Prostate cancer is the development of a malignant growth or tumor caused by uncontrolled or abnormal cell division in the tissues of the prostate gland. An estimated 217,730 new cases of prostate cancer will be diagnosed in the United States in 2010, and an estimated 32,050 men will die of the disease. It is the second most common cancer among men in the United States, and it most often develops in men older than age 65.
Although experts have identified risk factors for prostate cancer, the underlying cause of the disease is not known. Like other cancers, prostate cancer is believed to develop in two steps. During step one, the cells are exposed to factors, such as viruses or toxins, that cause or trigger the unusual or uncontrolled cell growth. During step two, other factors such as diet, hormones, and environmental influences promote the growth and development of the abnormal cells.
Certain factors such as age, ethnicity and genetics cannot be influenced however there are a number of lifestyle, nutrition and other factors that can form part of a program to help both prevent prostate cancer and to maximize your recovery and long term wellness in the event you are diagnosed with the disease. Maintaining maximum prostate health is about both reducing your risk factors as well as providing your body with maximum immunity through preventative wellness.
Just being on the planet for 65 years or longer is considered to be the strongest risk factor for prostate cancer. That’s the age group in which more than 60 percent of prostate cancers show up. (American Cancer Society) Since there’s nothing you can do about this risk factor, concentrate on those that you can control such as lifestyle, nutrition and exercise as well as maintaining a positive, stress and toxin free environment as well as other factors.
Ethnicity – African-American Men
Compared with white men, African-American men are twice as likely to develop prostate cancer in their early 50s and twice as likely to die of the disease. (American Cancer Society) They are also more likely to be in an advanced stage of the disease when diagnosed. (Winterich 2009) On the other end of the spectrum, Asian-Americans and Hispanic/Latino men are less likely to develop prostate cancer.
If your father or brother had or has prostate cancer, you are more than twice as likely to develop the disease. Your risk is ever greater if you have more than one close relative with prostate cancer. (American Cancer Society). Research shows that approximately 10% of prostate cancer cases are hereditary.
Men who typically consume foods that promote inflammation and contain cancer-promoting substances; that is, a high-fat diet, lots of red meat, and one that is low in fiber, fruits and vegetables, and whole grains, have a higher risk of developing prostate cancer than men who do not eat these foods. Calcium, dairy and other foods and additives have also been linked to a higher risk of prostate cancer and men whose diets are low in certain nutrients and foods such as lycopene, omega 3, vitamin D, antioxidants and other cancer killers have also been shown to have a higher risk of prostate cancer. In addition, according to the World Health Organization “diet might influence prostate cancer risk by affecting hormone levels.”
Exposure to Chemicals
Studies show that men who work in certain occupations (e.g., tire plant workers, farmers, painters) are more likely to get prostate cancer. This is believed to be related to their exposure to chemicals. A 2009 study, for example, found a two-fold increased risk of prostate cancer among farmers who were exposed to pesticides compared with farmers who were not exposed. (Parent 2009) It’s also been estimated that 90 percent of people in the United States have detectable levels of BPA toxin in their bodies. BPA has been associated with various health problems, including an increased risk of cancer, including prostate cancer.
Scientists agree that genetics are responsible for 5 to 10 percent of prostate cancer cases. Among the genes identified as being responsible is one called HPC1 (Hereditary Prostate Cancer Gene 1).
Lifestyle and Exercise
Men who are physically inactive are more likely to develop prostate cancer and other prostate disease. A study published in November 2009 reported that men who regularly engaged in moderate exercise appeared to have a lower risk of developing prostate cancer. (Antonelli 2009)
Research indicates that elevated levels of the male hormone testosterone may be a risk factor, as this hormone is part of the process in encouraging prostate growth. However, while testosterone has a major role in prostate cancer, it is an imbalance of hormones—including testosterone—and not the hormone alone that is of the most concern in the development of prostate cancer.
The presence of inflammation as a risk factor is a relatively new theory.
Inflammation may contribute to the development of prostate cancer by damaging cellular DNA and encouraging normal prostate cells to become cancerous. (American Cancer Society) In fact, an increasing amount of research points to the major role inflammation plays not only in prostate cancer but other serious diseases as well.
Most health experts agree that obesity is linked to prostate cancer and can have an impact in several areas, yet they are not sure why this is so. Some possible reasons are that obese men tend to have lower testosterone levels, higher (or relatively so) estrogen levels, elevated levels of insulin-growth factor (which might spur the cancer on), and greater amounts of saturated fats in their diet (which can encourage cancer growth).
