PROSTATE CANCER

The Prostate is a part of the male reproductive system, which includes the penis, prostate, and testicles. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder). Its function is to produce fluid that makes up semen. Cancer is a common term for a large group of diseases characterized by the growth of abnormal cells.

Prostate cancer is the second most commonly occurring cancer in men. There was an estimated recorded amount of 1.1 million cases and 307,000 deaths in 2012; the highest death rates of prostate cancer are found in African and Caribbean countries. Men of African decent have a significantly higher rate of prostate cancer than men of other races. It should be noted that black men:

• Are more than twice as likely to die from prostate cancer than white men
  
• Are more at risk of getting prostate cancer at a younger age
  
• May have more advanced prostate cancer when the disease is found
  
• May have a more severe type of prostate cancer
  

RISK FACTORS

1. Old age (over 50 years)
   
2. Family history of prostate cancer (father, brother or other relative)
   
3. Minor risk factors may include: a poor diet, excessive alcohol consumption, tobacco smoking, and obesity.
   

SYMPTOMS

Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the urethra (the tube that carries urine from the bladder out of the penis).  Some common symptoms include:

• An increased need to urinate (even at night)
• Straining to pass urine
• Weak or interrupted flow of urine
• Difficulty emptying the bladder completely
• Pain or burning during urination
• Blood in the urine or semen
• Pain in the back, hips, or pelvis
• Painful ejaculation

TESTS FOR PROSTATE CANCER

The most commonly used tests to detect prostate cancer are blood tests, a physical examination of the prostate and a biopsy.

Digital Rectal Exam (DRE)

This used to be a very common test to screen for prostate cancer. For this test, a doctor would lubricate a gloved finger and gently insert it into the rectum. The prostate is just in front of the rectum, and if it is is enlarged or has an abnormal shape, then the doctor would easily notice it. The test is quick but might be uncomfortable. However this test as a method to screen for prostate cancer has been replaced by the PSA blood test.

Blood Tests (PSA Testing/ Screening)

This is a test that measures the level of Prostate Specific Antigen (PSA) in the blood, which is made by the prostate. A man’s PSA level may be raised if he has prostate cancer, and so the PSA test can be used as a prostate cancer-screening test. However, the test is not very specific, because PSA may be elevated in other circumstances too, (for example in some illnesses and when using some medications). Sometimes the PSA test can have false positive or false negative results. However, if a patient’s PSA level is abnormal, that is above the amount of 4.0 ng/mL, then a biopsy would have to be done in order to confirm whether a man has cancer or not.

Biopsy

A prostate biopsy is when a small piece of tissue is removed from the prostate (using a small needle) and looked at under a microscope to see if there are any cancer cells. It is the most accurate test to diagnose prostate cancer.

If prostate cancer is diagnosed, other tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. This process is called staging. The stage of prostate cancer determines the type of treatment.

TREATMENT

There are several possible treatments methods available for prostate cancer, these include:

• Watchful waiting / Active surveillance
• Surgery
• Radiotherapy

Watchful waiting/ Active Surveillance

Watchful waiting /Active surveillance is more of an observational approach to the disease. It involves having regular PSA tests, MRI scans and sometimes biopsies to ensure that any signs of advancement of the cancer are found as early as possible.
This type of treatment is often recommended:

1. For older men when it is unlikely that the cancer will affect them during the rest of their lifetime
2. For men whose overall health is too poor for them to undergo surgery and other types of treatment.
3. If the size of the cancer is very small
4. If the cancer is slow growing
5. If the cancer is only located in the prostate and has not spread anywhere else in the body

Surgery

Surgery is a common treatment method to try to cure prostate cancer (if it has not spread outside the prostate gland). The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it. There are some common (serious) side effects of prostate surgery. These include:

1. Urinary Incontinence (where you may not be able to control your urine or have leakage or dribbling)
   
2. Erectile Dysfunction
3. Infertility (during a radical prostatectomy, the vas deferens is cut, which are the pathways between the testicles and the urethra. Your testicles will still make sperm, but they can’t leave the body as a part of the ejaculate.) *See image of male reproductive system below
   

Radiotherapy

Radiotherapy involves using radiation or high-energy-rays to kill cancerous cells. In External Beam Radiation Therapy (EBRT), beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers. There are several other types of radiotherapy treatments available as well. Some side effects of radiotherapy include urinary problems, bowel problems and erectile dysfunction.

Tip#1:

Symptoms

It is important to recognize prostate cancer early. Older men who begin noticing problems with urination, blood in the urine or semen and other symptoms should see a doctor as soon as possible. All men over 50 years, should ask their doctor to be screened using the PSA test, because cancer that is treated at an earlier stage leads to a better outcome.

Tip#2:

Diet

A healthy diet may decrease the chance of developing prostate cancer. A plant-based diet is best and try to avoid processed foods. Also, avoid tobacco smoking and reduce alcohol consumption as much as possible.

Tip#3:

Exercise

Regular physical activity has many benefits. It is said that regular exercise can help the body to fight cancer cells. Exercise also helps to maintain a healthy body weight. Everyone should aim for at least 150 minutes of moderate intensity exercise spread over 3 to 5 days per week.

Tip#4:

Active Surveillance

If you and your doctor have agreed to use active surveillance as a treatment method for prostate cancer, then it is important to keep your doctor appointments and get your tests done on time. This will ensure that the cancer is being monitored appropriately.

Tip#5:

Surgery

If you have agreed to have surgery done as a treatment for prostate cancer, you must be aware of the risks involved, including Infertility. This is important for younger men who may still want to start a family. If infertility is a concern for you, you might want to consider “banking” your sperm before the surgery.
 
I hope these tips on PROSTATE CANCER were helpful; Remember your health is Invaluable.

By Dr. J. Lawarna Matthew
 
Acknowledgements
American Cancer Society
Center for Disease Control (CDC)
 American Urological Association
 Visit https://www.cdc.gov/cancer/prostate/basic_info/ and http://www.urologyhealth.org/urologic-conditions/prostate-cancer for more information.