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Prostate cancer


Definition:
A malignant tumor growth within the prostate gland.

Causes, incidence, and risk factors:
The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels. When testosterone levels are lowered either by surgical removal of the testicles (orchiectomy) or by medication, prostate cancer can regress. There is no known association with benign prostatic hyperplasia (BPH).

Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger that 40 years of age.

Men at higher risk include black men over 60 years old, farmers, tire workers, painters, and men exposed to cadmium. The lowest incidence occurs in Japanese men and vegetarians.

Prostate cancers are classified or staged based on their aggressiveness and how different they are from the surrounding prostate tissue. There are several different ways to stage tumors; one of the more common is the A-B-C-D staging system (also known as the Whitmore-Jewett system).

A: tumor not palpable (unable to be felt on physical examination). Usually detected by accident after prostate surgery done for other reasons.
B: confined to the prostate and usually detected by physical examination or PSA testing.
C: extension of tumor beyond the prostate capsule without spread to lymph nodes.
D: cancer has spread (metastasized) to regional lymph nodes or other parts of the body (bone and lungs for example).
This system also contains several substages.


Symptoms:
With the advent of PSA testing, most prostate cancers are now found before they cause symptoms. Additionally, while most of the symptoms listed below can be associated with prostate cancer, they are more likely to be associated with non-cancerous conditions.

Urinary hesitancy (delayed or slowed start of urinary stream)
Urinary dribbling, especially immediately after urinating
Urinary retention
Pain with urination
Pain with ejaculation
Lower back pain
Pain with bowel movement
Additional symptoms that may be associated with this disease:

Urination, excessive at night
Incontinence
Bone pain or tenderness
Hematuria (Blood in the urine)
Abdominal pain
Anemia
Weight loss
Lethargy


Signs and tests:
A rectal exam often reveals the hard, irregular surface of an enlarged prostate.

Testing considerations:
PSA (prostate specific antigen) may be elevated, although other conditions such as benign prostatic hypertrophy (BPH) can cause the PSA to rise.
Free PSA may be more specific in differentiating BPH from prostate cancer.
Urinalysis may reveal blood in the urine.
Urine or prostatic fluid cytology may reveal atypical cells.
A prostate biopsy confirms the diagnosis.
CT scans may be performed to rule out metastasis (spread of the cancer).
A bone scan may be performed to rule out metastasis.
Chest X-ray may be performed to rule out metastasis.

Genetic Research:
Today, the cure for cancer of the prostate is being explored with gene therapy. Genes are the basic bricks and mortar that makes our body parts and helps it to function. Understanding genes will bring us one step closer to understanding prostate cancer.

The HPCX Project: This is also known as the "Human Prostate Cancer on the X Chromosome." Researchers developed the theory that the X Chromosome, which is inherited from the mother, would play a key role in Prostate Cancer, while the Y Chromosome which is inherited from the father is not as important.

Researchers have known for years that the brother of a man who develops prostate cancer is much more likely to be diagnosed with Ca Prostate than if his father had it. The inheritance pattern is characteristic of X-linked traits such as hemophilia. Researchers are hard at work to map out or discover the gene that is in control of prostate cancer.

This is a long tedious process. There are millions upon millions of genes that can become damaged and trigger the prostate cancer. How difficult is it to find the responsible gene? Imagine 23 city telephone books, with each volume representing one of our 23 chromosome pairs. Somewhere within 17 sets of these volumes of telephone books, there is a misspelled word, which represents the damaged gene.

First, the scientists have to discover which volume the gene resides. Then they have to discover the page and the misspelled word. At this time we are getting closer. Scientists are within 50 pages of the misspelling. Once the correct page is found, the process will move quicker. Numerous pharmaceutical companies are devoting great resources and funds toward this project. We are hopeful to find the answer within 5-10 years.

There are 3 new areas of research, which hold promise:

Gene Therapy - This process is where we use the body's own tools and DNA molecules to treat cancer cells that are resistant to surgery and radiation. Research at John Hopkins Hospital is using genetically altered tumor vaccine to rev up the body's immune system to help attack the cancer cells. The goal is to knock the tumor into remission.

Angiogenesis Research at Harvard: In order for tumor cells to survive, new blood vessels must develop so oxygen and other nutrients in the blood can feed the tumor. New blood vessels or angiogenesis also occurs with wound healing and menstruation. New medications will attempt to block the formation of these blood vessels in cancers and help to stop the growth of cancer.

