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
·
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
·
US
TOO! Prostate Cancer Education and Support
Written by:
Fatema
Yusufali, Doctor of Pharmacy candidate
University
of Illinois at Chicago
UIC Pharmacy
September
2012
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