Prostate Cancer Treatment Information

PROSTATE CANCER TREATMENT INFORMATION

What is the Prostate?

The prostate (not "prostr ate") is a gland, normally the size of a walnut, that is found in the male pelvis. It is located directly under the bladder, and surrounds a portion of the tube draining the bladder, called the "urethra". It is right in front of the lower rectum, and thus can be felt ("palpated") with an examining finger("digital exam") inserted into the rectum. The prostate has 5 distinct portions, or"lobes", including "anterior" and "median", but the examining finger palpates only the "posterior" lobe and right and left "lateral" lobes. The prostate manufactures "prostatic fluid", a clear high-sugar substance, which mixes with semen to activate it. Coming off the prostate are two "wing-shaped" sacs, called"seminal vesicles", which store semen for injection into the urethra, to be mixed with prostatic fluid, during ejaculation. The prostate is surrounded by a tough, fibrous "capsule." It is fed blood by pelvic arteries ("internal iliac") and it drains to similarly named veins. A network of"lymphatic channels" run through and around the prostate, collecting blood serum to purify it. These channels lead to"lymph nodes" which are glands filled with White Blood Cells that filter the blood, destroying germs. The lymph nodes are named as groups, and connected to each other so that their filtrate can eventually be returned to the bloodstream. Lymph channels can act as conduits for spread of infections or cancers, and usually swell when they capture these. Pelvic Lymph node groups pertinent to the prostate include the peri-prostatic, obturator, hypogastic, sacral and common iliac "nodes." Once prostate cancer or infection has gone to local lymph nodes, it is not longer considered to be confined to the prostate (but may still be confined to the pelvis).A bundle of nerves ("neurovascular bundle") lies in the pelvis on either side of the prostate. If these area are damaged, it will impair a man's ability to get an erection and ejaculate, possibly causing complete impotence.

The prostate tends to swell in size as a man ages; this is called "Benign Prostatic
Hypertrophy" or"BPH" for short. The enlarged prostate may press upon the urethra and restrict urine outflow from the bladder, causing small frequent urinations ("frequency"), dribbling urine, and incomplete bladder emptying ("post- void residual"). Medications like Prescore and Hytrin may help alleviate these problems without surgery. If medications fail, a "Tans Urethral Resection of Prostate"("TARP") may be done to chip away the swollen prostate tissue and decompress the urethra, to reestablish easy urination. The prostate may become infected ("prostatitis") or develop calcium "stones" which lead to BPH type symptoms, or develop frank cancer . However, any prostate problem is rare in a man younger than 50 years old.

What is Prostate Cancer?

The prostate is made up of many individual cells, which work together in harmony. Normally these cells divide quickly to make new cells, and grow the prostate, in womb life, early childhood, and through male puberty. In adulthood, the cells only divide to replace those lost to injury, disease or old age. The division of cells to produce new ones is under tight control by the "genes" within each cell. These genes are made up of "DNA", and if it becomes damaged, the cell may start dividing out of control.Prostate cancer starts in a single cell which has become abnormal. This cells produces millions, and eventually billions, of copies of itself. The copies are called"clones." These clones fail to function as normal prostate tissue, but instead divert resources from healthy cells to fuel their own growth. When there are about 1 billion cells, they form a clump, or "tumor" 1/2 inch across. A "tumor" merely means a swelling, it can be caused by infection, inflammation, cancer or whatever. If a tumor only grows in it's local area (even very large) but does not have the capacity to spread to distant body areas, it is called"benign" and isnot cancer. If, however, the tumor has the ability to spread to distant body areas, it is called "malignant" andthis is cancer. The actual process of spread is called"metastasis", and can occur to any area of the body. This is what makes cancer so dangerous.

How Common is Prostate Cancer?

Prostate cancer is the most common cancer in men, in the U.S.A, with 317,000 new cases in 1996 . It is the second leading cause of cancer death in men, killing about 35,000 men per year in the U.S.A. Although the deadliness of certain prostate cancers is obvious, it is also important to note that only about 5% of men with prostate cancer actually die from it, instead dying with it . Most often, some other "co-morbid" condition like heart attack or lung cancer kills the patient long before prostate cancer would. As many as 80% of men over age 80 years can be shown to have some trace of cancer in their prostates! The average patient is 65 years old at time of detection. The aggressiveness of prostate cancer is variable, and each man must understand the nature of his particular disease to make wise decisions about it. In general, Black men get prostate cancer more often than White men in the U.S.A, but Blacks in Africa have a low risk. Asian men have a low risk of prostate cancer.

What Causes, or Increases the Risk for Prostate Cancer?

