HEALTH - PROSTATE CANCER (PROSTATE - SYMPTOMS & TREATMENT)
What is Prostate Cancer?
Prostate cancer is a malignant (cancerous)
tumor that begins in the prostate gland of men. The prostate is a
walnut-sized gland located behind the base of the penis, in front of
the rectum, and below the bladder. It surrounds the urethra, the
tube-like channel that carries urine and semen through the penis. Minerals and sugar are some of the substances found in normal semen.
The urethra is the passage through which urine drains from the bladder to exit from the penis. One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds. The prostate's main function is to produce seminal fluid, the liquid in semen that protects, supports, and helps transport sperm. A man can manage quite well health wise, without his prostate gland.
Cancer develops when changes occur in DNA, the genetic material containing instructions for growth and development for all types of cells. When DNA is altered, normal cells may multiply without control or order, and a tumor can form.
Some prostate cancers grow very slowly and may not cause symptoms or health problems for years. In this situation, the cause of death is usually not from prostate cancer, but other causes. However, if cancer does metastasize (spread) to other parts of the body, it can cause pain, fatigue, and other symptoms. Prostate cancer is somewhat unusual from other types of cancer, in that many tumors that are diagnosed do not spread from the prostate. Metastatic prostate cancer can often be treated, with the person surviving in good health for some years.
Prostate cancer is one of the most common types of cancer in men, affecting about one in six men in the United States. A diagnosis of prostate cancer can be scary not only because it can be life-threatening, but also because treatments can cause side effects such as bladder control problems and erectile dysfunction (impotence). But diagnosis and treatment of prostate cancer have gotten much better in recent years.
Prostate cancer 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
treatment, other types are aggressive and can spread quickly. If
prostate cancer is detected early — when it's still confined to the
prostate gland — you have a better chance of successful treatment.
In young men, the normal prostate gland is the size of a walnut. 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. Both BPH and prostate cancer, however, can cause similar problems in older men. For example, an enlarged prostate gland can squeeze or impinge on the outlet of the bladder or the urethra, leading to difficulty with urination. The resulting symptoms commonly include slowing of the urinary stream and urinating more frequently, particularly at night.
More than 95% of prostate cancers are adenocarcinomas, cancer that develops in glandular tissue. A rare type of prostate cancer known as neuroendocrine cancer or small cell anaplastic cancer tends to spread earlier, but usually does not produce prostate-specific antigen (PSA).
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Health: Risk Factors of Prostate Cancer (Men - Prostate)
Prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer. Most experts in this field, therefore, recommend that beginning at age 40, all men should undergo yearly screening for prostate cancer.
Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health care choices. Because the exact cause of prostate cancer is still unknown, it is also unknown how to prevent prostate cancer. The following factors can raise a man’s risk of developing prostate cancer:
Age. The risk of prostate cancer increases with age, rising rapidly after age 50. More than 80% of prostate cancers are diagnosed in men who are 65 or older.
Race/ethnicity. African American men are at higher risk for
prostate cancer than white men. They are more likely to develop
prostate cancer at an earlier age and to have aggressive tumors that
grow quickly. The precise reasons for these differences are not known
and probably involve both biologic and socioeconomic factors. Some
scientists believe that a high-fat diet, which can be common in many
parts of the African American community, plays a role in the
development of prostate cancer.
It may also be due to genetic factors within the African American community, but the specific genes are not known. Prostate cancer occurs most often in North America and northern Europe and is less common in Asia, Africa, and Latin America. Of importance, it appears that its frequency is increasing in Asian populations living in urbanized environments, such as Hong Kong, Singapore, and North American and European cities.
Family history. A man who has a father or brother with prostate cancer has a higher risk of developing the disease than a man who does not. Researchers have discovered specific genes that may possibly be associated with prostate cancer, although these have not yet been shown to cause prostate cancer or to be specific to this disease.
Diet. No study has shown conclusively that diet can directly influence the development of prostate cancer, but many studies have indicated there may be a link. There is not enough information yet to make clear recommendations about the role diet plays in prostate cancer, but the following may be helpful:
- A diet high in fat, especially animal fat, may increase prostate
cancer risk. In fact, many doctors believe that a low-fat diet may help
to reduce the health risk of prostate cancer.