Dairy, Calcium and Other Food Additives
Several prestigious research organizations, namely the World Cancer Research Fund and the American Institute for Cancer Research, found that consuming too much calcium in foods and/or supplements is a probable risk factor for prostate cancer. (Itsiopoulos 2009).
Symptoms and Severity
Not all men who have prostate cancer experience symptoms, but those who do may have urinary problems that include an inability to pass urine, difficulty starting or stopping the flow of urine, urinary urgency, a weak urinary flow, and pain or burning during urination. Other symptoms may include difficulty having an erection, blood in the urine or semen, and frequent pain in the hips, lower back, or upper thighs.
In the early stages of the disease, prostate cancer does not give you any hint that cancer is brewing. You may have no symptoms at all and cancer may be discovered as a result of a general health check up and routine prostate cancer screening.
Physical symptoms of prostate cancer may include:
- Strong urge to urinate immediately
- Difficulty starting the urinary stream
- A weak urinary stream once it starts
- Dribbling after you think you’re finished
- Frequent nighttime urination
- Pain and/or burning when you urinate
- Pain in the genital and pelvic area
- Pain when you ejaculate
- Frequent urinary tract infections
- Blood in your urine or semen
- Unexpected weight loss
- Pain in the lower back or abdomen.
During a routine examination Dr. Alarcon will usually complete a thorough medical history and ask questions about your urinary function. He may also have you fill out a form or answer questions based on the International Prostate Symptoms Test or Chronic Prostatitis Although certain answers to these questions can suggest that the prostate is diseased, at this point exactly what the problem is cannot be determined without further testing. These tests include:
Digital rectal examination (DRE): This test is the “gold standard” for checking on prostate health. For the DRE, Dr. Alarcon will insert a lubricated finger into the rectum to check for any irregularities in the shape and size of the prostate.
PSA (prostate-specific antigen) test: The PSA test is a simple blood test that measures the levels of prostate specific antigen in the bloodstream. The blood level of PSA generally rises when cancer is present however, a high PSA level is not necessarily a sign of prostate cancer because several other factors can cause the level to increase.
TRUS: A transrectal prostate ultrasound allows Dr. Alarcon to get a picture of your prostate via an ultrasound probe that is inserted into the rectum. Although the TRUS is not 100 percent reliable as a way to detect prostate tumors, it does find some that escape the DRE. The TRUS can also help Dr. Alarcon to estimate the size of your prostate, which is used to calculate the PSA density. This information helps doctors differentiate between prostate cancer and prostate enlargement. Generally, a PSA density greater than 15 percent suggests (but does not definitively identify) prostate cancer, while a lower density suggests BPH.
Prostate Biopsy: The biopsy procedure allows Dr. Alarcon to take small core samples of prostate tissue for examination in a laboratory. If cancer is found, it can be “staged” and “graded” according to a number of factors. More on the prostate biopsy procedure. In some cases, although cancer is not initially found, the laboratory may discover something called PIN which are irregular, but not cancerous cells in the prostate, that some experts believe set the stage for cancer in some men. PIN is graded “high” or “low” depending on the extent of the cellular irregularity.
Other Imaging Techniques: Other imaging used to diagnose prostate cancer may include an MRI scan. A MRI uses a magnetic field, radio waves, and a computer to produce very clear pictures of internal structures without the use of x-rays. Images from an MRI can provide physicians with information that may not be visualized adequately using x-rays, ultrasound, or computed tomography (CT).
There is no “one size fits all” treatment for prostate cancer. Today men diagnosed with localized prostate cancer may live for many years, any decision made now will probably reverberate for a long time. Your decision-making process should include a combination of factors, including:
- The need for treatment
- The risk level of your cancer
- Your personal circumstances
- Your desire for a certain therapy
There is a growing number of options for treating prostate cancer including:
- Watchful Waiting
- Hormone Therapy
You and Dr. Alarcon may discuss “watchful waiting” or “active surveillance” (as it is also known), depending on the stage, level of risk, and other factors like your age and lifestyle priorities. This is the most basic treatment for prostate cancer, and it involves doing nothing more than keeping an eye on the situation, typically by returning to Dr. Alarcon routinely for examinations to make sure the disease has not taken a turn for the worse. Watchful waiting entails regular prostate-specific antigen (PSA) tests, digital rectal exams (DRE) and/or other tests. “Waiting” means being alert for any indication that the cancer has developed to the point that it may require surgery or other treatment. If you meet the criteria for watchful waiting, you may avoid the discomfort and possible side effects of treatment by choosing this option. If you have limited remaining life span or other serious disease, watchful waiting may enable you to maximize your quality of life and avoid prolonged recovery and other complications. Generally, watchful waiting is appropriate for men who meet one or more of these criteria.
