among the men over the age of 50 and the risk increases with age. The scientists are trying to find if the aging process is responsible for the biochemical reactions that accelerate abnormal cell growth. But the research is still going on.

Hereditary:The disease may be hereditary. This indicates that if any of your forefathers have had prostate cancer then the risk increases. It is found that the risk is higher among the African American men.

In this case genes may be responsible for the inherited prostate cancer. The genes are called Hereditary Prostate Cancer Genes 1 and 2 (HPC1, HPC2) and HPCX.

Possibly the genetically acquired prostate cancer develops differently than the cancer caused due to other reasons. But the matter needs further study on this assumption.

Genetics:The researchers are eager to detect whether the genetic flaws are responsible for the cancers. A genetic defect may prevent the development of a certain enzyme that could prevent the cells affinity to the agents responsible for cancer.

Diet:The high intake of animal fat may increase the risk of prostate cancer. So, it is safe to increase the intake of fruits and fresh vegetables; mainly tomato-based products that controls the risk factor.

The symptoms of Prostate Cancer:It is difficult to detect prostate cancer in its early stage as it generally shows any symptoms. But the possible symptoms that may occur are:

  • Tendency to urinate frequently, especially at night.
  • Difficulty in starting urination.
  • Interrupted flow of urine.
  • Painful or burning urination.
  • Difficulty in having an erection.
  • Pain during ejaculation.
  • Trace of blood in the urine or semen.
  • Pain or stiffness in the lower back, hips, or thighs.

How is Prostate Cancer diagnosed?

A person has to undergo a variety of medical tests to screen for and diagnose correctly the prostate cancer. The tests include:

  • PSA test
  • Digital rectal exam
  • MRI scan
  • Ultrasound
  • CT scan
  • Biopsy

PSA Test:The PSA test actually means Prostate-Specific Antigen test. This is one of the suitable ways to screen for prostate cancer. This blood test measures the amount of a protein, present in the blood, formed by the prostate. Men having prostate cancer have high amount of this protein present in their blood.

The amount of this protein is measured in nanograms per milliliter (ng/ml): The count reads:

  • 0 to 4 ng/ml = below normal (and in some men, 1.0 or 2.0) is normal.
  • 4 to 10 ng/ml = slightly elevated.
  • 10 to 20 ng/ml = moderately elevated.
  • > 20 ng/ml = highly elevated.

An abnormal PSA test result is not necessarily an indicative of having cancer. The PSA level may fluctuate due some other reasons also. Keeping this in mind, doctors suggest repeating the PSA test a little later to see if the PSA level becomes normal. In case PSA level continues to rise rapidly, other tests may be suggested.

Digital Rectal Exam:

In a DRE or digital rectal exam, a gloved, lubricated finger is inserted into a man\’s rectum to feel the prostate. If any irregular unevenness to the tissue and roughness is detected, it may be a sign of Prostate cancer. But remember that an enlarged prostate is not cancerous and will likely feel smooth.

The Digital Rectal Exam is not performed to diagnose prostate cancer rather to examine the size and surface of the prostate to determine if there is any need of further examination. Prevention is better than cure; an early detection makes the situation easier to handle. So experts recommend all men over the age of 50 to have a DRE yearly along with a PSA test.

MRI Scan:

An MRI scan produces computerized picture by magnetic fields and makes detailed, cross-sectional images of the inner body visible. It is, therefore, useful to produce clear picture of the prostate gland.

Ultrasound:

High-frequency sound waves are allowed to pass the body to produce a computerized image of internal organs.

The prostate is usually examined commencing an ultrasound called Transrectal Ultrasonography where a tube is inserted into the rectum that carries the sound waves to the nearby prostate and thus helps producing a better picture.

CT scan:

Computed Tomography scan is a sort of x-ray producedure that uses a computer and rotating x-ray beams to produce pictures of soft tissues, bones, and blood vessels. Areas of dense tissue, such as tumors, can be seen well by this process.

Biopsy:

A small sample of tissue is taken through a fine needle in this test to examine under a microscope if the cells are malignant. Biopsy is a more suitable method to detect prostate cancer.
But the method varies depending upon the doctors concerned. Few questions may arise before a man go for a biopsy test:

➢ How the test is performed?

➢ Is medication given to prevent any discomfort?

➢ IS there is any risk related to the biopsy procedure?

Determining the stage of Prostate Cancer:As soon as prostate cancer is diagnosed, it is very crucial to identify how far the disease has spread; i.e. determining its stage. Oncologists (Cancer Specialists) follow various systems to measure the extent of the cancer. This is performed by ascertaining the stage of development and arrangement of cancer cells. This guides them to decide the proper treatment plan.

