Prostate Cancer Treatments, Symptoms, Diagnosis

A. What is Prostate Cancer?



Prostate cancer
is a disease in which cancer develops in the prostate, a gland in the male reproductive system. Cancer occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.
The prostate is the gland below a man's bladder that produces fluid for semen. The gland surrounds the first part of the urethra. The urethra is the passage through which urine drains from the bladder to exit from the penis. Prostate cancer is the third most common cause of death from cancer in men of all ages. It is rare in men younger than 40.

Levels of a substance called prostate specific antigen (PSA) is often high in men with prostate cancer. However, PSA can also be high with other prostate conditions. Since the PSA test became common, most prostate cancers are found before they cause symptoms. Symptoms of prostate cancer may include:

- Problems passing urine, such as pain, difficulty starting or stopping the stream, or dribbling
- Low back pain
- Pain with ejaculation

Prostate cancer treatment often depends on the stage of the cancer. How fast the cancer grows and how different it is from surrounding tissue helps determine the stage. Treatment may include surgery, radiation therapy, chemotherapy or control of hormones that affect the cancer.

B. What Causes Prostate Cancer?

What causes prostate cancer and why some types behave differently are unknown. Research suggests that a combination of factors may play a role, including :

• Testosterone, the male hormone, does not cause prostate cancer but is known to feed its growth. Therefore, some prostate cancer treatments are aimed at blocking the body's production of testosterone.
• Age, men over age 50 are at risk for prostate cancer and risk increases with age. As studies into aging continue, scientists may find that the aging process produces biochemical reactions that contribute to abnormal cell growth. This is an area of intense research.
• Heredity, if a man's father or an older sibling has had prostate cancer, he is at increased risk. Also, African American men are at increased risk.
  Scientists are looking at genes that may be responsible for inherited prostate cancer. The genes under investigation are called Hereditary Prostate Cancer Genes 1 and 2 (HPC1, HPC2) and HPCX.
  It is not yet known to what degree these genes are responsible for prostate cancer. It may be that genetically acquired prostate cancer develops differently than cancer from other causes, but more research into this theory is needed.
• Genetics, researchers are finding that genetic flaws are responsible for many cancers. Recent research has shown that a genetic defect may keep some men from developing a certain enzyme. This enzyme could mount a defense against cells vulnerable to cancer-causing agents in the environment.
• Diet, some studies have found that a diet high in animal fat may increase a man's risk for developing prostate cancer, while a diet high in fruits and vegetables (especially tomato-based products) may decrease the risk.

C. What Are The Syptoms of The Prostate Cancer?

The three most common types of prostate disease are:

1. Benign prostatic hyperplasia
2. Prostatitis
3. Prostate cancer

Although these diseases have different causes, they have similar symptoms. This is why it's important to be checked for prostate cancer as part of your yearly physical examination. Your doctor will often refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) if you have symptoms of any of the following diseases.

1. Benign Prostatic Hyperplasia (BPH)
   Often called BPH, benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland. It is very common but rarely causes symptoms before age 40. According to the American Urological Association about half of men between the ages of 51 and 60 and up to 90% of men older than age 80 have BPH.
   Symptoms of BPH include:
   * Difficulty urinating
   * An urge to urinate even when the bladder is empty
   * Frequent urination, especially at night
   * A weak or intermittent stream of urine and a sense of incomplete emptying when urinating .
2. Prostatitis
   Prostatitis is an inflammation of the prostate. This can be caused by a bacterial infection. Men of all ages can get prostatitis, and it can occur in any size prostate (enlarged or not).
   Symptoms of prostatitis include:
   * Difficulty urinating
   * Frequent urination, especially at night
   * Pain or burning during urination
   * Chills and fever along with urinating problems
3. Prostate Cancer
   Prostate cancer, in its early stages, may not cause any symptoms. But as it progresses, symptoms often appear.
   Symptoms of prostate cancer include:
   * A need to urinate frequently, especially at night
   * Difficulty starting urination
   * Inability to urinate
   * Weak or interrupted flow of urine (dribbling)
   * Painful or burning urination
   * Painful ejaculation
   * Blood in urine or semen
   * Frequent pain or stiffness in the back, hips, or upper thighs

by Paul O'Neill, MD on December 01, 2006

D. Prostate Cancer Treatment.

One of the most important factors in deciding how to treat prostate cancer is staging. The size, location, and whether your cancer has spread will help your medical team plan the right treatment.