- Short life expectancy
- Have significant other illnesses
- Have small tumors, a low Gleason score, and a low PSA level
- Any man fearful of treatment, regardless of age or health.
All prostate cells are stimulated by the male hormone called testosterone. Some types of prostate cancer cells actually require high doses of this hormone. By eliminating testosterone, hormonal therapy can temporarily slow down the growth of the prostate cancer cells but not stop it. Dr. Alarcon will normally use hormonal deprivation therapy to slow the spread or growth of prostate cancer. Additional indication for hormonal deprivation therapy is shrinkage of the prostate gland prior to the primary therapy. Dr. Alarcon may also suggest hormonal deprivation therapy when prostate cancer has spread beyond the prostate gland to other parts of the body.
Risks and side effects of hormonal therapy:
- Loss of sexual desire
- Hot flashes
- Weight gain
- Reduced brain function
- Loss of muscle mass
Radical prostatectomy is major surgery performed under general or regional anesthesia that removes the entire prostate gland plus some surrounding tissue. During the procedure the pelvic lymph nodes may also be sampled for a biopsy. The goal is to remove the cancer entirely and prevent its spread to other parts of the body. Radical prostatectomy is performed under anesthesia and the procedure takes from 1.5 to 4 hours to complete. The patient is either unconscious during the prostatectomy or remains awake but numb below the waist. After removal of the prostate, the urethra is sewn to the neck of the bladder over a urinary catheter. The catheter is a narrow tube that is passed through the urethra into the bladder. Drains are placed around the site and then the incision is closed. Success rates for a radical prostatectomy can range from 30 – 98%. Studies have shown success rates between 76 – 98% for low-risk disease; 60 – 76% for moderate-risk disease; and 30 – 76% for high-risk disease. It is also recognized that the experience of the surgeon performing the surgery is important i.e. surgeons have greater success rates and lower complication rates if they routinely perform the procedure. There are two main types of prostatectomy procedures, including:
Is the most common radical prostatectomy procedure, the incision begins below the navel and extends to just above the pubic bone. In a variation of this procedure, a smaller, curved incision is made between the anus and the base of the scrotum; the prostate is then removed from underneath the pubic bone. A nerve sparing radical prostatectomy may be employed in an attempt to preserve the man’s erectile function.
Minimally Invasive Surgery (MIS) allows physicians to perform many kinds of major surgery with a variety of benefits for the patient, incliding; less trauma and pain, minimal scarring, faster recovery and shorter hospital stays. Surgeries are performed through small incisions, which replace the large incisions needed for conventional open surgeries. The benefits of MIS are numerous. Traditional surgery often requires a lengthy hospital stay and weeks of recovery. With minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery. Many procedures require fewer days in the hospital and promote reduced recovery time. Patients can often get back to their normal routines more quickly.
There are several types of radiation including:
Brachytherapy is a type of internal radiation therapy that delivers a doses of radiation from implants placed close to, or inside, the tumor(s) in the body. This technique ensures radiation is given to cancerous tissues, while striving to minimize exposure to the surrounding healthy tissue. Before each brachytherapy treatment, a radiation oncologist will determine the position and radiation dosage with millimeter precision. During treatment, hollow catheters placed into the prostate to deliver a dose of radiation. Next, a series of radioactive pellets are inserted into each catheter. Computer guidance controls how far the pellet goes into the catheter and how long the pellet stays in the catheter to release its radiation dose.
External Beam Radiation Therapy (EBRT)
External beam radiation therapy (EBRT) is a type of radiation therapy that directs a beam of radiation from outside your body at cancerous tissues within your body. EBRT delivers high-energy rays to tumors, using a special X-ray machine called a linear accelerator. This machine allows radiation to be delivered from any angle and shapes radiation beams to the contour of the tumor.