STAGE A: This is the primary stage of prostate cancer determined by PSA Tests and Biopsy. It is necessary to first determine the spread of the cancer cells before making prognosis.

STAGE B: In this stage malignancy of cancer is found in several places within the prostate.

STAGE C: This stage indicates that cancer has spread throughout the prostate and may also have afflicted nearby tissues or the bladder.

STAGE D: This is the highest stage of malignancy where cancer is found to be spread beyond the prostate and nearby tissues. Now if the cancer remains confined within the Pelvic area, the stage is called D1 and if it has spread to the bones, it is considered as D2 stage.

Gleason Score:

Oncologist have developed another set of staging criteria called the Gleason Score depending on the arrangement of cancer cells in tumors which is visible under the microscope by the pathologist. The lower the score, the better.

  • The lowest possible Gleason score = 2.
  • Typical Gleason scores = between 5 and 7.
  • High Gleason scores = between 7 and 10.

TNM Staging:The TNM system is also followed by physicians to detect the stage. It is rather a universal scoring system. To get the TNM staging the oncologist examines:

The tumor size (T staging)

The lymph node involvement (N staging)

The presence of cancer in other parts of the body, or its metastasis (M staging).

T staging goes from T1 to T4, with some sub-stages:

  •  T1 indicates that cancer cannot be seen or felt, but a biopsy has confirmed its presence.
  • T1a indicates cancer is present in 5% or less of the prostate tissue that has been examined.
  • T1b indicates cancer is present in more than 5% of the prostate tissue.
  • T2 indicates the cancer is confined only to the prostate.
  •  T2a indicates that cancer has spread on one side of the prostate.
  • T2b denotes that cancer is on both sides.
  • T3 means the cancer spreads beyond the prostate to nearby tissues and organs.
  • T3a suggests cancer is not found in the seminal glands (which helps to produce semen).
  • T3b hints it has spread to the seminal glands.
  •  T4 means tumors have spread to other organs like the bladder or rectum.

N staging goes from N0 to N1:

  • N0 denotes that cancer has not spread to the lymph nodes.
  • N1 indicates that cancer has been found in the lymph nodes.

M staging goes from M0 to M1, with some sub-stages:

  •  M0: cancer has not spread to distant tissues.
  • M1: cancer has been found in distant tissues.
  • M1a: cancer has been found in lymph nodes beyond the pelvic area.
  • M1b: cancer has been found in the bone.
  • M1c: cancer has been found in other sites.

How Is Prostate Cancer Treated?

With the advancement of medical science it is now possible to find cure to large number of men having prostate cancer. The treatments include:

➢ Watchful waiting

➢ Radiation therapy

➢ Chemotherapy

➢ Cryotherapy

➢ Hormone therapy

➢ Prostate removal

➢ TURP

Watchful Waiting

Watchful waiting is necessary to observe prostate cancer carefully but is not immediately treated. This is not the case of ignoring prostate cancer but approves that prostate cancer is generally slow growing.

In some cases, the cancer grows so slowly that it may not affect the man over the course of his lifetime. Watchful waiting may be preferable to aggressive treatment for those who have other health problems or men over the age of 80.

If symptoms develop or if the malignancy begins to spread rapidly, other treatments may be considered.

Radiation Therapy

Radiation kills fast-growing malignant cells of cancer. It can be performed either externally or internally.

External radiation therapy uses a beam sent from outside the body toward the tumor. Radiation therapy is done at a hospital or treatment center, usually five days a week for several weeks. Though Radiation therapy is painless it may cause side effects such as tiredness, nausea, hair loss, skin soreness, and loss of appetite.

Brachytherapy is an internal radiation therapy in which radioactive seeds or pellets are surgically implanted in the prostate using fine needles. An ultrasound picture guides physicians to implant the seeds. Medication can be applied to block discomfort from the procedure.

This procedure is also called radioactive seed implant. It allows a higher total dose of radiation to a smaller area which is not possible with external radiation. Men may have to stay in the hospital for a short period to receive this treatment. The length of time depends on the amount of radioactivity needed for effective treatment. Once the implant is removed, no radioactivity remains in the body.

Chemotherapy-In this treatment chemicals are applied to kill cancer cells only if the cancer has spread beyond the prostate, but not in its early stage. The drugs used in chemotherapy are administered on an outpatient basis and do not require a hospital stay.

Side effects of chemotherapy:

  • Fatigue
  • Nausea
  • Hair loss.

