About Prostate Cancer
The prostate is a male sex gland, about the size of a walnut. It is located below the bladder and in front of the rectum. The prostate surrounds the upper part of the urethra, the tube that empties urine from the bladder. Although there are several other types of cells found in the prostate, more than 99 percent of prostate cancers develop from glandular cells. A cancer that originates in glandular cells is called an adenocarcinoma. in prostate cancer risk. Some studies that noticed an increase in risk found it was highest in men who were younger than 35 when they had a vasectomy. Research continues on this issue.
Does anyone know what causes prostate cancer?
Although researchers have identified some risk factors, no one knows forsure what causes the disease. Scientists have made progress in understanding how certain changes in DNA can cause normal prostate cells to form cancers. But genetic mutations appear to be responsible for only 5 – 15 percent of prostate cancers. Other theories suggest that DNA changes may occur as a result of exposure to cancer-causing chemicals, but this has not been proven. Some studies link development of prostate cancer to increased levels of certain hormones. High levels of androgens (male hormones) may contribute to prostate cancer.
What can I do to prevent prostate cancer?
Based on a study conducted by scientists at the Harvard Medical School and Harvard School of Public Health, it may be a good idea to eat less red meat. In their study of 50,000 health professionals over four years, they found that the men who ate the most beef, bacon, pork and lamb were 2.6 times more likely to develop prostate cancer than the men who ate the least. A diet rich in fruits, grains and vegetables is associated with a lower risk of prostate cancer. Other research indicates that tomatoes (especially cooked tomatoes or tomato paste), which contain lycopenes (the red carotenoid pigments of tomatoes), appear to help prevent prostate cancer.
Does having a vasectomy increase my risk for prostate cancer?
Although some studies have found that prostate cancer develops one to two times more often in these men, other studies have found no difference
What are the treatment options when cancer is confined to the prostate gland?
Early-stage prostate cancer (Stage I and II) is localized to the prostate. The most promising therapy is one of the oldest – radical prostatectomy, surgical removal of the prostate gland. Its use in the 1990s has been on the rise as many more localized cancers are being detected that would not have been found prior to the development and use of the prostate specific antigen (PSA) screening test. Studies have found that most men are cured if the surgeon is able to cut out the entire tumor. In a few select medical centers around the country, surgeons are investigating the use of laparoscopic prostatectomy, a less invasive form of the operation, which means a shorter hospital stay and convalescence, and a quicker return to normal activities. Research is underway to compare the effectiveness of the laparoscopic technique with the conventional procedure.
What are the disadvantages of radical prostatectomy?
Impotence and/or incontinence are possible side effects. The degree of sexual function is determined by the man’s age, how sexually active he was before the procedure, and how much the surgical procedure affects the nerves. Newer procedures are currently being investigated in some major medical centers that may spare the nerves during the procedure, thus preserving sexual potency. Total urinary control (continence) may be regained within four weeks after surgery, although there is a chance of incontinence depending on age.
When is radiation therapy recommended?
Radiation therapy, used to kill cancer cells and shrink tumors, is a good choice for men between the ages of 65 and 75 with early stage tumors who are not surgical candidates. Radiation therapy can be delivered by an external source or through the use of radioactive pellets inserted into the prostate through the rectum. This approach is called brachytherapy.
What does hormonal therapy involve?
Since male hormones, especially testosterone, can stimulate growth of prostate cancer, female hormones or drugs that decrease the amount of male hormones may be given. In men with advanced prostate cancer, an operation to remove the testicles (orchiectomy) may be recommended to stop the production of testosterone. Hormone therapy may be used in conjunction with radiation and surgery.
What are the side effects of hormonal therapy?
Side effects include hot flashes, impaired sexual function and loss of sexual desire.
Is chemotherapy a treatment option?
Prostate tumors are rarely treated with chemotherapy unless the disease has spread to other organs. Researchers are investigating whether chemotherapy should be administered prior to any surgical intervention.
Are there any new treatments for prostate cancer?
Cryosurgery is an investigational procedure that offers an alternative to surgery for some patients. This technique involves freezing cancerous tissue to destroy it. It may reduce the risks, postoperative pain, and side effects that may accompany traditional treatments, but its long-term effectiveness is uncertain.
Scientists are also evaluating the use of a vaccine (adoptive immunotherapy) that appears to trigger the immune system to fight advanced prostate cancer. The vaccine is made from tissue of patients’ tumors grown in a laboratory. A gene that produces a substance that promotes the growth of disease-fighting blood cells is inserted into the tissue. When this is injected into the patient, an immune response results. This research is important because it is not a single treatment for killing cells, but a method for stimulating the immune system to go to work against the cancer. The data emerging from these studies are preliminary. Some patients with advanced prostate cancer may be considered for clinical trials to test the vaccine’s effectiveness.