IMRT uses a powerful, advanced computer program that plans a precise dose of radiation in three dimensions, before every treatment. Three-dimensional planning allows the radiologist to simultaneously treat multiple tumors with different doses of radiation, while minimizing radiation exposure to healthy tissue and organs. Because of its greater degree of accuracy, IMRT may be a treatment option if you have reached the maximum allowable dose of conventional radiation therapy and have a recurrent tumor.
Cryotherapy is an option for prostate cancer patients who want to avoid major surgery and/or radiation. Cryotherapy can treat prostate cancer patients with low, intermediate and high risk cancers as well as those who have failed previous radiation treatment. The goal of cryotherapy is to eradicate prostate cancer by freezing. During the procedure ultrasound is used to accurately guide the insertion of the small ultra-thin needles into the prostate. The needles are precisely controlled and monitor during the freezing. The main risk associated with prostate cryotherapy is impotence. This can occur since in order to ensure the destruction of all cancer cells, the goal is to freeze tissue beyond the prostate. In doing so, the nerve bundles associated with erection that lie close to the prostate may be affected.
High Intensity Focused Ultrasound, or HIFU, an emerging therapy that destroys tissue with rapid heat that is focused on the malignancy in the prostate gland. Ultrasound energy, or sound waves, is focused at a specific location and at that “focal point,” the temperature raises to almost 90 degrees Celsius in a matter of seconds. Any tissue at the “focal point” is destroyed; however, any tissue outside of the focal point remains unharmed. HIFU has produced results, in studies performed outside the United States, that are broadly comparable to standard therapies and HIFU is a minimally invasive prostate cancer therapy that does not use ionizing radiation, which can be potentially harmful.
IMPORTANT INFORMATION The Sonablate® 500 is not approved for use in the U.S. The Sonablate® 500 remains investigational in the U.S. and is being studied for the treatment of prostate cancer in clinical trials in the U.S. FDA has made no decision as to the safety or efficacy of the Sonablate® 500 for the treatment of prostate cancer.
Chemotherapy is the use of any one or combination of cancer-killing drugs. It is prescribed in cases of recurrent or advanced prostate cancer that has not responded to hormone treatment, but it is not used to treat early stage disease.
Chemotherapy is given in cycles of treatment followed by a recovery period. The entire treatment generally lasts three to six months, depending on the type of chemotherapy medications given.
Generally, chemotherapy drugs are given intravenously (directly into the vein) or rarely, by mouth.
Once the drugs enter the bloodstream, they travel to all parts of the body to reach cancer cells that may have spread beyond the prostate.
Because chemotherapy acts to kill rapidly dividing cancer cells, it also kills other rapidly dividing healthy cells in the bodies, such as the membranes lining the mouth, the lining of the gastrointestinal tract, hair follicles, and bone marrow. As a result, the side effects of chemotherapy relate to these areas of damaged cells. The good news is that the damaged non-cancerous cells will be replaced with healthy cells, so the side effects are only temporary. The specific side effects you have depends on the type and amount of medicines you are given and how long you are taking them. The most common, temporary side effects of chemotherapy include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Mouth sores
PROVENGE is the first FDA-approved autologous cellular immunotherapy, is a breakthrough treatment that uses a patient’s own antigen-presenting cells to stimulate the body’s immune system against prostate cancer.
PROVENGE is approved by the FDA as an autologous cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer.
PROVENGE is made from a patients own immune cells. Your cells will be collected at a cell collection center approximately 3 days before each scheduled infusion of PROVENGE. There can be risks associated with the cell collection process, which you should discuss with Dr. Alarcon before deciding to begin treatment with PROVENGE.
The most common side effects reported with PROVENGE are chills, fatigue, fever, back pain, nausea, joint ache, and headache. These are not all the possible s side effects of PROVENGE treatment.
Prostate Cancer Treatment Side Effects
Many men understand that when prostate cancer is caught early, it can be treated effectively, and the primary treatment options for localized disease are all excellent choices. However, many men also have significant concerns about the side effects of these treatments.
The concerns are justified, but there are many misunderstandings about how often side effects occur, how severe they really are and what can be done to manage them and counteract their occurrence.
Many of the side effects that men fear most following local treatment are often less frequent and severe than they might think, thanks to:
- Technical advances in both surgery and radiation therapy
- New ways to help overcome side effects
- Improvements in treatment delivery
It’s still important to understand how and why these effects occur, and to learn how you can minimize their impact on your daily life. There are three main categories of side effects typically associated with prostate cancer treatments, includes:
- Urinary dysfunction
- Bowel dysfunction
- Erectile dysfunction