Symptoms and treatments of prostate cancer

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Prostate Cancer

Prostate cancer ranks as the most common cancer in Jamaica and the leading cause of cancer-related deaths, according to the Journal of Cancer Epidemiology, Volume 2016.

The Jamaica Cancer Registry reports that 873 new cases of prostate cancer were diagnosed in Kingston and St. Andrew between 1998 and 2002. Kingston and St. Andrew, which comprise 2.6 million persons, represents approximately 26% of the population of Jamaica. In 1999, the 445 reported deaths from prostate cancer in Jamaica represented 30% of all male cancer-related deaths in the island.

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. Prostate cancer often grows very slowly, but some types are more aggressive and can spread quickly if not treated. Advanced age, black ethnicity, family history, and dietary habits are significant risk factors for development of the disease.

Symptoms of Prostate Cancer

There may be no discernable symptoms, but where they occur may include:

  • Frequent urination, especially at night
  • Difficulty starting or stopping urination
  • Weak or interrupted urinary stream
  • Painful or burning sensation during urination or ejaculation
  • Blood in urine or semen

When at an advanced stage, prostate cancer can cause severe pain in the lower back, hips, or upper thighs.

In some cases, the prostate may grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms normally associated with prostate cancer. This condition, known as benign prostatic hyperplasia (BPH), is not cancer, and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis, which is an inflammation or infection.

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What are the Risk Factors?

Ageing is the greatest risk factor for prostate cancer, particularly after age 50. Studies suggest that most men have some form of prostate cancer after age 70, though there may be no outward symptoms. Family history increases a man’s risk: having a father or brother with prostate cancer doubles the risk. Men of African ethnicity are at high risk and have the highest rate of prostate cancer in the world.

Diet seems to play a role in the development of prostate cancer. The disease is much more common in countries where meat and high-fat dairy are some dietary items. Dietary fat, particularly animal fat from red meat, may boost male hormone levels, which may fuel the growth of cancerous prostate cells.

Early Detection of Prostate Cancer

The Jamaica Cancer Society has the largest and most organized screening clinic for prostate cancer to date in Jamaica. Jamaica lacks a formalized national governmental policy for prostate cancer screening. Hence, prior to the establishment of the JCS, screening was infrequent and largely opportunistic.

It is advisable that men talk with a doctor about screening tests, beginning at:

  • Age 50 for average-risk men who expect to live at least 10 more years;
  • Age 45 for men at high risk;
  • Age 40 for men with more than one first-degree relative diagnosed at an early age.

Types of Screening: DRE and PSA

Screening for prostate cancer initially requires a digital rectal exam (DRE) to feel for bumps or hard spots on the prostate. Thereafter, a blood test may be used to 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.

digital rectal examination
Digital rectal examination (courtesy of WebMD)

Widespread screening for the disease has the potential to reduce its mortality significantly but Jamaican men, for the most part, are not availing themselves for testing and treatment, if required. Why?

The digital rectal examination requires a doctor to put a lubricated, gloved finger into the rectum to check the prostate gland. A tumour in the prostate can often be felt as a hard lump. However, according to consultant psychiatrist, Professor Wendel Abel, Jamaican men fear this examination, because they associate it with homosexuality. Jamaican men abhor the thought of having another person, especially another male, inserting his finger inside their anus. Professor Abel says “The other factor may also be the fear of being diagnosed with prostate cancer or any life-threatening disease”.

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 biopsy
Prostate biopsy (courtesy of WebMD)

Treatment: Radiation Therapy

External beam radiation to kill cancer cells can be used as a first treatment or after prostate cancer surgery. It can also help relieve bone pain from the spread of cancer. In brachytherapy, tiny radioactive pellets about the size of a grain of rice are inserted into the prostate. Both methods can impair erectile function. Fatigue, urinary problems, and diarrhea are other possible side effects.

Treatment: Surgery

Removing the prostate, or radical prostatectomy, is used to eliminate the cancer when it is confined to the prostate. New techniques use smaller incisions and seek to avoid damaging nearby nerves. If lymph nodes are also cancerous, prostatectomy may not be the best option. Surgery may impair urinary and sexual function, though both may improve over time.

Treatment: Hormone Therapy

Hormone therapy may shrink or slow the growth of cancer. However, unless it is used with another therapy it will not eliminate the cancer. Drugs or hormones block or stop the production of testosterone and other male hormones, called androgens. Side effects can include hot flashes, growth of breast tissue, weight gain, and impotence.

Treatment: Chemotherapy

Chemotherapy kills cancer cells throughout the body, including those outside the prostate, so it is used to treat more advanced cancer and cancer not responsive to hormone therapy.  Treatment is usually intravenous and is given in cycles lasting 3-6 months. Hair loss and mouth sores may result from the use of chemotherapy. Other side effects include nausea, vomiting, and fatigue.

Treatment: Cryotherapy

Cryotherapy freezes and kills cancerous cells within the prostate. The treatment is not used widely because little is known about its long-term effectiveness. It is less invasive than surgery, with a shorter recovery time. Freezing damages nerves. Consequently, many men who use cryosurgery become impotent after its use.

cryotherapy
Cryotherapy (courtesy of WebMD)

Treatment: Prostate Cancer Vaccine

Prostate Cancer Vaccine is designed to treat, not prevent, prostate cancer by spurring your body’s immune system to attack prostate cancer cells. Immune cells are removed from your blood, activated to fight cancer, and infused back into the blood. Three cycles occur in one month. It’s used for advanced prostate cancer that no longer responds to hormone therapy. Mild side effects can occur such as fatigue, nausea, and fever.

Eating to Fight Prostate

A cancer-conscious diet may be the best choice for those hoping to lower their risk and for survivors who want to bolster their health. The dietary considerations are:

  • Five or more fruits and veggies a day;
  • Whole grains instead of white flour or white rice;
  • Limit or eliminate high-fat and processed meat;
  • Limit alcohol to 1-2 drinks daily (if you drink).

Foods high in folate (such as spinach, orange juice, and lentils) may be effective, somewhat, against prostate cancer.

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