Prostate Cancer Awareness Month

Prostate Cancer Awareness Month

What is prostate cancer?

Prostate cancer is defined as the spread of cancerous cells in the prostate gland.  The prostate is a small gland that lies below the urinary bladder.  Normally, the cells that line the prostate gland divide as needed by the body. However, cancerous cells divide and grow even when not needed, and over time these cells accumulate to form a tumor, causing the prostate gland to become enlarged. Most prostate cancers are slow growing; however, there are cases of fast growing cancers that spread beyond the prostate into the surrounding tissues and to the other parts of the body.

How many people are affected by prostate cancer?

Prostate cancer is the second most common cause of death among men in the United States.  In 2010, approximately 271,000 men were diagnosed with prostate cancer. It is rare in men less than 40 years of age, occurring in about 1 in every 10,000 men. However, this rate increases after age 40, with 1 in every 103 men being diagnosed with prostate cancer. The prevalence of the disease is higher in African Americans than in whites or Hispanics. Prostate cancer is also more aggressive in African Americans compared to other races or ethnic groups.

Who is at risk for prostate cancer?

There are certain risk factors that increase a man’s chance of developing prostate cancer. Some of which include:

·      Older than 50 years of age

·      Family history: Having relatives with prostate cancer and also having female relatives with the BRCA breast cancer gene.

·      Race and ethnicity: Prostate cancer is more common in African Americans than in  whites, Hispanics or Asians

·      Smoking and more than 2 alcohol drinks per day

·      A diet rich in animal fats, red meats, and dairy products

What symptoms will I be experiencing if I had prostate cancer?

Prostate cancer is a silent disease usually with no symptoms in the early stages.  However, during the later advanced stages, signs and symptoms may begin to appear; some of the commons ones are listed below.

Signs and symptoms of prostate cancer

·      Bone pain

·      Pain and difficulty urinating

·      Dribbling after completion of urination

·      Frequent nighttime urination and bedwetting (nocturia)

·      Blood in semen and urine

·      Pain in the lower part of the pelvis and back

·      Painful ejaculation

·      Unintended weight loss

What is prostate cancer screening?

Prostate cancer screening is a way in which doctors check the prostate gland for signs of cancer.  Doctors offer screening in hopes of catching the disease during the early stages before it has a chance to spread or cause symptoms.

Who should be screened for prostate cancer?

There are a few tests that can be done to diagnose prostate cancer.  The American Cancer Society (ACS) recommends that average risk men receive information on screening and be able to make a decision about screening at age 50, whereas men at high risk (such as African American men or those with a family history of the disease) should be screened earlier at age 40. A digital rectal exam (DRE) and prostate specific antigen (PSA) are recommended tests, however, these are not definitive. The combination of these 2 tests are used first-line and are better at diagnosing prostate cancer compared to either test alone. When PSA and DRE test results appear abnormal, a prostate biopsy will be done to confirm the diagnosis. A description of these tests are given below.

Digital Rectal Exam (DRE)

This test is performed by a physician who will place his gloved and lubricated finger a few inches into the rectum.  A normal prostate would feel soft, even, and mobile; however, if it feels hard, bumpy, or uneven, the physician may recommend additional tests.

Prostate Specific Antigen (PSA)

This is a blood test in which the PSA level is measured.  PSA is a protein produced by the prostate. A normal PSA level is 4 ng/mL. There is controversy as to the exact level of PSA to be considered elevated, and many clinicians do not refer to high levels of PSA as “elevated or abnormal”. Instead they use the test results along with other risks present such as family history or race and DRE results. This is because the test is not specific, and there are other conditions such as benign prostatic hypertrophy (BPH) and prostatitis that may also cause an elevation in the PSA level.

Prostate Biopsy

When both the DRE and PSA tests are abnormal, a prostate biopsy may be done to rule out cancer.  Physicians may take several tissue samples to confirm the diagnosis and spread of the cancer. A device known as transrectal ultrasound (TRUS) is used and inserted into the rectum. This device has a probe that helps the physician to see the prostate and ensures accuracy of sample removal.   

What are the choices of treatments for prostate cancer? How do I chose between these treatments?

There are a number of treatment choices for men who are newly diagnosed with prostate cancer. When the cancer is confined to the prostate gland, standard treatment procedures include radical prostectomy, radiation, or active surveillance. Hormonal therapy may be used for cancer that has advanced.

  

Radical prostectomy

Radical prostectomy is a surgical procedure during which the prostate gland and some of the  surrounding tissue is removed.  The major side effects of this surgery include erectile dysfunction and urinary incontinence (inability to control release of urine). In both instances, the expertise and skill of the surgeon can make a difference in how severe these complications can be.

Radiation

Radiation therapy has been used for the treatment of prostate cancer for a long time, and there have been many advances in its use.  There are 2 main types of radiation treatments used for prostate cancer: external beam radiation therapy and brachytherapy.  