Cryotherapy

An ultrasound probe is inserted into the rectum to produce a picture that can be watched on a monitor. The physician inserts probes into the prostate through small opening between the rectum and scrotum. These probes deliver liquid nitrogen to the prostate in order to freeze the tissue and kill cancer cells.

Cryosurgery is definitely an effective way to treat small areas of cancer. But there is a risk of an injury to the bladder. Men may also experience temporary swelling in the penis and scrotum.

Hormone Therapy

As prostate cancer feeds on the male hormone testosterone, reducing testosterone will decelerate the growth of cancer. Methods to be adapted:

The female hormone, estrogen may be taken as a pill to neutralize the effects of testosterone. This may cause breast tenderness and the growth of breast tissue, which will slacken when treatment is stopped.

Luteinizing hormone-releasing hormone agonists (LH-RH agonists) are drugs that reduce the production of testosterone. LH-RH agonists can stop the production of testosterone without some of the side effects of estrogen. LH-RH is often used with hormones called antiandrogens, which aim at stopping testosterone from interacting with cancer cells.

The removal of the testicles prevents the production of testosterone. This is known as orchiectomy.

Prostate Removal

If cancer has not spread beyond the prostate, removing the prostate, known as prostatectomy, is an excellent way to cure.

In a suprapubic prostatectomy, the prostate is removed through a slit in the abdomen.

In a perineal prostatectomy, the prostate is removed through an opening between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.

2 main side effects of prostate removal:

Possibility of urinary incontinence due to damage in the muscles that control urine flow

Impotence (the inability to have an erection).

TURP

Trans Urethral Resection of the Prostate (TURP) removes only a part of the prostate, with an instrument inserted through the urethra. The cancer is removed from the prostate passing electricity through the end of this special instrument.

This procedure may prove to be helpful for:

  • Men who cannot have a prostatectomy because of health factors or other reasons.
  • Men who need to have freer urine flow because an enlarged or cancerous prostate is constricting the urethra.

What can you expect after treatment?

  • Incontinence
  • Impotence
  • Physical discomfort

Incontinence

The inability to control urination affects about 10% of men treated for prostate cancer. Surgery or radiation may cause Incontinence. There are 3 kinds of incontinence:

  1. Stress incontinence – Urines leaks when you exercise, cough, or sneeze, because control muscles have been damaged in surgery.
  2. Overflow incontinence – This happens when the urine flow is temporarily blocked.
  3. Urge incontinence – Sudden strong urges to urinate that occur because the bladder has become very sensitive. (Normal bladder function often returns within weeks after surgery or after radiation treatments have stopped.)

Special treatments to control urinary incontinence may appear useful. Exercises help to gain control over muscle.

Special disposable undergarments are available for men with incontinence.

If incontinence continues to be a problem, surgery may be an option to help restore bladder control.

Impotence

Impotence, also known as erectile dysfunction, is the inability to have an erection. It can result from surgery, radiation therapy, or hormone therapies.

The damage of the nerves controlling an erection may cause impotence. After some months of surgery potency may return.

Drugs such as sildenafil (Viagra) can help a man achieve an erection.

Vacuum devices also prove effective in achieving an erection.

Penile implants can be inserted surgically to help create an erection.

Physical Discomfort:One can experience following physical discomforts after a surgery.

  • Fatigue caused by radiation therapy, chemotherapy, or hormone therapies.
  • Nausea and vomiting caused due to radiation therapy or chemotherapy.
  • Hair loss from chemotherapy.
  • Medications can relieve nausea and vomiting. Hair will usually grow back when chemotherapy treatment is finished.

Living with Prostate Cancer

It is not so easy to get back to normal life after treatment but they will be able to have a dry orgasm (a sexual climax without the release of semen from the penis). It may take time to adjust.

Semen can no longer be ejaculated after the removal of prostate gland. Whether a man can achieve an erection will depend on the degree to which nerves have been affected by the surgery. Now many men can return to his sexual life with the help of newer surgical techniques that can save nerves controlling erection.

Medication proves helpful if impotence or erectile dysfunction is a side effect. Drugs like Viagra have become so popular among men but it must be prescribed by a physician. It is to be noted that some of these drugs can cause low blood pressure, and heart-related side effects.

Men hoping to father children may consider having their sperm frozen for future use.

What Is Long-Term Outlook-If cancer has not spread beyond the prostate, one can survive five years. The long-term outlook depends on:

  • Age
  • Stage of cancer
  • Treatment

Most of the oncologists and urologists believe that treatment is important for younger men. But the therapies like radiation and chemotherapy are difficult to endure. You have to go for a frank discussion with your care providers on this issue of long term. Quality of life issues, especially for older men and those whose cancer has spread, is an important part of the long-term outlook.

