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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