- A diet high in vegetables, fruits, and legumes (beans and peas) may
decrease risk of prostate cancer. It is unclear which nutrients are
directly responsible. Lycopene, found in tomatoes and other vegetables,
may slow or prevent cancer growth. A low-fat diet that is high in
vegetables and fruits can lower blood pressure and the risk of heart
disease, with no evidence that such a diet causes harm.
- Selenium, an element that people get in very small amounts from food and water, may play a role in lowering the risk of prostate and other cancers. Vitamin E may also help lower the risk of prostate cancer. However, in a clinical trial of more than 35,000 men called SELECT (Selenium and Vitamin E Cancer Prevention Trial), researchers found that selenium and vitamin E supplements (pills), taken alone or together for an average of five years, did not prevent prostate cancer and may even cause harm in some men. Because of this risk, the National Cancer Institute has suspended the SELECT study. Men should talk with their doctor or health care provider before taking selenium and vitamin E supplements to prevent prostate cancer.
Hormones. High levels of testosterone (a male sex hormone)
may speed up or cause the development of prostate cancer. Prostate
cancer does not develop in men who, for other reasons, were castrated
(the removal of the testicles) before puberty and whose bodies no
longer make testosterone. Stopping the body’s production of
testosterone, called androgen deprivation therapy, often treats
advanced prostate cancer.
In a clinical trial, the drug finasteride (Proscar, Propecia) was found to lower the risk of prostate cancer. However, it has also be suggested that those tumors that do occur in the presence of finasteride may be more aggressive in their biology. This drug has not been approved yet for prostate cancer prevention by the U.S. Food and Drug Administration (FDA).
Health: Symptoms of Prostate Cancer (Men - Prostate)
In the early stages, prostate cancer often causes no symptoms for many years. So many cases of prostate cancer aren't detected until the cancer has spread beyond the prostate. For most men, prostate cancer is first detected during a routine screening such as a prostate-specific antigen (PSA) test or a digital rectal exam (DRE); as a hard nodule (lump) in the prostate gland. Usually, the doctor first feels the nodule during a routine digital (done with the finger) rectal examination.
When symptoms do occur, they depend on how advanced the cancer is and how far the cancer has spread.
Early symptoms of prostate cancer can include urinary
problems, caused when the prostate tumor presses on the bladder or on
the tube that carries urine from the bladder (urethra). As the cancer
enlarges and presses on the urethra, the flow of urine diminishes
and urination becomes more difficult. Men may also experience burning
with
urination or blood in the urine.
As the tumor continues to grow, it can completely
block the flow of urine, resulting in a painfully obstructed and enlarged
urinary bladder. However,
urinary symptoms are much more commonly caused by benign prostate
problems, such as an enlarged prostate (benign prostatic hyperplasia)
or prostate infections. Less than 5 percent of cases of prostate cancer
have urinary problems as the initial symptom.
When prostate cancer does cause symptoms, the following symptoms may occur. Sometimes, men with prostate cancer do not show any of these symptoms. Or, these symptoms may be caused by a health condition that is not cancer. If you are concerned about any symptoms on this list, please talk with your doctor or health care provider.
None of these symptoms is specific to prostate cancer. The same
symptoms occur in men who have a noncancerous health condition known as benign
prostatic hyperplasia (BPH), or enlarged prostate. Urinary symptoms
also can indicate an infection or other health conditions. If cancer has spread beyond the prostate gland, a man may experience:
- Swelling in your legs
- Discomfort in the pelvic area
- Bone pain that doesn't go away
- Bone fractures
- Compression of the spine
If you have difficulties with urination, see your doctor or health care provider. This
health condition doesn't always relate to prostate cancer, but it can be a
sign of prostate-related health problems.
Beginning at age 50, the American Cancer Society recommends having yearly screening tests for prostate cancer. If you're black or have a family history of the disease, you may want to begin at a younger age. Yearly screenings can help detect prostate cancer early, when it's easier to treat. They include:
- PSA test. This blood test checks levels of prostate-specific antigen (PSA), which can be a sign of prostate cancer. While this test can detect signs of cancer, elevated PSA levels are sometimes caused by conditions other than cancer, such as prostate enlargement, infection or inflammation.