For most men, the decision will rest on a combination of clinical and psychological factors. Men diagnosed with localized prostate cancer today will likely live for many years, so any decision that is made now will likely reverberate for a long time. Careful consideration of the different options is an important first step in deciding on the best treatment course.

1. Active Surveillance. The concept of active surveillance, or watchful waiting, has increasingly emerged in the past years as a viable option for men who, for one reason or another, have decided not to undergo immediate surgery or radiation therapy. During active surveillance, the cancer is carefully monitored for signs of progression. A PSA blood test and DRE are usually administered every six months along with a yearly biopsy of the prostate. If symptoms develop, or if tests indicate that the cancer is growing, treatment might be warranted.
2. Prostatectomy (Surgery). A surgical approach toward the treatment of prostate cancer can be used to remove all or part of the prostate. Typically, men with early-stage disease or cancer that is confined to the prostate will undergo radical prostatectomy, or surgical removal of the entire prostate gland plus some surrounding tissue.
3. Radiation Therapy. Radiation involves the killing of cancer cells and surrounding tissues with directed radioactive exposure. Some forms of radiation therapy: External Beam Radiation Therapy ( CT scans and MRIs are used to map out the location of the tumor cells, and x-rays are targeted to those areas. With 3D conformal radiotherapy, a computerized program maps out the exact location of the prostate tumors so that the highest dose of radiation can reach the cancer cells within the gland ) , Brachytherapy ( tiny little metal pellets containing radioactive iodine or palladium are inserted into the prostate via needles that enter through the skin behind the testicles. As with 3D conformal radiation therapy, careful and precise maps are used to ensure that the seeds are placed in the proper locations ).
4. Hormone Therapy. Also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent the hormone from acting on the prostate cells. Although hormone therapy plays an important role in men with advancing prostate cancer, it is increasingly being used before, during, or after local treatment as well. The most common types of hormone therapy are : Orchiectomy ( Because about 90% of testosterone is produced by the testicles, surgical removal of the testicles, or orchiectomy, is an effective solution to blocking testosterone release. This approach has been used successfully since the 1940s, but because it’s a permanent and irreversible surgical solution, most men opt for drug therapy instead.), LHRH Agonists ( LHRH, or luteinizing-hormone releasing hormone, is one of the key hormones released by the body before testosterone is produced. (Note that LHRH is sometimes called GnRH, or gonadotropin-releasing hormone.) Blocking the release of LHRH through the use of LHRH agonists or LHRH analogues is one of the most common hormone therapies used in men with prostate cancer.).
5. Chemotherapy. The term "chemotherapy" refers to any type of therapy that uses chemicals to kill or halt the growth of cancer cells. The drugs work in a variety of ways, but are all based on the same simple principle: stop the cells from dividing and you stop the growth and spread of the tumor.
6. Cryotherapy. Cryotherapy, also known as cryosurgery or cryoablation, has been around for years, but until a few years ago, it was rarely used. With this approach, probes are inserted into the prostate through the perineum (the space between the scrotum and the anus), and argon gas or liquid nitrogen is delivered to the prostate, literally freezing to death the prostate cells and any prostate tumors. Cryotherapy is also used as a secondary local therapy in men who underwent radiation therapy as initial treatment for early-stage prostate cancer.
7. High-Intensity Focused Ultrasound. works in exactly the opposite way compared with cryotherapy: with HIFU, the prostate cells are heated to death. A probe is inserted into the rectum, from which very high-intensity ultrasound waves are delivered to the target area.

resources : Prostate Cancer Foundation

E. Prostate Cancer - Prevention

Eat more low-fat, high-fiber foods, such as:

• Soy products, like tofu and soy beans.
• Tomatoes and foods that contain tomato sauce.
• Vegetables, like broccoli, cauliflower, and cabbage.

Researchers are looking into other things that may help prevent prostate cancer. More research is needed in all these areas.

• Finasteride is a pill that is used to treat enlarged prostates. It prevents prostate cancer from starting in 1 out of 4 men (25%). But men who take finasteride and do get prostate cancer may have a higher risk of getting more serious (high-grade) tumors than normal.
• Taking a nonsteroidal anti-inflammatory drug (NSAID) every day may help protect men who are 60 or older from prostate cancer.
• One recent study suggests that drinking red wine may prevent some prostate cancer.