How will I know what treatment is best for me?
Treatment recommendations depend upon the stage of the cancer, how threatening it is, your age and overall medical condition. Treatment may range from active surveillance or watchful waiting to surgery, radiation and/or participation in clinical trials of experimental therapies.
What are the survival rates for men with prostate cancer?
Survival rates after five years for all stages of prostate cancer have improved over the past 20 years from 67 percent to 93 percent. Treatments continue to improve, so there is often a more favorable outlook for those recently diagnosed. Fifty-eight percent of all prostate cancers are found while they are confined to the prostate; the five-year survival rate for men with localized prostate cancer is greater than 95 percent, according to the American Cancer Society.
Cancer Myths & Facts
Myth: Benign prostatic hyperplasia (BPH) leads to prostate cancer.
Fact: Prostate enlargement (benign prostatic hyperplasia) does not lead to prostate cancer, though its early symptoms, such as frequency of urination, may be similar to those of prostate cancer. Finasteride, a drug used to treat BPH is currently being studied to determine if it helps prevent prostate cancer. The results won’t be in for several years.
Myth: Infrequent sexual activity increases the risk of prostate cancer.
Fact: There is no documented evidence that not having regular orgasms increases the risk, or that having too many orgasms is bad for the prostate. As far as anyone knows, sexual behavior is unrelated to prostate cancer.
Myth: Most men who develop prostate cancer have a family history.
Fact: Only 15 percent of all prostate cancer patients have a family history of the disease. Research suggests that prostate cancer may be inherited through the X chromosome, meaning it comes from the mother’s side of the family. Sons of mothers with breast cancer may be at increased risk for prostate cancer.Members of families affected by the disease typically develop it at an early age.
Prevention & Screening
Although prostate cancer is typically silent in its early stages, there are screening tests your physician can perform to find the disease when it is most curable.
The diagnosis of prostate cancer used to rely solely upon the physician’s examination of the prostate gland during a digital rectal exam (DRE). However, the incidence of diagnosed prostate cancer increased dramatically between 1989 and 1992, most likely due to the introduction of prostatespecific antigen (PSA) blood screenings that led to earlier diagnosis in men without symptoms.
The PSA test is a blood test that measures the level of prostate-specific antigen, an enzyme made by prostate tissue that dissolves the proteins that cause semen to clump. Elevated amounts of PSA may indicate the presence of prostate cancer, although PSA levels can increase due to age, sexual activity and a variety of factors other than cancer. Total PSA is the most widely used and accepted form of testing. Results of the test are reported in nanograms per milliliter (ng/mL), with results under 4 ng/mL considered normal. If the results are above 4 ng/mL, your physician may recommend a prostate needle biopsy.
A needle biopsy involves removal of a tissue sample from the tumor. Examination of the tissue sample by the pathologist will determine whether the cancer is localized and how quickly it is growing. Needle biopsies are usually performed along with transrectal ultrasonography, a procedure utilizing sound waves (ultrasound) that are sent out by a probe that has been inserted into the rectum.
NFCR recommends DRE be performed annually for all men after the age of 40. Annual PSA testing should begin at age 50. However, if you have a family history of the disease or are African-American, PSA screening should begin at age 40.
The DRE remains an important test for prostate cancer, but PSA screeningand ultrasound imaging of the prostate gland can detect prostate cancer early enough to potentially cure it. A study in the Journal of the American Medical Association indicated that PSA testing could find 90 percent of aggressive prostate cancers five years before they would have been otherwise detected. Many physicians compare PSA testing to the introduction of the mammogram, which resulted in earlier detection and increased survival of women with breast cancer.
It is estimated that nearly 60 percent of all prostate cancers are now discovered early, before they have spread beyond the prostate to surrounding tissue or parts of the body. The five-year survival rate for men whose tumors are diagnosed at this stage is greater than 95 percent.
- Weak or interrupted urine flow
- Inability to urinate
- Difficulty stopping or starting urine flow
- Blood in urine
- Age – 65 plus
- Animal fat
- Race – African American
- Family history
- Digital rectal exam
- PSA blood test
- Transrectal ultrasonogram
- Needle biopsy
- Hormone therapy
- Chemotherapy (for metastatic disease)
- Clinical trials
- Limit animal fat