- Digital rectal exam (DRE). This test involves insertion of a lubricated finger into the rectum to feel for bumps on the prostate. While it can be slightly uncomfortable, an annual DRE is a quick, simple exam that can be a lifesaver.
Health: Diagnosis of Prostate Cancer (Men - Prostate)
Doctors
use many tests to diagnose cancer and determine if it has metastasized.
Some tests may also determine which treatments may be the most
effective. For most types of cancer, a biopsy is the only way to make a
definitive diagnosis of cancer. If a biopsy is not possible, the doctor
may suggest other tests that will help make a diagnosis, but this
situation occurs infrequently with prostate cancer. For example, this
occurs when a patient has another health problem that makes it
difficult to carry out a biopsy, or when a person has a very high PSA
level and a bone scan that indicates cancer. Imaging tests may be used
to find out whether the cancer has metastasized. Your doctor may
consider these factors when choosing a diagnostic test: Prostate cancer may not cause any symptoms at first. The earlier prostate cancer is detected, the more likely it can be
cured. Two tests are now commonly used to detect prostate cancer in
men: the PSA test and the DRE. Details about these tests are provided
below.
- 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 and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. Studies have not been able to show that routine screening decreases the chance that anyone will die of prostate cancer, but screening with PSA and DRE can help identify cancer at an earlier stage.
- Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.
- Prostate biopsy. If initial test results suggest prostate cancer, your doctor may recommend biopsy. To do a prostate biopsy, your doctor inserts a small ultrasound probe into your rectum. Guided by images from the probe, your doctor uses a fine, spring-propelled needle to retrieve several very thin sections of tissue from your prostate gland. A pathologist who specializes in diagnosing cancer and other tissue abnormalities evaluates the samples. From those, the pathologist can tell if the tissue removed is cancerous and estimate how aggressive your cancer is.
Determining how far the cancer has spread
Once a cancer diagnosis has been made, you may need further tests to
help determine if or how far the cancer has spread. Many men don't
require additional studies and can directly proceed with treatment
based on the characteristics of their tumors and the results of their
pre-biopsy PSA tests.
- Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.
- Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.
- Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but they can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.
- Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.
- Lymph node biopsy. If enlarged lymph nodes are found by a CT scan or an MRI, a lymph node biopsy can determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present.
Grading of Prostate Cancer
When a biopsy confirms the presence of cancer, the next step, called
grading, is to determine how aggressive the cancer is. The tissue
samples are studied, and the cancer cells are compared with healthy
prostate cells. The more the cancer cells differ from the healthy
cells, the more aggressive the cancer and the more likely it is to
spread quickly.
Cancer cells may vary in shape and size. Some cells may be aggressive,
while others aren't. The pathologist identifies the two most aggressive
types of cancer cells when assigning a grade. The most common scale
used to evaluate prostate cancer cells is called a Gleason score. Based
on the microscopic appearance of cells, individual ratings from 1 to 5
are assigned to the two most common cancer patterns identified. These
two numbers are then added together to determine your overall score.
Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive
cancer).
Health: Staging of Prostate Cancer (Men - Prostate)
Staging is a way of describing a cancer, such
as where it is located, if or where it has spread, and if it is
affecting the functions of other organs in the body. Knowing the stage helps
the doctor to decide what kind of treatment is best and can help
predict a patient's prognosis (chance of recovery).
After the level of aggressiveness of your prostate cancer is known, the next step, called staging, determines if or how far the cancer has spread. Your cancer is assigned one of four stages, based on how far it has spread:
- Stage I. Signifies very early cancer that's confined to a microscopic area that your doctor can't feel.
- Stage II. Your cancer can be felt, but it remains confined to your prostate gland.
- Stage III. Your cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
- Stage IV. Your cancer has spread to lymph nodes, bones, lungs or other organs.
Health: Complications of Prostate Cancer (Men - Prostate)
Complications from prostate cancer are related to both the disease and its treatment. One of the biggest fears of many men who have prostate cancer is that treatment may leave them incontinent or unable to maintain an erection firm enough for sex (erectile dysfunction). Fortunately, therapies exist to help cope with or treat these health conditions.
The typical complications of prostate cancer and its treatments include:
- Spread of cancer. Prostate cancer can spread to nearby organs or travel through your bloodstream or lymphatic system, affecting your bones or other organs. Treatments for prostate cancer that has spread can include hormone therapy, radiation therapy and chemotherapy.
