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 You Need to Know About Prostate Cancer

At UIC Pharmacy we want to keep you informed so you can make the best decisions on your health. 

Prostate Cancer is the 3^rd most common cancer in men and leading cause of cancer death in men over 75 years of age.¹  So far in 2011, almost 241,000 men have been newly diagnosed with prostate cancer and over 33,000 deaths have occurred in the U.S. ²

Quick question…What is a prostate?

The prostate is a gland that is only found in men.  This gland secretes a fluid that helps carry sperm during ejaculation.³  It is about the size of a walnut and sits right under the bladder and in front of the rectum.

Is BPH the same as prostate cancer?

No.  Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland.¹  Many men have BPH and it does not increase the risk for prostate cancer.  Prostate cancer is the spread of cancerous cells in the prostate tissue.² 

What are some risk factors for prostate cancer?^3,4

Age:  As you age, your risk for prostate cancer increases.  Prostate cancer is rarely seen under the age  of 50.

Ethnicity:  Prostate cancer is more common in African Americans than in Whites or Hispanics.

Family history:  You have an increased risk of developing prostate cancer if your father or brother has the disease.  Also, if a female relative has the BRCA breast cancer gene, you are more likely to develop prostate cancer.

Location:  Depending on where you live can actually increase your chance of prostate cancer.  Those who live north of 40 degrees latitude, have a higher risk of developing prostate cancer.  This is thought to be attributed to the lack of sunlight during the winter months.

What symptoms would I be experiencing if I had prostate cancer?¹

Unfortunately, not all men will have symptoms and the symptoms of prostate cancer are not specific.  Here are some common symptoms of prostate cancer:

·       Urinating more frequently

·       Having trouble urinating

·       Pain or stinging while urinating

·       Blood in the urine or semen

·       Painful ejaculation

·       Stiff lower back, upper thighs, or hips

Are there any lifestyle changes I can make to prevent prostate cancer?⁵

Although there are no proven ways to stop prostate cancer from happening, there are some changes you can make that are thought to decrease the risk.  These include:

·       Minimize red meat and dairy products

·       Do not exceed the recommended daily allowance (RDA) of calcium (RDA 1000 mg/day for men ages 19 to 70 years old)⁶

·       Maintain a healthy weight with exercise (≥30 minutes/day of aerobic exercise most days of the week)⁷

·       Incorporate healthy food into your diet (fruits, vegetables, whole grains, olive oil and fish)

·       Avoid smoking and decrease alcohol intake (≤2 drinks/day for men)⁷

·       The increased intake of soy and coffee (caffeinated or decaffeinated) has been thought to decrease the risk of prostate cancer, although this has not yet been proven

Should I make an appointment with my physician?

Prostate cancer screening has not yet been proven to save lives.⁸  During yearly check-ups, you and your physician should have a long talk about the pros and cons of screening.  If you decide to be screened, the National Comprehensive Cancer Network recommends to offer screening at 40 years of age and checking again every year or 5 years, depending on the results.  For men that have risk factors, especially African Americans and men with a family history, it is beneficial to start screening around 40 or 45 years of age.  The National Comprehensive Cancer Network recommends men with a family history or black ethnicity should do annual screening with prostate specific antigen and a digital rectal exam.  However, if you are experiencing any of the symptoms previously mentioned, do not wait until you next check-up.  Schedule an appointment with your physician right away.

What kind of tests will my doctor run?^3,8

Digital Rectal Examination:  Your physician may gently insert a finger in your rectum to feel for any abnormalities of the prostate.

Blood Test:  You physician will take a sample of your blood to run a PSA test.  Prostate specific antigen (PSA) is a protein that can be detected in the blood of all men and is often elevated with prostate cancer.  However, there are other reasons why a PSA can be elevated and not be cancerous.  Some reasons include:

·       Injury to the prostate gland (sometimes from bike riding)

·       Ejaculation 48 hours prior to PSA testing

·       Infection in the prostate gland

·       Benign Prostatic Hyperplasia

Transrectal Ultrasound: This exam is often done when your physician is suspicious of abnormalities.  A probe is placed up the rectum that releases sound waves that bounce off the prostate and creates a picture on a computer.

Prostate Biopsy:  If the PSA is elevated after repeat testing, it is recommended for your doctor to take small pieces of prostate tissue to further analyze them.   

Where can I go for more information?

National Cancer Institute: www.cancer.gov

National Comprehensive Cancer Network: www.nccn.org

American Cancer Society: www.cancer.org

References

1. United States National Library of Medicine. Medline plus: prostate cancer.  http://www.nlm.nih.gov/medlineplus/ency/article/000380.htm.  Accessed August 8, 2011.

2.  National Cancer Institute at the National Institutes of Health: Prostate cancer. http://www.cancer.gov/cancertopics/types/prostate. Accessed August 8, 2011.

3. Hoffman, RM. UpToDate. Patient information: prostate cancer screening. http://www.uptodate.com/contents/patient-information-prostate-cancer-screening?source=search_result&selectedTitle=1%7E150. Accessed July 29, 2011.

4. Prostate Cancer Foundation.  Understanding prostate cancer: prostate cancer risk factors. http://www.pcf.org/site/c.leJRIROrEpH/b.5802027/k.D271/Prostate_Cancer_Risk_Factors.htm. Accessed August 10, 2011.  

5.  Sartor AO.  UpToDate. Risk factors for prostate cancer. http://www.uptodate.com/contents/risk-factors-for-prostate-cancer?source=search_result&selectedTitle=1%7E150. Accessed July 29, 2011.

6.  Institute of Medicine. Dietary reference intakes for calcium and vitamin D. http://iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed August 15.

7.  Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.

8. Kawachi MH, Bahnson RR, Barry M, et al. NCCN clinical practice guidelines in oncology: prostate cancer early detection. J Natl Compr Canc Netw. 2010;8(2):240-262.

By: Tara Gallagly, PharmD Candidate, 2012