Researchers are studying the possibility that vitamins D and E, selenium, and green tea may help prevent prostate cancer.

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Autoimmune Disorders Types, Symptoms, and Treatments

A. What are Autoimmune Disorders?

An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. There are more than 80 different types of autoimmune disorders.

B.Causes of Autoimmune Disorders

The cause of autoimmune diseases is unknown, but it appears that there is an inherited predisposition to develop autoimmune disease in many cases. In a few types of autoimmune disease (such as rheumatic fever), a bacteria or virus triggers an immune response, and the antibodies or T-cells attack normal cells because they have some part of their structure that resembles a part of the structure of the infecting germ.

Normally the immune system's army of white blood cells helps protect the body from harmful substances, called antigens. Examples of antigens include bacteria, viruses, toxins, cancer cells, and foreign blood or tissues from another person or species. The immune system produces antibodies that destroy these harmful substances.

But in patients with an autoimmune disorder, the immune system can't tell the difference between healthy body tissue and antigens. The result is an immune response that destroys normal body tissues. The response is a hypersensitivity reaction similar to allergies, where the immune system reacts to a substance that it normally would ignore. In allergies, the immune system reacts to an external substance that would normally be harmless. With autoimmune disorders, the immune system reacts to normal body tissues.

What causes the immune system to no longer distinguish between healthy body tissues and antigens is unknown. One theory holds that various microorganisms and drugs may trigger some of these changes, particularly in persons who are genetically prone to autoimmune disorders.

Autoimmune disorders fall into two general types:

1. Systemic Autoimmune Disease: those that damage many organs, include: rheumatoid arthritis (joints; less commonly lung, skin), lupus [Systemic Lupus Erythematosus] (skin, joints, kidneys, heart, brain, red blood cells, other), Scleroderma (skin, intestine, less commonly lung), Sjogren's syndrome (salivary glands, tear glands, joints), Goodpasture's syndrome (lungs, kidneys), Wegener's granulomatosis (sinuses, lungs, kidneys), Polymyalgia Rheumatica (large muscle groups), Temporal Arthritis / Giant Cell Arthritis (arteries of the head and neck).
2. Localized Autoimmune Disease: those where only a single organ or tissue is directly damaged by the autoimmune process, include: Type 1 Diabetes Mellitus, Hashimoto's thyroiditis, Graves' disease (thyroid),celiac disease, chron's disease, ulcerative colitis, Multiple sclerosis*, Guillain-Barre syndrome (central nervous system), Addison's disease (adrenal), Primary biliary sclerosis, Sclerosing cholangitis, Autoimmune hepatitis (liver), Raynaud’s phenomenon (fingers, toes, nose, ears)

An autoimmune disorder may result in:

• The destruction of one or more types of body tissue
• Abnormal growth of an organ
• Changes in organ function

An autoimmune disorder may affect one or more organ or tissue types. Organs and tissues commonly affected by autoimmune disorders include:

• Red blood cells
• Blood vessels
• Connective tissues
• Endocrine glands such as the thyroid or pancreas
• Muscles
• Joints
• Skin

C. Symptomps of Autoimmune Disorders.

Symptoms of an autoimmune disease vary widely and depend on the specific disease. A group of very nonspecific symptoms often accompany autoimmune diseases, and may include:

• Dizzines
  
• Fatigue
• General ill-feeling
• Low-grade fever

Signs and tests:

The health care provider will perform a physical exam. Specific signs vary widely and depend on the specific disease.

Tests that may be done to diagnose an autoimmune disorder may include:

• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)

D. Treatment of Autoimmune Disorders

The goals of treatment are to reduce symptoms and control the autoimmune process while maintaining the body's ability to fight disease. Treatments vary widely and depend on the specific disease and your symptoms.

Some patients may need supplements to replenish a hormone or vitamin that the body is lacking. Examples include thyroid supplements, vitamins, or insulin injections.

If the autoimmune disorder affects the blood, the person may need blood transfusions.

Measures to help with movement or other functions may be needed for autoimmune disorders that affect the bones, joints, or muscles.

Medicines are often prescribed to control or reduce the immune system's response. Such medicines may include corticosteroids and immunosuppressant drugs such as cyclophosphamide or azathioprine.