- Pain. Although early-stage prostate cancer typically isn't painful, once it's spread to bones it can be. Not all people with cancer that has spread to bones have pain, but in some cases, pain is intense and doesn't go away. Treatments directed at shrinking the cancer often can produce significant pain relief. Medications ranging from over-the-counter pain relievers to prescription narcotics can alleviate pain. If your pain is severe, you may need to see a pain specialist. While it's not always possible to make all of your pain go away, your doctor will work with you to try to control pain to a point where you're comfortable. If you're in serious pain, tell your doctor. Pain can be controlled, and there's no reason you have to suffer.
- Difficulty urinating (urinary incontinence). Both prostate cancer and its treatment can cause incontinence. Treatment depends on the type of incontinence you have, how severe it is and the likelihood it will improve over time. Treatments include behavior modifications (such as going to the bathroom at set times rather than just according to urges), exercises to strengthen pelvic muscles (commonly called Kegel exercises), medications and catheters. If incontinence continues for a prolonged period without getting better, your doctor may suggest more aggressive procedures. These may include implanting an artificial urinary sphincter, placement of a sling of synthetic material to compress the urethra, or the injection of bulking agents into the lining of the urethra at the base of the bladder to reduce leakage.
- Erectile dysfunction (ED) or impotence. Like incontinence, ED can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications and vacuum devices that assist in achieving erection are available to treat ED. Medications include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). If other treatments fail, penile implants can be inserted surgically to help create an erection.
- Depression. Many men may feel depressed after a diagnosis of prostate cancer or after trying to cope with the side effects of treatment. These feelings may last for only a short time, they may come and go, or they may linger for weeks or even months. Talk to your doctor if you have depression that interferes with your ability to get things done or enjoy your life. Treatment such as counseling or antidepressant medication can make a big difference.
_______________________________________________________________________________________________________
Natural Alternative Treatment Option: NATURAL CANCER TREATMENT
_______________________________________________________________________________________________________
Health: Conventional Treatment for Prostate Cancer (Men - Prostate)
The treatment of prostate cancer depends on the size and location of the tumor, whether the cancer has spread, and the man’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. It is important to discuss the goals and possible side effects of treatment with your doctor before treatment begins.
Active surveillance (watchful waiting), for early-stage cancer
If a prostate cancer is in an early stage, growing slowly, and if
treating the cancer would cause more discomfort than the disease
itself, a doctor may recommend watchful waiting, also called active
surveillance or watch-and-wait. The cancer is monitored closely, and
treatment would begin only when the tumor shows signs of becoming more
aggressive or spreading. This approach may be taken in much older
patients or in those with other serious or life-threatening illnesses.
However, real caution must be taken not to make errors of judgment about the disease. In other words, doctors must collect as much information as possible about the patient’s other illnesses and potential life expectancy, so they don’t miss the chance to detect an early, aggressive prostate cancer. New information is becoming available all the time, and it is important for men to discuss these issues carefully with a specialist in this field to obtain current information.
Surgery
Surgery is used to try to cure cancer before it has spread outside the prostate. The type of surgery depends on the stage of the disease, the man’s general health, and other factors.
Radical (open) prostatectomy. A radical prostatectomy involves surgical removal of the whole prostate and accompanying seminal vesicles and possibly lymph nodes in the pelvic area. This operation has the risk of interfering with sexual potency. Nerve-sparing surgery, when possible, increases the chances that a man will remain sexually potent after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur. Orgasm can occur even if some nerves are cut; these are two separate processes. Urinary incontinence (inability to control urine flow) is also a possible complication of prostatectomy. To help resume normal sexual function, men can receive drugs, penile implants, or injections. Sometimes, additional surgery can fix the complication of urinary incontinence.
Laparoscopic prostatectomy (with or without robotic assistance). This type of surgery is potentially much less invasive than an open radical prostatectomy, but the recovery time may not necessarily be shorter. A camera and instruments are inserted through small, keyhole incisions in the patient's abdomen. The surgeon then directs the robotic instruments (if robotic assistance is being used) to remove the prostate gland and surrounding tissue. In general, laparoscopic prostatectomy has less bleeding and less pain, but sexual and urinary side effects can be similar to an open radical prostatectomy. This procedure has not been available for as long a time as open radical prostatectomy, so longer-term follow-up information, including permanent cure rates, are not yet certain.