Blocking Formation of Cancer Cells: There is a process called signal transduction inhibition which prevents the formation of metastatic cancer cells. There is research to find the cells that control this process. [Stephen M. Auerbach, MD,]

Preventative Measures:

Neutralizing Free Radicals - Chemical processes in our body cause an oxidative process where an electron is removed from an oxygen molecule and thus the formation of free radicals. These are very unstable compounds and are thought to cause regular prostate cells to change into cancer cells.

Use of Anti-Oxidants

Lycopene - Lycopene is a carotenoid that has been shown to reduce not only the risk of cancer, but also heart disease and macular degeneration. No one knows how Lycopene reduces the risk of prostate cancer, but a study from Harvard, and other studies suggest that it has the ability to neutralize free radicals.

VITAMIN E - Research has shown that Vitamin E is helpful in reducing not only prostate cancer but also the risk of heart attack and stroke. Simply using 400 units of Vitamin E daily can have good health benefits

SELENIUM - Oral Selenium tablets has shown effects on lowering not only prostate cancer but also lung and colon cancer >50%.

Low Fat Diets - Eating low fat foods can lower the risk and incidence of prostate cancer. Japanese men living in Japan eating a low fat diet have a very low incidence of prostate cancer. Yet move them to the United States and expose them to the American diet, their incidence of prostate cancer will more than double to match the incidence of American men.
I have seen some of my own patients who have refused standard treatment, go onto very strict low fat macrobiotic diets and have a drop in PSA and actual shrinkage of their prostate tumors. This is what I would call anecdotal observation and should not be considered curative.

However, for some men who completely refuse any medical treatment, this is a weapon that can be considered in the fight against prostate cancer. Also, men who undergo standard therapy have used low fat diets.

High Fiber Diets - Populations who eat high fiber diets (. 30 grams per day) have a lower incidence of prostate cancer, colon cancer, rectal cancer, heart attack, diabetes, diverticulosis, and diverticulitis. The average diet in the United States has a fiber intake between 12-15 grams, which is about « the recommended intake. We can increase the fiber intake by eating more fruits, vegetables, and unprocessed grains. Supplements such as Fibercon tablets and Metamucil can add fiber. These types of fiber are called "Insoluble fiber" that is helpful for the GI tract, but do not lower the incidence of heart attack. "Soluble fiber" which is found in a product called BIOS- LIFE 2 adds 10-15 extra grams of fiber daily to one's diet. This soluble type of fiber has been shown to lower the bad cholesterol and raise the good cholesterol, thus reversing the heart risk ratio. The Harvard Study showed a 41 percent drop in heart attack rates when a person took 30 grams of fiber per day.[Stephen M. Auerbach, MD,]

Treatment Options:
When prostate cancer is confined to the prostate gland and is treated in frequently can be eradicated. Usually, it is a slow growing tumor. At times it can even be left untreated and depending on the age of the man and grade of the tumor, it is not fatal. Frequently, the cancer is so slow growing that other complications of aging take over before the cancer becomes a significant clinical problem.

There are many different ways to treat prostate cancer. Talk to 6 different doctors and you may get 5 or 6 different opinions about how to treat this cancer. At this time there is no known cure, once this cancer spreads beyond the gland. The tumor is treated with hormone deprivation once it reaches this stage. Approximately 200,000 men are diagnosed each year with prostate cancer. Approximately 40,000 men will die from prostate cancer yearly, making it the second leading cause of deaths after lung cancer.

The mortality rate of prostate cancer is highest in blacks. This thought to be partly due to genetic factors, diet, access to medical care, and the reluctance to have regular prostate exams. The death rates from prostate cancer of different ethnic groups in the United States are shown below:

Blacks - 55 blacks per 100,000
Whites - 24.1 per 100,000
Chinese-Americans have the lowest rate of prostate cancer with a rate of 6.6 deaths per 100,000 people.[Stephen M. Auerbach, MD,]

Complications:
Impotence is a potential complication after prostatectomy or radiation therapy. Recent improvements in surgical procedures have made this complication occur less often.

Urinary incontinence is another possible complication. After transurethral surgery, urethral stricture may develop. Medications can have side effects, including hot flashes and loss of sexual desire.

Calling your health care provider:
Call for an appointment if you are a man over 50 years old, who has:

Never been screened for prostate cancer (by rectal exam and PSA level determination)
Not maintained annual evaluations
A family history of prostate cancer
You should discuss the advantages and disadvantages to PSA screening with your physician.


References

Bradley Somer, M.D. Division of Hematology-Oncology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

Stephen M. Auerbach, MD, http://www.hisandherhealth.com/articles/Prostate_Cancer-everything_You_Want_to_Know.shtml