·      External beam radiation is delivered from a distance. The source usually is a machine that is outside the body that emits high energy x-rays to kill the cancer cells. Patients would have to visit the clinic every day for a number of weeks to receive radiation.

·      Brachytherapy is when the radiation source is placed inside the prostate gland. This is  often a one-time treatment.

Active surveillance

Active surveillance is when a patient chooses not to receive any treatment right away.  Instead the patient is placed under active surveillance. The patient is routinely monitored by their physician and recommended to get frequent biopsies and PSA tests.  This method is only used for men with prostate cancer that has not spread and has a very low risk of progressing further.

Who receives hormonal therapy?

Hormonal therapy is usually recommended for patients with prostate cancer that has spread throughout the body to involve other tissues.  The cancer cells require male hormones (androgens) for growth and survival.  The purpose of hormonal therapy is to lower the level of male hormones to prevent further growth of the cancer. Several classes of drugs can be used for this, including the antiandrogens.  

What can I do to prevent prostate cancer?

There are several steps you can take to lower your risk of prostate cancer.

·      Regular screening for prostate cancer is important in early detection of the disease.

o   Patients who have first degree relatives with prostate cancer or are of African American decent should begin annual screening early.

·      Have a healthy diet

o   High consumption of animal fats, red meats and total consumption of fats has been shown to increase the risk of prostate cancer.

o   Foods rich in omega-3 fatty acids and carotenoids have been recommended as they have been shown to have a protective effect.

o   Eating fruits and vegetables, especially tomatoes, that contains lycopene (an antioxidant) has been shown to lessen a man’s risk of developing prostate cancer.

o   Regular exercise for at least 30 minutes a day, 5 times a week  is essential for prostate and total body health.

o   Avoid smoking and keep alcohol intake to less than 2 drinks a day.

 

Where can I find more information on prostate cancer?

Below are a few resources where patients can find more information on prostate cancer.

·      National Comprehensive Cancer Network

www.nccn.org/patients/patient_guidelines/prostate/index.html

·      American Cancer Society (1-800-4-CANCER): http://www.cancer.org/Cancer/ProstateCancer/index

·      National Cancer society: http://www.cancer.gov/cancertopics/types/prostate

·      People Living With Cancer: The official patient information

website of the American Society of Clinical Oncology

http://www.cancer.net/cancer-types/prostate-cancer

·      US TOO! Prostate Cancer Education and Support

www.ustoo.com/Early_Detection.asp

Written by:

Fatema Yusufali, Doctor of Pharmacy candidate

University of Illinois at Chicago

UIC Pharmacy

September 2012

What is Atrial Fibrillation?

September is National Atrial Fibrillation Awareness Month

What is atrial fibrillation?

Atrial fibrillation (AF) is the most common arrhythmia or irregular rhythm of the heart. The human heart has four chambers; two upper chambers called the atria and two lower chambers called the ventricles. Normally, the blood is pumped from the atria into the ventricles and then to the lungs and the rest of the body. The electric impulse that begins this heartbeat starts in the sinoatrial (SA) node, which is located on the right atria.  This electrical impulse spreads throughout the right and left atria and causes the atria to contract and pump blood into the ventricles. The electrical signal then spreads to the atrioventricular (AV) node and to other fibers in the heart causing the ventricles to contract and pump blood out to the lungs and throughout the rest of the body.

In atrial fibrillation, however, the electric signals do not work properly and start somewhere other than the SA node. This causes the atria to beat rapidly or quiver, which may cause symptoms in some patients.  Because the atria do not contract properly, blood cannot be  efficiently pumped into the ventricles. When this happens, blood tends to pool in the atria. This could lead to the formation of a blood clot, and if this clot breaks through from the atria and travels to the brain, it can cause a stroke. For this reason, patients with AF are at a particularly high risk for stroke.

How many people are affected by atrial fibrillation?

Approximately 2.3 million Americans are affected by AF.  In the general population, the frequency of AF is 0.4% to 1% and increases with age. The frequency of AF, however, does not differ between males and females.  The rate of stroke in those with AF is about 5% per year, which is 2 to 7 times higher than those without AF.

What types of atrial fibrillation are there?

AF can be classified as paroxysmal, persistent, or permanent. Paroxysmal AF is used to describe AF that goes away on its own within 7 days, while persistent AF describes AF that lasts longer than 7 days.  Persistent AF that lasts for over 1 year is considered to be longstanding.  For longstanding AF, if the heart’s rhythm cannot be returned to normal with treatment, it is called permanent AF. Some cases of AF may not necessarily fall into just one of the classifications.  For example, a patient can sometimes have paroxysmal AF, while at other times have persistent AF or vice versa.

There is also another term referred to as lone AF that describes people who are younger than 60 years old and have AF, but do not have high blood pressure or any other structural problems with their heart.  Compared to the other types of AF, patients with lone AF are not at a high risk for stroke.