As for all cancers, the exact reason why one man gets prostate cancer and another does not remains unknown . However, there are some associations, called "risk factors", that seem to increase the chances a man will develop it in the U.S.A:

1) Male Sex (since only males have a prostate), Black, older than age 60.
2) Family History of prostate cancer in father or uncles.
3) Multiple Sex Partners, a transmitted virus may be a factor.
4) High Testosterone Levels, the "sex hormone" is low in Asians, high in Blacks!
5) Benign Prostatic Hypertrophy increases risk 4 times (or chance of detection?).
6) Exposure to high dietary fat, cadmium metal.

*** Cigarettes and Alcohol do not increase the risk for getting prostate cancer.

Is Prostate Cancer Preventable?

Having only one sex partner and lowering dietary fat may help. Also, having one's testicles cut off ("bilateral orchiectomy") at a young age will reduce the risk to nearly zero (eunuchs don't get it) but this is not advised. The truth is, there isn't much you can do to prevent prostate cancer; the key is to recognize it's existence and characteristics early.

What are the Symptoms of Prostate Cancer?

As with any cancer, very early prostate cancer produces no symptoms, since the "tumor burden" is too small to cause interference with normal body functioning. It is most commonly detected symptom less ("asymptomatic") by a screening blood test called "Prostate Specific Antigen" or "PSA" for short. The prostate normally produces this enzyme and releases it into the bloodstream; it's level increases with BPH, infection, cancer or even vigorous rectal exam. However, in cancer the PSA is usually markedly increased (when adjusted for the volume of prostate tissue), compared to smaller increases with other conditions. A PSA reading of over 4.0 milligrams per milliliter of blood starts getting suspicious for prostate cancer, since 95% of men under age 50 will be below this number. A PSA reading of 30 mg/ml or over almost certainly indicates cancer (technical note-- In general, the PSA increases by 3 mg/ml for each gram of cancerous tissue). It is possible to see PSA's in the thousands when the cancer is widespread.

If and when prostate cancer actually produces symptoms, they are most likely to resemble those of BPH-- a swollen prostate causing urinary frequency, especially at night ("nocturia") along with incomplete emptying of the bladder ("post-void residual"). Symptoms of more advanced prostate cancer include pain in the pelvis (from the cancer invading nerves), impotence (ditto), swelling of the legs or genitalia (from blockage of lymphatic flow by tumor) or even complete shutdown of urine output ("uremia") which causing itching ("pruritis") and blurred thinking ("uremic encephalopathy"). The first symptoms noted may even be from cancer spread to other organs, with bone pain, weight loss, fatigue and low blood counts ("anemia"). The most common area for spread to bone is the pelvis and spine, spread to the finger or toe areas is rare. Spread to the brain may occur in advanced disease and produce neurologic symptoms of poor judgment, partial paralysis, sensory loss, and seizures. Spread to spinal cord may cause weakness and numbness requiring immediate therapy to prevent irreversible paralysis. Fortunately, most of the symptoms of prostate cancer can be alleviated (see section on "palliation" ).

How is Prostate Cancer Detected and Evaluated?

Today, the most common way of detecting Prostate Cancer is through the PSA test (Hospitals often run free screening programs, hoping to treat you if they detect cancer). Another common way the disease comes to attention is during an annual physical exam when the doctor does a"digital rectal examination" and feels a lumpy ("nodular") or diffusely enlarged prostate gland. The gloved examining finger is then applied to a specially treated card and "developer" placed on it ("guiac test") to look for occult (too little to be seen with the naked eye) blood in the rectum. If there is suspicion of prostate cancer, a PSA test will be ordered, and the patient usually sent to a "urologist." A urologist is a surgeon who specializes in operating on the urinary tract, and treating all sorts of "genito-urinary" diseases.

Prostate cancer is the most common organ cancer in men, and is the source of much confusion. While it is the second leading cause of cancer death in men, only about 5% of men with early stage prostate cancer will die from it! There are many treatment options, including surgery, radiation therapy, hormones, castration, and even just "watching" it.

It is crucial for a man to understand in options in dealing with a prostate cancer problem. Being knowledgable may help him preserve his potency, continence or even his life. It is important to know that one has done everything possible to fight prostate cancer successfully.

The most difficult part about prostate cancer is that it can be challenging to diagnose. Unlike the symptoms of AIDS or even the more prevalent signs or pregnancy, signs of cancer aren't always clear and can be misdiagnosed as other illnesses.

CancerAnswers's materials explain, in plain English, the definition, types, risk factors, frequency, symptoms, evaluation, historical and latest effective treatment for prostate cancer. We desribe the specifics of radical surgery, radiation, hormones and combination therapies with their results. We tell you everything you must know to help make the right choices today for a prostate cancer problem.

This is just an excerpt of CancerAnswers's report on Prostate Cancer. Much more, including latest can be sent to you by mail when you order the complete Prostate Cancer transcript at a nominal cost. Thank you for using CancerAnswers as your information resource.