1. health and fitness
2. disease
3. cancer

Part 1.
WHAT IS PROSTATE CANCER
Prostate cancer develops in a man's prostate, the walnut-sized gland just below the bladder that produces some
of the fluid in semen. It wraps around the Urethra, the tube that carries urine out of your body. It forms part of the
male reproductive system, secreting seminal fluid. This fluid acts as a nutrient-rich transport medium for sperm,
produced by the testes.
About 80% of the ejaculate volume is produced by the prostate. The prostate is under direct influence of the
male hormone testosterone.
Overview:
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It is the second most common cause of cancer death in men.
Risk is greatest for men over 60, and if a father or brother had the disease.
Early prostate cancer usually causes no symptoms.
Treatment may include surgery, radiation or hormone therapy.
Annual screening is recommended for men over 45 or over 40 if there is a positive family history.
(Please note that this number is constantly dropping)
A lower intake of dietary fat and red meat may help prevent prostate cancer.
Prostate cancer is second only to lung cancer in terms of causing death in men. It occurs most commonly in men
above 60 years of age, and it very rarely occurs under the age of 40 years. It is a slow growing but progressive
cancer. If it is detected early and managed correctly, the survival rates are high.
Currently, the incidence of prostate cancer is rising, but the mortality rate of prostate cancer is decreasing. This
paradox is most likely because of more active prostate cancer screening, due to better health awareness by
males nowadays.
With routine screening for prostate cancer, the diagnosis can be made at an earlier stage, where it is still curable
and this contributes to the decline in mortality from the disease.
Causes, incidence, and risk factors
As mentioned earlier, Prostate cancer is the second 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 age 70.
People who are at higher risk include:
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African and Coloured men, who are also likely to develop cancer at every age
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Men who are older than 60
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Men who have a father or brother with prostate cancer
Other people at risk include:
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Men exposed to agent orange exposure
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Men who abuse alcohol
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Farmers
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Men who eat a diet high in fact, especially animal fat
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Tire plant workers
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Painters
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Men who have been exposed to cadmium
A common problem in almost all men as they grow older is an enlarged prostate (benign prostatic hyperplasia, or
BPH). This problem does not raise your risk of prostate cancer.
Symptoms of Prostate Cancer
It is important to note that early prostate cancer is usually completely asymptomatic. By the time that prostate
cancer becomes symptomatic or clinically apparent it has usually spread beyond the confines of the prostatic
capsule and is no longer amenable to cure.
Ideally early prostate cancer should be diagnosed following routine screening. Many men can have a normally
enlarged prostate due to BPH (Benign prostatic hyperplasia) and at time prostate cancer can also be a chance
finding in the tissue removed by transurethral resection for symptomatic BPH.
In the early stages, men may have no symptoms. However, later symptoms can include:
• Delayed or slowed start of urinary stream
• Dribbling or leakage of urine, most often after urinating
• Slow urinary stream
• Straining when urinating, or not being able to empty out all of the urine
• Urgency and nocturia (getting up often to pass urine at night)
• Blood in the urine or semen
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Advanced cancer can cause deep pain in the lower back, hips, or upper thighs.
In advanced prostate cancer the tumour cells can break loose, with typical spread (metastases) to the bony
skeleton and the lymph glands of the pelvis. Bony metastases commonly involve the lower spine and pelvic
girdle causing lower backache and hip pain. If these bone lesions are left untreated, they can lead to spinal
fractures and paralysis. Lymphatic involvement can cause swelling of the legs and obstruction of the ureters
(the tubes leading from the kidneys to the bladder), which can lead to renal failure.
Screening: DRE and PSA
Your doctor may initially do a digital rectal exam (DRE) to feel for bumps or hard spots on the prostate. A blood
test will measure prostate-specific antigen (PSA), a protein produced by prostate cells. An elevated level may
indicate a higher chance that you have cancer, but you can have a high level and still be cancer-free. It is also
possible to have a normal PSA and have prostate cancer. A normal PSA level is considered to be under 4
nanograms per millilitre (ng/mL) of blood, while a PSA above 10 suggests a high risk of cancer. But there are
many exceptions:
• Men can have prostate cancer with a PSA less than 4.