This procedure remains very controversial among some specialists. Although this procedure may reduce the side effects of this surgery, there may be a higher rate of incomplete tumor removal, which, in turn, may require additional treatment after surgery, such as radiation therapy. As noted, more follow-up data are needed. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results to the conventional open radical prostatectomy.
Transurethral resection of the prostate (TURP). TURP is most often used to relieve symptoms of urinary obstruction, not to cure cancer. In this procedure, under a full anesthetic, a surgeon inserts a cystoscope (a narrow tube with a cutting device) into the urethra and into the prostate to remove prostate tissue. This is rarely used to treat prostate cancer in current clinical practice.
Cryosurgery. Most commonly used in experimental studies, cryosurgery (also called cryotherapy or cryoablation) involves freezing cancer cells with a metal probe inserted through a small incision in the area between the rectum and the scrotum, the skin sac that contains the testicles. Cryosurgery may be useful for early-stage cancer and for men who cannot have a radical prostatectomy. Some doctors view cryotherapy as experimental and have concerns about complications, which can include the development of fistulae (holes between the prostate and the bowel), although this complication appears to occur much less frequently with the development of newer cryosurgery techniques.
Radiation therapy is the use of high-energy rays or other particles to kill cancer cells. Radiation therapy may be given externally, called external-beam radiation therapy, in which radiation is given from a machine outside the body, or internally, where a radioactive substance or seeds are placed inside the prostate, near the tumor. Radiation therapy can be useful at all stages of localized cancer. It is also used to relieve symptoms, such as pain in patients with advanced or metastatic cancer. Several treatments or “fractions” may be needed.
External-beam radiation therapy. External-beam radiation therapy focuses a beam of radiation on the area affected by cancer. Some cancer centers use conformal radiation therapy (CRT), where computers help precisely map the location and shape of the cancer. CRT reduces radiation exposure to healthy tissues and organs around the tumor by directing the radiation therapy beam from different directions with the intention of focusing the dose on the area of the tumor.
Intensity-modulated radiation therapy (IMRT). IMRT is a form of three-dimensional (3-D) CRT. CRT uses CT scans to form a 3-D picture of the prostate before treatment. In IMRT, the radiation beams of various strengths are aimed at the tumor from many angles. The doses of radiation treatment are precise enough to avoid damaging healthy tissue around the prostate.
Brachytherapy. Brachytherapy involves insertion of radioactive sources directly into the prostate. These sources (called seeds) give off localized radiation and may be used for hours (high-dose rate) or for weeks (low-dose rate). Low-dose rate seeds are left in the prostate permanently, even after all the radioactive material has been used up.
Radiation therapy may cause the such side effects as diarrhea or other disruption of bowel function; increased urinary urge or frequency; fatigue; impotence (inability to get an erection); and rectal discomfort, burning, or pain. These side effects usually go away after treatment.
Hormone therapy
Because prostate cancer growth is driven by male sex hormones known as androgens, reducing levels of these hormones can help slow the growth of the cancer. Hormone treatment is also called androgen ablation or androgen deprivation therapy. The most common androgen is testosterone. The production of testosterone can be reduced either surgically, with surgical castration, or with drugs that turn off the function of the testicles (see below).
Hormone therapy is used to treat prostate cancer that has continued to grow after surgery and radiation therapy or when it is widespread at the time of diagnosis. More recently, hormone therapy has also been used with radiation therapy for men with a cancer at a higher risk for recurrence. In some men, hormone therapy will be used first to shrink a prostate cancer tumor before radiation therapy or surgery. In some men with prostate cancer that has spread locally (and identified during a radical prostatectomy), hormone therapy is given after the surgery for two to three years as adjuvant therapy (treatment that is given after the first treatment).
Traditionally, hormone therapy was used until it stopped controlling the cancer. Then the cancer was said to be hormone refractory (meaning that the hormone therapy has stopped working), and other options were considered. Recently, researchers have begun studying intermittent hormone therapy, which is hormone therapy that is given for specified periods and then discontinued temporarily according to a schedule. Giving hormones in this way appears to lower the symptoms of this therapy. In addition, intermittent hormone therapy may possibly maintain hormone responsiveness for a longer time than standard (continuous) hormone treatment; this concept is currently being tested in clinical trials.
