Prostate Cancer: A Stitch on Time Saves Nine

By Dr. Goke Akinrogunde

I never get tired of “airing” the above message on this page simply because it pays to act on time and save oneself from avoidable stress and death.

Prostate cancer is one medical condition that easily got me depressed each time I came across a victim of the disease. This is not so much because of its appalling effects on its victims but more because we know that unlike most cancers, prostate cancer is one condition that is easily preventable, easy to detect and ‘cure’ if necessary precautionary and detective measures are utilized early in the course of its progression.

As the name implies, prostate cancer is an abnormal growth in the
prostate gland. A peculiar feature is the fact that it is only found in
men, usually elderly men, since the prostrate is not present in women.
An inverse condition is cervical cancer which is peculiar to women – the bearers of the womb, the cervix is the neck of the womb.

What is the prostate?
The prostate gland is an important part of the male reproductive
system. It is an important contributor to the formation of the semen in
men. It produces nourishing materials, including fructose, for the
sperm cells. It is located just below the urinary bladder- which stores the
urine, and behind the rectum – the last portion of the large intestine,
where stool is stored before it is passed to the exterior.

Synopsis
* Worldwide, prostate cancer is a very common in men.
* One of the commonest type of cancer found in men
* About a quarter of a million cases annually.
* Second leading cause of cancer death in men
* 1 in 6 men will develop prostate cancer; 1 in 32 will die of the disease.
* Prostate cancer noted in 70% of autopsies at age 80 or beyond
* Blacks generally are more likely to develop prostate cancer than white or Asian men
* Higher death rate in blacks; twice as high as white or Asian men

Risk factors for Prostate Cancer

The risk for this disease increases exponentially with age.

Age: It is more common with increasing age; the older a person the higher the risk of developing prostate cancer.
Race: Blacks/African Americans 70% have greater risk than whites or Asians, also twice the death rate.
Diet: Red meat, high-fat dairy products, fewer fruits and vegetables. Reduced intake of these mentioned meals has been shown to have a casual relationship with the development of prostate cancer.
Family history: Chances of developing prostate cancer is higher in people whose close relatives have the disease, this is especially true for the likelihood of developing the disease at a relatively young age.

Prevention
Eating well:
Less fat, red meat; more fresh fruits and vegetables as well as tomatoes, grapefruit, watermelon are beneficial.

Medications
A drug called Finasteride (Proscar) shows some promises per prevention and moderation although there are broader studies in progress on the actual efficacy of this drug.
Relevant tests
There are two main simple tests that are usually done to screen for prostate cancer.

* Blood test: PSA (prostate specific antigen)
When it is less than 4ng/ml: normal
4 – 10ng/ml: 25% risk.
Greater than 10ng/ml: 67% risk.
* Digital rectal exam
This is done by the attending doctor via passing a finger into the rectum via the anus in order to assess the status of the prostate gland which is located in front of the rectum in men.

Ultrasound scan can also be of help in early detection

Usually the prostate gland surface is smooth but it becomes rough and ragged in men with prostate cancer.

* It is recommended that these tests are performed both yearly in all men after age 50, after age 45 in Blacks especially African Americans and other high risk groups.
Symptoms
One dangerous ‘sign’ of prostate cancer is that in the first instance it has no symptoms. It grows unfettered inside the gland with no discernable symptoms. However, with time some complications start to set in. The following are likely associated symptoms that can be developed by someone with prostate cancer:

* Urinary difficulties
* Difficulty maintaining an erection
* Blood in urine
* Pain in pelvis, spine or ribs

However, note that other diseases or problems other that prostate cancer can also cause the symptoms mentioned above.

Evaluation
Further evaluation can be done in suspected cases of prostate cancer in order to confirm the presence of the disease and the stage it has progressed to. These include the under-mentioned techniques:

* Prostate biopsy: Ultrasound guided needle biopsy
* Multiple biopsies are taken to prevent missing small cancers
* Grading of cancer when found
* Staging to determine the extent of spread to other nearby organs

Treatment Options
Many optional treatments are available; different choices for individual patients depending on their age, health, stage and grade and the tolerance for side effects.

The first step is to develop a close relationship with an experienced physician, open discussion of treatment and risks.

Treatment could come in form of surgery, radiation therapy, hormone therapy and chemotherapy or “none” but with relevant psychotherapy and other palliatives.
Surgery
A radical approach to treating prostate cancer is through surgical intervention.

Radical prostatectomy
Here the goal is cure; two main types of this major surgery can be done. What is basically done is the removal of the whole prostate gland and the tissues close-by.

Transurethral prostatectomy
This is a ‘finer’ surgery with minimal tissue removal; it is a more expensive procedure. Here the prostrate is approached through the urethra – the small tube inside the penis through which urine flows out of the body.

It relieves urinary blockage for those who cannot undergo major surgery and will have other treatments


Radiation Therapy
This is the heating up of the cancer cells under the focus of high power radiations. Cure rates similar to open surgery.

Side effects
Intestinal irritation, bowel dysfunction
Urinary difficulties
Impotence

Side effects may be delayed

Hormonal Therapy
This is relevant in cases when “cure” is not an option as in cases outlined below:

Advanced age, extensive spread of disease, used to control symptoms, or for “palliation”.

Removal of testes
Orchidectomy (removal of testicles) – this becomes handy because the testes produce the main hormone (testosterone) that maintain the existence of the prostate gland. So by removing the testes, the prostate gland with the contained cancer dies off.


Chemotherapy
This is the use of anti-cancer drugs. The use of chemotherapy in prostate cancer is however limited as shown in the following respects:
* It is used to slow down the disease, does not provide “cure”
* Often used when hormonal therapy fails, or side effects are undesirable
* Treatment of advanced disease
•Bone pain, fractures

Outcome and Survival
The prognosis and general outlook of prostate cancer is good if detected early enough before complications set in. This assertion is enumerated below:
•5 year survival: 97%
•10 year survival: 79%
•15 year survival: 57%

Disease contained in or near the prostate gland:
•5 year survival: nearly 100%

Disease spread beyond the prostate:
•5 year survival: 34%

This invariably implies that early detection will definitely save your life.

Action Plan to Prevent Prostate Cancer
•Talk to a doctor and let him assess you as outlined above.
•Annual Physical Examinations: these are cheap, easily available and no side effects.
•Digital rectal examination – this can detect both prostate cancer and cancer of the colon.
•Blood PSA test – this is not cumbersome, easy to read and analyse
•Relevant ultrasound scan helps detect early occurrence and their actual location within the gland
•Healthy diet

•Regular exercise: here consistency is the key word; not necessarily rigorous exercises that could suddenly become detrimental to health.