What are the common signs and symptoms associated with atrial fibrillation?

Symptoms of AF vary, and some patients may not experience any symptoms at all.  However, most patients complain of palpitations or abnormal heartbeats, chest pain, shortness of breath, fatigue, lightheadedness, and fainting.

What are common causes or risk factors for atrial fibrillation?

There are many causes of AF. AF can be related a temporary condition or to more permanent medical disorders or genetics.  Temporary causes of AF include alcohol use, exercise, surgery, electrical shock, and hyperthyroidism.  Medical conditions such as obesity are also associated with AF as well as heart conditions such as high blood pressure, heart failure, and valvular heart disease, which is a disease where the valves of the heart are damaged.  Those with a family history of AF are also at risk for developing AF.  In some patients, AF may not be associated with any of these factors and the cause is unknown.

How is atrial fibrillation diagnosed?

Atrial fibrillation is diagnosed based on the patient’s symptoms, physical exam, and electrocardiogram findings.  Electrocardiogram (ECG) is a machine that measures the heart’s electrical activity.  Other tests done when evaluating someone with AF include thyroid, liver, and kidney function tests.

Why is early diagnosis of AF important?

If AF is not properly diagnosed and treated, it can progress.  Patients with AF are at increased risk for stroke and disability or death; therefore, early diagnosis and treatment is important so that proper measures can be taken to help prevent or reduce the risk of complications.

What medications are used in the treatment of AF?

There are 3 goals in treating AF: to prevent blood clots with the use of anticoagulants (blood thinners), to control the heart rate (rate control), and to restore the heart’s rhythm to normal (rhythm control).

Anticoagulation

Patients with AF are at risk of forming blood clots and are at increased risk of a stroke. Anticoagulation is, therefore, necessary to help prevent the formation of blood clots in the first place, especially in patients who are at high risk of stroke.  Patients who are at high risk of stroke include those who have had a stroke before, are older than 75 years old, have high blood pressure, diabetes, and/or heart failure.  Drugs such as warfarin or dabigatran, which work by preventing the formation of blood clots, are used in these patients to help reduce their risk of stroke.  Those considered to have a low risk of stroke may only require aspirin.

Rate Control

Rate control is done to help slow the contractions of the ventricles and the number of beats of the heart per minute.  Usually drugs called beta-blockers (including metoprolol or propranolol) or calcium channel blockers (specifically verapamil and diltiazem) are used.  These drugs can help with some of the symptoms experienced by patients with AF.  Side effects of beta-blockers include low blood pressure and/or heart rate, worsening of asthma, and heart failure.  Some major side effects for calcium channel blockers are similar to beta-blockers and include low  blood pressure and heart failure. The heart rate can be controlled without necessarily having to return the heart’s rhythm back to normal.

 

Rhythm Control

Rhythm control, also called cardioversion, is done to restore the heart’s normal rhythm.  This can be done either with medications or by other methods.  Cardioversion with medication is most effective when given within 7 days after an episode of AF.  Medications used to achieve rhythm control include flecainide, dofetilide, propafenone, and ibutilide. The side effects vary with these drugs and include heart effects and stomach upset. Amiodarone is another medication that can be considered for rhythm control and, although effective, this drug is usually not preferred due to its potential to cause severe side effects. Therefore, the other agents are generally preferred when considering rhythm control with medication.

Another method of rhythm control is by electrical or direct current cardioversion, which requires shocking the heart in order to get it back to normal rhythm.  Sometimes this is done along with the use of medications that control the rhythm of the heart.  Use of both of these methods (medications and electrical cardioversion) may be more successful for some patients in achieving and maintaining a normal heart rhythm. 

Another procedure called catheter ablation can also be used to restore normal rhythm of the heart, especially when the rhythm is not well controlled by cardioversion.  This procedure involves inserting a catheter into a vein in the leg and up into the heart.  Radiofrequency or freezing is then used to destroy the tissue that is causing the abnormal electrical signal.  For many patients, catheter ablation can result in a long-term cure of AF.  

What can I do to prevent atrial fibrillation?

Avoiding the triggers associated with AF and treating the underlying causes of AF can help prevent AF. For example, since alcohol ingestion may trigger AF in some individuals,  avoidance of alcohol intake can help prevent it. Also, managing a healthy weight and blood pressure can also minimize one’s risk for AF. These are just some ways to help prevent AF.

Where can I find information on atrial fibrillation?

More information on AF can be found from the following organizations:

American Heart Association:

http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial-Fibrillation-AF-or-AFib_UCM_302027_Article.jsp

Heart Rhythm Society: http://www.hrsonline.org/patientinfo/heartrhythmdisorders/afib/

National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/af/

National Library of Medicine: http://www.nlm.nih.gov/medlineplus/atrialfibrillation.html

Written by: Yoradyl Bendebel, Doctor of Pharmacy candidate

University of Illinois at Chicago
UIC Pharmacy

September 2012
        

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