One important complication of hormonal therapy is the risk of developing metabolic syndrome. Metabolic syndrome refers to a set of conditions, such as high levels of blood cholesterol and high blood pressure that place a person at high risk of heart disease, stroke, and diabetes. At present, it is not certain how often is occurs, nor the exact mechanism, but it is quite clear that patients who undergo a surgical or medical castration with hormone therapy (even a temporary medical castration) are at increased risk for developing metabolic syndrome. This risks and benefits of castration should be carefully discussed with your doctor. For men with metastatic prostate cancer, especially if it is advanced and causing symptoms, most doctors believe that the benefits of castration far outweigh the risks of metabolic syndrome.
Types of hormone therapy
Bilateral orchiectomy. Bilateral orchiectomy involves surgical removal of both testicles. Even though this is surgery, it is called a hormone treatment because it removes the main source of testosterone production, the testicles. This surgery is permanent and cannot be reversed.
LHRH agonists. LHRH stands for luteinizing hormone-releasing hormone. LHRH agonists are drugs that reduce the body's production of testosterone by interfering with hormonal control mechanisms within the brain, which control the functioning of the testicles.
Anti-androgens. While LHRH agonists lower testosterone levels in the blood, anti-androgens block testosterone from binding to so-called “androgen receptors,” chemical structures in the cancer cells that allow testosterone and other male hormones to enter the cells.
Female hormones. Estrogen can lower testosterone levels. When this drug is given as a pill, side effects can include heart problems and blood clots. More recently, estrogens have been administered as injections or as skin patches, and this type of treatment may be associated with a lower chance of heart and clotting side effects.
Combined androgen blockade. Sometimes, LHRH agonists are used in combination with peripheral-blocking drugs, such as anti-androgens, to more completely inhibit male hormones. Many doctors feel that this combined approach is the safest way to start hormone treatment, as this prevents a potential flare-up or increase in activity of the prostate cancer cells that sometimes occurs as a result of a temporary surge in testosterone production by the testicles (in response to the LHRH agonists). Major clinical trials have not shown a big difference in long-term survival results from the use of combined androgen blockade as permanent therapy; therefore, some doctors prefer to give combined drug treatment only for the first two to three months.
Hormone therapy may cause significant side effects. Side effects generally go away after hormone treatment is finished, except in men who have had an orchiectomy. Patients may experience impotence, loss of libido (sexual desire), hot flashes, gynecomastia (enlarged breasts), and osteoporosis (weakening bones). Patients who have received LHRH agonists for more than two years will frequently have ongoing hormonal effects, even if the drugs are no longer given.
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
Chemotherapy can be taken orally (by mouth) or intravenously (injected into a vein), and it may help patients with advanced or hormone-refractory prostate cancer. There is no standard chemotherapy for use against prostate cancer, but a number of clinical trials are exploring chemotherapy for advanced prostate cancer. The most popular, current approach involves the use of a drug called docetaxel (Taxotere) given in conjunction with a steroid called prednisone. This combination has been shown to make men with advanced prostate cancer live longer than another chemotherapy, mitoxantrone (Novantrone), which is most useful for controlling prostate cancer symptoms.
The FDA has approved the drugs mitoxantrone and docetaxel for use in men with prostate cancer that is resistant to hormone therapy. Also, the drugs paclitaxel (Taxol) and estramustine (Estracyt) have shown some beneficial effects in treating advanced prostate cancer. Estramustine is being used less often in current clinical practice because of its side effects, which includes an increased risk of blood clots. Although clinical trials have shown that docetaxel prolongs survival and has a higher rate of remission than mitoxantrone, the difference in survival is only an average of a few additional months, and the side effects of mitoxantrone are generally milder than for docetaxel. Many new medications for prostate cancer are in development and may be available in clinical trials.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
Advanced prostate cancer
Prostate cancer that develops the ability to grow without the presence of male sex hormones, and causes hormone treatments to stop working is called androgen-independent cancer, or hormone-refractory prostate cancer. Although there is no cure for this type of cancer, it is treatable with radiation therapy or chemotherapy.
