Prostate Cancer

The Prostate

The normal prostate is a small, squishy gland about the size of a walnut (20 milliliters). It sits under the bladder and in front of the rectum. The urethra - the narrow tube that runs the length of the penis and carries both urine and semen out of the body - runs directly through the prostate. The rectum, or lower end of the bowel, sits just behind the prostate and the bladder.

Sitting just above the prostate are the seminal vesicles - two little glands that secrete about 60% of the substances that make up semen. Running alongside and attached to the sides of the prostate are the nerves that control erectile function.

Normal Functioning of the Prostate

The prostate is not essential for life, but it's important for reproduction. It seems to supply substances that facilitate fertilization and sperm transit and survival. Enzymes like PSA are actually used to loosen up semen to help sperm reach the egg during intercourse. (Sperm is not made in the prostate, but rather the testes.)

Other substances made by the seminal vesicles and prostate - such as zinc, citrate, and fructose - give sperm energy to make this journey. Substances like antibodies may protect the urinary tract and sperm from bacteria and other pathogens.

The prostate typically grows during adolescence under the control of the male hormone testosterone and its byproduct DHT, or dihydrotestosterone.

What is prostate cancer?

Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. Generally, the tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs (abnormalities on physical examination). However, all prostate cancers do not behave similarly. Some aggressive types of prostate cancer grow and spread more rapidly than others and can cause a significant shortening of life expectancy in men affected by them. A measure of prostate cancer aggressiveness is the Gleason score (discussed in more detail later in this article), which is calculated by a trained pathologist observing prostate biopsy specimens under the microscope.

As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.

Risk Factors

There are several major factors that influence risk, some of them unfortunately cannot be changed.

Age: The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 men under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69.

In fact, more than 65% of all prostate cancers are diagnosed in men over the age of 65. The average age at diagnosis of prostate cancer in the United States is 69 years. After that age, the chance of developing prostate cancer becomes more common than any other cancer in men or women.

The most common risk misperception is that the presence of non-cancerous conditions of the prostate will increase the risk of prostate cancer.

While these conditions can cause symptoms similar to those of prostate cancer and should be evaluated by a physician, there is no evidence to suggest that having either of the following conditions will increase a man's risk for developing prostate cancer.

  • Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate. Because the urethra (the tube that carries urine from the bladder out of the body) runs directly through the prostate, enlargement of the prostate in BPH squeezes the urethra, making it difficult and often painful for men to urinate.
  • Prostatitis, an infection in the prostate, is the most common cause of urinary tract infections in men. Most treatment strategies are designed to relieve the symptoms of prostatitis, which include fever, chills, burning during urination, or difficulty urinating. There have been links between inflammation of the prostate cancer and prostate cancer in several studies. This may be a result of being screened for cancer just by having prostate related symptoms, and currently this is an area of controversy.

What can you do about it to prevent or delay the onset of the disease?

  1. Eat fewer calories or exercise more so that you maintain a healthy weight.
  2. Try to keep the amount of fat you get from red meat and dairy products to a minimum.
  3. Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
  4. Eat more fish - evidence from several studies suggest that fish can help protect against prostate cancer because they have "good fat" particularly omega-3 fatty acids. Avoid trans-fatty acids (found in margarine).
  5. Try to incorporate cooked tomatoes that are cooked with olive oil, which has also been shown to be beneficial and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy and green tea are also potential dietary components that may be helpful.
  6. Avoid smoking for many reasons. Alcohol in moderation, if at all.
  7. Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer
  8. What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may "fuel the cancer", and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin.
  9. Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
  10. Finally, eating all the broccoli in the world, though it may make a difference in the long run, does not take away your risk of having prostate cancer right now. If you are age 50 or over, if you are age 40 or over and African or have a family history of prostate cancer, you need more than a good diet can guarantee. You should consider a yearly rectal examination and PSA test

Symptoms

Not everyone experiences symptoms of prostate cancer. Many times, signs of prostate cancer are first detected by a doctor during a routine check-up.

Some men, however, will experience changes in urinary or sexual function that might indicate the presence of prostate cancer. These symptoms include:

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

You should consult with your doctor if you experience any of the symptoms above.

Because these symptoms can also indicate the presence of other diseases or disorders, such as BPH or prostatitis, men will undergo a thorough work-up to determine the underlying cause.

Should I Be Screened?

The question of screening is a personal and complex one. It's important for each man to talk with his doctor about whether prostate cancer screening is right for him. It is generally recommended to start screening from the age of 40.

There is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects.

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 Page Created: 1 February 2012