Prostate cancer develops in a man’s
prostate — the walnut-sized gland just below the bladder that produces
some of the fluid in semen. It’s the most common cancer in men after
skin cancer. Prostate cancer often grows very slowly and may not cause
significant harm. But some types are more aggressive and can spread
quickly without treatment.
Symptoms
In the early stages, men may have no
symptoms. Later, symptoms can include frequent urination, especially at
night; difficulty starting or stopping urination; weak or interrupted
urinary stream; painful or burning sensation during urination or
ejaculation; blood in urine or semen.
Continue reading after the cut...
Advanced cancer can cause deep pain in the lower back, hips, or upper thighs.
Enlarged prostate or prostate cancer?
The prostate can grow larger as men age,
sometimes pressing on the bladder or urethra and causing symptoms
similar to prostate cancer. This is called benign prostatic hyperplasia.
It’s not cancer and can be treated if symptoms become bothersome.
A third problem that can cause urinary
symptoms is prostatitis — an inflammation or infection that may also
cause fever and, in many cases, is treated with medicine.
Risk factors: Growing older is
the greatest risk factor for prostate cancer, particularly after age 50.
After 70, studies suggest that most men have some form of prostate
cancer, though there may be no outward symptoms. Family history
increases a man’s risk.
Again, diet seems to play a role in the
development of prostate cancer, which is much more common in countries
where meat and high-fat dairy are mainstays. The reason for this link is
unclear. Dietary fat, particularly animal fat from red meat, may boost
male hormone levels. And this may fuel the growth of cancerous prostate
cells. A diet too low in fruits and vegetables may also play a role.
Detection
Screening tests are available to find
prostate cancer early. You should talk with a doctor or, preferably, a
urologist, about screening tests once you are 40. This is highly
recommended for anyone at high risk such as those with a father,
brother, or son diagnosed before age 65, and those with more than one
first-degree relative diagnosed at an early age.
Your doctor may initially do a digital
rectal exam to feel for bumps or hard spots on the prostate. A blood
test can be used to measure prostate-specific antigen, a protein
produced by prostate cells. An elevated level may indicate a higher
chance that you have cancer, but you can have a high level and still be
cancer-free. It is also possible to have a normal PSA and have prostate
cancer.
If a physical exam or PSA test suggests a
problem, your doctor may recommend a biopsy. A biopsy is the best way
to detect cancer and predict whether it is slow-growing or aggressive.
Survival rate: The good news
about prostate cancer is that it usually grows slowly. In advanced
countries, nine out of 10 cases are found in the early stages.
Unfortunately, in our part of the world, most people only present when
the disease has spread very far and is therefore in the late stages.
Treatment options
With low-risk cancer, one option is to
watch and wait. This is determined by several factors. Your doctor will
order periodic testing. Other treatments — with the risk of sexual or
urinary problems — may not be necessary. Some men who are older or have
serious health conditions may not need treatment. However, more
aggressive treatment is usually recommended for younger men or those
with more aggressive disease.
Radiation therapy: External beam
radiation to kill cancer cells can be used as a first treatment or after
prostate cancer surgery. It can also help relieve bone pain from the
spread of cancer. In brachytherapy, tiny radioactive pellets about the
size of a grain of rice are inserted into the prostate. Both methods can
impair erectile function. Fatigue, urinary problems, and diarrhoea are
other possible side effects.
Surgery: Removing the prostate,
or radical prostatectomy, is used to eliminate the cancer when it is
confined to the prostate. New techniques use smaller incisions and seek
to avoid damaging nearby nerves. If lymph nodes are also cancerous,
prostatectomy may not be the best option. Surgery may impair urinary and
sexual function, but both can improve over time.
Hormone therapy may shrink or slow the
growth of the cancer, but unless it is used with another therapy, it
will not eliminate the cancer. Drugs or hormones block or stop the
production of testosterone and other male hormones, called androgens.
Side effects can include hot flashes, growth of breast tissue, weight
gain, and impotence.
Chemotherapy kills cancer cells
throughout the body, including those outside the prostate, so it is used
to treat more advanced cancer and cancer that did not respond to
hormone therapy. Because the chemotherapy kills other fast-growing
cells in the body, you may have hair loss and mouth sores. Other side
effects include nausea, vomiting, and fatigue.
Cryotherapy freezes and kills cancerous
cells within the prostate. It is not as widely used because little is
known about its long-term effectiveness. It’s less invasive than
surgery, with a shorter recovery time. Because the freezing damages
nerves, as many as 80 per cent of men become impotent after cryosurgery.
There can be temporary pain and burning sensations in the bladder and
bowel.
Prostate cancer vaccine is designed to
treat, not prevent, prostate cancer by spurring your body’s immune
system to attack prostate cancer cells. Mild side-effects can occur such
as fatigue, nausea, and fever.
Hope for advanced cancer. Your doctor
will continue to monitor your PSA levels and may perform other tests
after treatment for prostate cancer. If it recurs or spreads to other
parts of the body, additional treatment may be recommended. Lifestyle
choices may matter, too. One study found that prostate cancer survivors
who exercised regularly had a lower risk of dying.
And be sure to tell your doctor if you are taking vitamins or supplements.- Andrew Mene (dr.mene@lagoonhospitals.com)
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