• A prostate that is inflamed (prostatitis) or enlarged (BPH) can boost PSA levels, yet further testing may
show no evidence of Prostate Cancer at all
What are the Causes of Prostate Cancer:
The exact cause of prostate cancer is still not clear. There are, however, a few risk factors for developing this
disease. These include genetic factors (a positive family history), increase in age, and environmental factors
such as diet and lifestyles.
Ten percent of prostate cancer is inherited. These cancers usually develop at a younger age and are more
aggressive. If one first degree family member (father or brother) has prostate cancer, the risk for developing
prostate cancer is twice as high as it is for the normal population. This increases to eleven-fold if three first
degree family members have prostate cancer.
An increase in age also increases the risk of developing prostate cancer. Prostate cancer is quite rare before the
age of 40, although there are know cases of earlier ages such as 25. However, the stats still show that one in six
men between the ages of 60 and 80 years suffer from the disease. In very old men prostate cancer is not always
clinically significant. Autopsy data indicate a 70% incidence of prostate cancer in 80-year-old men. The majority
of these men died with rather than from prostate cancer.
Acquired risk factors from the environment mainly include diet and lifestyles. A typical Western diet high in
animal fats and with a large consumption of red meat may increase the risk of developing prostate cancer, as
well as the hustle and bustle of our daily lives, work, stress and junk foods.
Part 2.
WHAT IS PROSTATE CANCER: Stages & Treatment
Prostate Cancer Biopsy
If a physical exam or PSA test suggests a problem, your doctor may recommend a biopsy. A needle is inserted
either through the rectum wall or the skin between the rectum and scrotum. Multiple small tissue samples are
removed and examined under a microscope. A biopsy is the best way to detect cancer and predict whether it is
slow-growing or aggressive.
Prostate Cancer Staging
Staging is used to describe how far prostate cancer has spread (metastasized) and to help determine the best
treatment.
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Stage I: Cancer is small and still within the prostate.
Stage II: Cancer is more advanced, but still confined to the prostate.
Stage III: Cancer has spread to the outer part of the prostate and nearby seminal vesicles.
Treatment
The best treatment for your prostate cancer may not always be clear. Sometimes, your doctor may recommend
one treatment because of what is known about your type of cancer and your risk factors. Other times, your
doctor will talk with you about two or more treatments that could be good for your cancer.
In the early stages, talk to your doctor about several options, including surgery and radiation therapy. In older
patients, simply monitoring the cancer with PSA tests and biopsies may be an option.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the
testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance. Problems with
urine control are common after surgery and radiation therapy. These problems may either improve over time or
get worse, depending on the treatment. Discuss your concerns with your health care provider.
Part 3.
WHAT IS PROSTATE CANCER: Forms of Treatment
Hormone Therapy
Testosterone is the body's main male hormone. Prostate tumors need
testosterone to grow. Hormonal therapy is any treatment that decreases the effect of testosterone on
prostate cancer. These treatments can prevent further growth and spread of cancer.
Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms. There are two
types of drugs used for hormone therapy.
The primary type is called a luteinizing hormone-releasing hormones (LH-RH) agonist:
• These medicines block the body from making testosterone. The drugs must be given by injection,
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usually every 3 - 6 months.
They include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix.
Possible side effects include nausea and vomiting, hot flashes, anaemia, lethargy, osteoporosis,
reduced sexual desire, decreased muscle mass, weight gain, and impotence.
The other medications used are called androgen-blocking drugs.
• They are often given along with the above drugs.
• They include flutamide, bicalutamide, and nilutamide.
• Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and
enlarged breasts.
Much of the body's testosterone is made by the testes. As a result, removal of the testes (called orchiectomy)
can also be used as a hormonal treatment. This surgery is not done very often.
Radiation Therapy
Radiation therapy uses high-powered x-rays or radioactive seeds to kill cancer
cells.
Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be
used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used
for pain relief when cancer has spread to the bone.
External beam radiation therapy uses high-powered x-rays pointed at the prostate gland.
• It is done in a radiation oncology centre usually connected to a hospital. You will come to the centre
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from home 5 days a week for the treatments. The therapy lasts for 6 -8 weeks.
Before treatment, a therapist will mark the part of the body that is to be treated with a special pen.
The radiation is delivered to the prostate gland using a device that looks like a normal x-ray machine.
The treatment itself is generally painless.
Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions, rectal burning
or injury, diarrhea, bladder urgency, and blood in urine.
