Prostate Cancer (PART I)
Prostate cancer (Pca) is cancer that occurs in a man’s prostate — a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.
During normal aging, however, the gland usually grows larger. This enlargement with aging is called benign prostatic hypertrophy (BPH), but this condition is not associated with prostate cancer.
Prostate cancer is the most commonly diagnosed cancer in men and the second leading cause of cancer deaths in men after lung cancer. It usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no immediate treatment, other types are aggressive and can spread quickly. It is rarely diagnosed in men younger than 40 years, and it is uncommon in men younger than 50 years. This cancer is estimated to be found in as many as half of all men over the age of 70 and in almost all men over the age of ninety. Since the discovery of the blood test for Prostate Specific Antigen (PSA) in the 1980’s, prostate cancer can now be detected at a much earlier stage, when it is still confined to the prostate gland and has a better chance of successful treatment.
The prevalent rate of prostate cancer remains significantly higher in African-American men than in white men. While the prevalence in Hispanic men is similar to that of white men have the lowest rates in southeastern and south central Asia and northern Africa. Although mortality rates are continuing to decline among white and African-American men, death rates in African-American men remain twice as high as in white men. In the US, the incidence of prostate cancer dramatically rose in the early 1990s concomitant with the increasing utilization of PSA testing. After an initial peak, the incidence rate fell, but it has persisted at a rate nearly twice that recorded in the pre-PSA era. A central argument against routine PSA screening is that many of these cancers, if left undetected, would never have become clinically meaningful during a man’s lifetime. In fact, the incidence of organ-confined disease at diagnosis has increased, because both PSA testing and standard digital rectal examination are performed.
Prostate cancer is also found during autopsies performed in men with other causes of death. The rate of this latent or autopsy cancer is much greater than that of clinical cancer. In fact, it may be as high as 80% by age 80 years. Interestingly, the prevalence of the latent or autopsy form of the disease is similar worldwide. Together with migration studies, this suggests that environmental factors, such as diet, may play a significant promoting role in the development of a clinical cancer secondary to a latent precursor. If Japanese men move from Japan to Hawaii, the risk of this cancer increases. If they move to California their risk increases even more, approaching that of American men .
It is largely unknown as to what causes prostate cancer. It is thought, as with other malignancies, to be a combination of environmental risk factors in conjunction with a genetic predisposition. It is important to understand that risk factors are not “causes”, but are factors that make you statistically more likely than others in the general population to have a certain condition.
Main risk factors for the development of prostate cancer include:
Older age – the risk of prostate cancer increases with age and it is most common in men older than 65.
Race – black men have a greater risk of prostate cancer than do men of other races and it is also more likely to be aggressive or advanced.
Family history – If one first-line relative has PCa, the risk is at least doubled. If two or more first-line relatives are affected, the risk increases by 5-11-fold . A small subpopulation of individuals with PCa (about 9%) has true hereditary PCa.
Obesity or dietary fat – Obese men and those who consume a diet high in animal fat diagnosed with prostate cancer may be more likely to have advanced disease that’s more difficult to treat. This risk is more pronounced in African American compared with whites.
It is recommended, due to the above mentioned risk factors, that men begin screening for prostate cancer at the age of 50, unless they are African American or have a family history, then screening is to begin at the age of 40.
Prostate cancer may not cause signs or symptoms in its early stages. However the advanced form may cause signs and symptoms such as: Trouble urinating, decreased force in the stream of urine, blood in the urine, blood in the semen, swelling in the legs, discomfort in the pelvic area, bone pain.
Prostate screening tests include:
Digital rectal exam (DRE) – during a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
Prostate-specific antigen (PSA) test – a blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.
PSA testing combined with DRE helps identify prostate cancers at their earliest stages, when the cancer cells are only in the prostate, the disease is very curable (cure rates of 90% or better).
Prostate cancer can spread to nearby organs or travel through your bloodstream or lymphatic system to your bones or other organs. The advanced cancer can cause fatigue, weakness and weight loss. It can grow to block the tubes (ureters) that carry urine from the kidneys to the bladder, causing kidney problems. Prostate cancer that spreads to the bones can cause pain and broken bones. Once the cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it can no longer be cured.
If you have been diagnosed with prostate cancer, you may feel overwhelmed by the many treatment options. Since there is no “one size fits all” therapy, you should learn as much as you can about your options. When deciding on a treatment plan, you and your doctor (Urologist) will take into account your:
- general health
- grade and stage of cancer
- quality of life (including possible side effects)
Early screening, diagnosis and treatment will quickly improve the long-term prognosis, but this disease does return in some cases. Regrettably, these screening procedure is almost nonexistent in Sub-Saharan Africa, despite the highest risk posed to the black race (men) proved by research studies. The work force or the strength of a nation depends on the health of its citizenry. So who is prepared to pull the bull by the horn?
Anatomy of the prostate gland
See the Next Edition for Part II (Diagnosis and Treatment of Prostate Cancer)
By: Amissah Samuel, MD
Clinic (Hospital) Combine Southwest
Dept. of Urology
Email: [email protected]
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