The treatment for autoimmune disorders is similar to the treatment for multiple chemical sensitivities, i.e., identifying and unlearning the specific allergic reactions, detoxification, and supporting adrenal and immune system function. However, the parts of your body that have been impacted by an autoimmune reaction, glands, organs, joints, even the nervous system, may also need attention. These will begin to heal themselves after the autoimmune reaction is cleared, but may also need healing, supplements or more conventional rehabilitation practices. Furthermore, in the cases where joint, organ, glandular, neural structures have been significantly impaired, major medical intervention and support is indicated, e.g., insulin or knee replacement.

Outlook (Prognosis)

The outcome depends on the specific disease. Most are chronic, but many can be controlled with treatment. Symptoms of autoimmune disorders can come and go. The sudden, severe development of symptoms is called a flare up.

Traits in Common

That such different-seeming diseases as psoriasis and diabetes could stem from a common cause actually is a relatively new notion, according to Noel R. Rose, MD, PhD, professor of molecular microbiology and immunology and pathology at the Johns Hopkins University in Baltimore. Back in the early days of the last century, he says, the idea took hold that if the immune system were to benefit us, it would have to be warding off foreign invaders from outside the body.

Now, scientists know that the immune system is a set of actions and reactions that can be triggered by a number of things besides an invading germ, virus, or bacteria. One thing that puts you at risk for being attacked by your own immune system is your genetics, says Rose. In other words, if your parents have a predisposition to autoimmune disease, you may, too. "And it's an overlapping inheritance," Rose says. "If you have one autoimmune disease, you may have more -- and you may have different ones than your parent did (or your siblings do)."

Another common characteristic of all autoimmune diseases is that it is thought that an outside agent is required to start the process. Even with a genetic tendency, a person may not develop an autoimmune disease without an environmental influence to set it off. Examples of these are infections, certain foods (iodine or gluten products), and toxins (some drugs, smoking, certain hair dyes, chemicals in the workplace).

Dozens of culprits have been identified. Shomon reels off a list of possible suspects in the more common autoimmune ailments: hair dye and certain drugs for lupus, silica exposure for scleroderma; gluten for diabetes; mycoplasmas for rheumatoid arthritis; measles virus for Epstein-Barr; coxsackie virus for diabetes; smoking for thyroid, lupus, and arthritis; hepatitis B infection for multiple sclerosis. She says physical trauma can also touch off the immune response.

As the disease develops -- or more than one, as Rose points out -- vague symptoms start to appear, such as joint and muscle pain (very common), general muscle weakness, possible rashes or low-grade fever, trouble concentrating, or weight loss. More specific signs can point toward something being wrong: numbness and tingling in hands and feet (also common), dry eyes (common), hair loss, shortness of breath, heart palpitations, or repeated miscarriages can also be caused by an autoimmune response.

Research Continues

Although autoimmune disorders can make life miserable, they usually are chronic and not fatal, Shomon says. Most are handled by a range of doctors from internist to rheumatologist to dermatologist. "There is no such thing as an autoimmunologist," she says. Usually, it's the researchers that are seeking to attack the disorders as a common group.

According to Rose, some approaches being tried include a complete "reboot" of the immune system -- the famous bone marrow transplant. "This is only tried if other treatments have failed," he says. "The idea is that if the entire immune system is erased, it might to a better job the second time around." Doctors at Johns Hopkins use a chemotherapy drug called cyclophosphamide to "reboot" the immune system. This has showed promise in a number of lupus patients.

If the causative agent of the disease is known, a vaccine can be developed. Immunoglobulin or antibodies are being used in children with the heart disease called Kawasaki disease, as well as Guillain-Barre and multiple sclerosis.

What You Can Do Now

If you suspect you may have an autoimmune problem, it's very important to identify and deal with any food allergies, according to Shomon. The main offenders are wheat, diary, corn, soy, fish (especially shellfish), nuts, and fruits. High sugar, she contends, stresses the immune system. Make sure you eliminate trans fats and other bad fats and get enough good fats such as olive oil, fish oil, and avocado.

You also want to minimize infections -- wash your hands frequently. Take care of your teeth for the same reason: Gum diseases leak triggers into the body. Some people even lavage their noses with warm salt water to remove possible troublemakers.

Each autoimmune disorder also will have separate dietary and therapeutic recommendations. It's important to follow your doctor's orders. This is not a quick fix -- it's a lifestyle.

SOURCES:

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Mary J. Shomon, author, Living Well With Autoimmune Disease. Noel R. Rose, MD, PhD, professor of molecular microbiology and immunology and pathology, Johns Hopkins University, Baltimore.

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