Prostate brachytherapy involves placing radioactive seeds inside the prostate gland.
• A surgeon inserts small needles through the skin behind your scrotum to inject the seeds. The seeds
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are so small that you don't feel them. They can be temporary or permanent.
Brachytherapy is often used for men with smaller prostate cancer that is found early and is slowgrowing.
It also may be given with external beam radiation therapy for some patients with more advanced
cancer.
Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or
semen, impotence, incontinence, and diarrhea.
Proton therapy is another kind of radiation used to treat prostate cancer. Doctors aim proton
beams onto a tumor, so there is less damage to the surrounding tissue.
Chemotherapy
Chemotherapy kills cancer cells throughout the body, including those outside the prostate, so it is used to treat
more advanced cancer and cancer that did not respond to hormone therapy. Treatment is usually intravenous
and is given in cycles lasting 3-6 months. Because the chemotherapy kills other fast-growing cells in the body,
you may have hair loss and mouth sores. Other side effects include nausea, vomiting, and fatigue.
SURGERY
Surgery is usually only recommended after a thorough evaluation and discussion of the benefits and risks of the
procedure.
• Surgery to remove the prostate and some of the tissue around it is an option when the cancer has not
spread beyond the prostate gland and also if not responding to the prescribed treatment. This surgery
is called radical prostatectomy and can also be done with robotic surgery.
• Possible problems after the surgeries include difficulty controlling urine or bowled movements and
erection problems.
WHAT IS PROSTATE CANCER: The Need to Know
MONITORING
After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This
involves routine doctor check-ups, including serial PSA blood tests (usually every 3 months to 1 year).
Risk Factors You Can Control
Diet seems to play a role in the development of prostate cancer, which is much more common in countries where
meat and high-fat dairy are mainstays. The reason for this link is unclear. Dietary fat, particularly animal fat from
red meat, may boost male hormone levels. And this may fuel the growth of cancerous prostate cells. A diet too
low in fruits and vegetables may also play a role.
Prostate Cancer Survival Rates
The good news about prostate cancer is that it usually grows slowly. And 9 out of 10 cases are found in the early
stages. Overall, the 5-year relative survival rate is 100% for men with disease confined to the prostate or nearby
tissues, and many men live much longer. When the disease has spread to distant areas, that figure drops to
31%. But these numbers are based on men diagnosed at least 5 years ago. The outlook may be better for men
diagnosed
Myths about Prostate Cancer
Here are some things that will not cause prostate cancer: Too much sex, a vasectomy, and masturbation. If you
have an enlarged prostate (BPH), that does not mean you are at greater risk of developing prostate cancer.
Researchers are still studying whether alcohol use, STDs, or prostatitis play a role in the development of prostate
cancer.
Coping With Erectile Dysfunction
Erectile dysfunction is a common side effect of prostate cancer treatments. Generally, erectile function improves
within two years after surgery. Improvement may be better for younger men than for those over 70. You also may
benefit from ED medications. Other treatments, such as injection therapy and vacuum devices, may help.
Prevention
Following a vegetarian, low-fat diet or one that is similar to the traditional Japanese diet may lower your risk. This
would include foods high in omega-3 fatty acids.
Food for Health
A cancer-conscious diet may be the best choice for survivors who want to bolster their health and those hoping
to lower their risk. That means:
Five or more fruits and veggies a day
Whole grains instead of white flour or white rice
Limit high-fat meat
Limit or eliminate processed meat (hot dogs, cold cuts, bacon)
Limit alcohol to 1-2 drinks per day (if you drink)
Foods high in folate may have some action against prostate cancer (spinach, orange juice, lentils). Studies found
mixed results on lycopene, an antioxidant found in tomatoes.
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Expectations (prognosis)
The outcome varies greatly. It is mostly affected by whether the cancer has spread outside the prostate gland
and how abnormal the cancer cells are (the Gleason score) when you are diagnosed.
Many patients with prostate cancer that has not spread can be cured, as well as some patients whose cancer
has not spread very much outside the prostate gland.
Even for patients who cannot be cured, hormone treatment can extend their life by many years.
Complications
The complications of prostate cancer are mostly due to different treatments.
Calling your health care provider
Discuss the advantages and disadvantages to PSA screening with your health care provider.
Support Groups
You can ease the stress of illness by joining a support group whose members share common experiences and
problems. See: Support group - prostate cancer