Can prostate cancer be prevented?

As the reason behind prostate cancer is still unknown, oncologists cannot guarantee the prevention. However the risks may be reduced for many types of cancer if you follow these guidelines:

  • No smoking
  • Eating a low-fat, high-fiber diet
  • Getting plenty of exercise

Recent nutritional studies have suggested that:

Men who eat large amounts of green leafy vegetables are less prone to prostate cancer.

omato-based foods at least twice a week may lower the risk.

Studies on diet and its relationship to prostate cancer are not convincing. However an antioxidant called lycopene is found in some fruits and vegetables, and research is going on in a believe that it may offer some protection against prostate cancer. Scientists think antioxidants (vitamins E & C) protect protein in cells from damage.

In July 2001, the largest prostate cancer prevention trial known as SELECT started enrolling participants. It stands for Selenium and Vitamin E Cancer Prevention Trial.

Frequently Asked Questions:

Here are some frequently asked questions related to prostate cancer.

Q: Is prostate enlargement the same as prostate cancer?

A: As a man ages, the prostate can increase in size many times. It may not suggest prostate cancer. The medical term for no cancerous prostate enlargement is benign prostatic hyperplasia, or BPH. Prostate enlargement and prostate cancer are not same. Moreover, BPH cannot \”turn into\” prostate cancer. But BPH and prostate cancer can exist together. Even if cancer is not present, an enlarged prostate may create other related problems causing a hindrance to man\’s ability to urinate.

Q: Who needs radical prostate surgery?

A: Radical prostate surgery is usually performed on younger men, below the age of 70, when the cancer is in danger of spreading.

Q: Is \”watchful waiting\” dangerous?

A: Watchful waiting is generally followed in older men for whom radical surgery would be taxing and for whom radical surgery might not prolong life. It is often said that an older man is likely to die \”with\” prostate cancer rather than \”from\” prostate cancer.

Q: At what stage is prostate cancer \”terminal\”?

A: The chances of cure are smallest when the cancer cells have spread to other organs including bone. Still, effective treatments are available.

Q: What is hospice care?

A: Hospice is a philosophy of end-of-life care that emphasizes dignity, quality of life, and pain relief.

Q: Should I worry about blood loss and safe transfusion during surgery?

A: Many patients are now \”donating\” their own blood before surgery. Any blood they lose during surgery can be replaced with their donated blood.

Q: Will hormone therapy cure prostate cancer?

A: Hormone therapy aims at slowing the rate of growth of prostate cancer. For this reason, hormone therapy may be recommended for older men who might not be able to undergo radical surgery.

Q: What about \”natural treatments,\” with herbs, foods, and vitamins?

A: Alternative treatments depending on herbs and vitamins are advancing. It may slow down the cancerous growth but one must seek advice from his physician before adapting this treatment.

Need To Know:

Some related Terms:

Malignancy means abnormal and uncontrolled growth of cells in the body. It is another term of cancer.

A tumor is created when the uncontrolled growth of cells destroys the tissues and forms masses of some abnormal tissues.

When cancer cells spread to other parts of the body, it is called metastasis. If cancer is spreading, it is said to be metastasizing (moving from one part of the body to another).

Facts about Prostate Cancer:

About 189,000 men in the U.S. are diagnosed with prostate cancer each year.

Prostate cancer is the second leading cause of cancer death in men in the U.S. (lung cancer is first)

One man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 30 will die of this disease.

About 96 % of all men diagnosed with prostate cancer survive at least five years, and 75 percent survive up to 10 years.

If cancer has not spread beyond the prostate, the five-year survival rate is nearly 100 %.

Ethnicity and environment plays a considerable role. African American men are more likely to have prostate cancer than Caucasian men. Asian men living in Asia have very low rates of prostate cancer. However, when Asian men migrate to the west, the rate increases.

A few studies reveal that having a vasectomy (a sterilization procedure in which the tubes that transport sperm cells are cut and tied, so that a man cannot make a woman pregnant) may increase a man\’s risk for prostate cancer. However, most studies do not support this finding.

An elevated PSA does not confirm that a man has prostate cancer. The PSA levels depend also on a benign enlargement of the prostate.

False positive tests results can occur when the PSA level is elevated, but no cancer is actually present.

False negative test results can occur when the PSA level is in the normal range even though prostate cancer is actually present.

So, experts recommend that the PSA test should be combined with a digital rectal exam for more accurate results.

A Newer PSA Test: Recent studies have revealed that the PSA test called percent-free PSA test, may be better at detecting prostate cancer.