If all treatments have failed to control prostate cancer, or if cancer comes back after treatment, a patient may experience pain, fatigue, and weight loss. At this point, the goal of treatment switches from curing the cancer to slowing it down and relieving symptoms.
It is important to note that many men outlive their prostate cancer, even those with advanced disease. Often, the prostate cancer grows slowly, and there are now effective treatment options that extend life even further. A few drugs can help treat the symptoms of advanced cancer.
Cytotoxic chemotherapy (see above). Chemotherapy is most commonly used for patients with advanced, hormone-refractory prostate cancer. It can be effective in relieving symptoms, such as pain, weight loss, and fatigue, and may prolong life for some patients.
Strontium and samarium. Given by injection, these radioactive agents are absorbed near the area of bone pain. The radiation that is released helps relieve the pain, probably by causing local tumor shrinkage.
Pamidronate (Aredia) and zoledronic acid (Zometa). Given by
injection, these drugs reduce the level of calcium in the blood and
cause a reduction of bone complications (such as pain, fracture, need
for surgery) due to metastases. A high calcium level is called
hypercalcemia and is sometimes present in advanced prostate cancer.
Health: Prevention of Prostate Cancer (Men - Prostate)
No specific measures are known to prevent the development of prostate cancer. At present, therefore, we can hope only to prevent progression of the cancer by making early diagnoses and then attempting to cure the disease. Early diagnoses can be made by screening men for prostate cancer.
Screening is done, as mentioned previously, by routine
yearly digital rectal examinations beginning at age 40 and the addition of an
annual PSA test beginning at age 50. The purpose of the screening is to detect
early, tiny, or even microscopic cancers that are confined to the prostate
gland. Early treatment of these malignancies (cancers) can stop the growth,
prevent the spread, and possibly cure the cancer.
Prostate cancer can't be prevented, but you can take measures to reduce your risk or possibly slow the disease's development by during the following:
- Eat well. Based on some research in animals and people, certain dietary measures have been suggested to prevent the progression of prostate cancer. Following a vegetarian, low-fat diet or one similar to the traditional Japanese diet may lower risk. For example, low fat diets, particularly avoiding red meats, have been suggested because they are thought to slow down the growth of prostate tumors in a manner not yet known. Soybean products, which work by decreasing the amount of testosterone circulating in the blood, also reportedly can inhibit the growth of prostate tumors. Finally, other studies show that tomato products (lycopenes), the mineral selenium, and vitamin E might slow the growth of prostate tumors in ways that are not yet understood. High-fat diets have been linked to prostate cancer. Therefore, limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods rich in lycopene, an antioxidant, also may help lower your prostate cancer risk. These foods include raw or cooked tomatoes, tomato products, grapefruit and watermelon. Garlic and some vegetables such as arugula, bok choy, broccoli, Brussels sprouts, cabbage and cauliflower also may help fight cancer. Other vitamins and minerals, including vitamin C, vitamin E and selenium, have been linked to lower prostate cancer risk, but studies haven't found a benefit to taking supplements to create high levels of these nutrients in your body. Instead, it may be helpful to choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of these nutrients in your body.
- Get regular exercise. Regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren't as clear-cut, but studies do indicate that regular exercise may reduce your cancer risk, including your risk of prostate cancer. Exercise has been shown to strengthen your immune system, improve circulation and speed digestion — all of which may play a role in cancer prevention. Exercise also helps to prevent obesity, another potential risk factor for some cancers. Regular exercise may also minimize your symptoms and reduce your risk of prostate gland enlargement, or benign prostatic hyperplasia (BPH). Men who are physically active usually have less-severe symptoms than do men who get little exercise.
- Ask your doctor about taking an NSAID. Nonsteroidal anti-inflammatory drugs (NSAIDs) might prevent prostate cancer. These drugs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). NSAIDs inhibit an enzyme called COX-2, which is found in prostate cancer cells. More studies are needed to confirm whether NSAID use actually results in lower rates of prostate cancer or reduced deaths from the disease.
Research on prostate cancer prevention has shown that the drug finasteride (Proscar, Propecia) may prevent or delay the onset of prostate cancer in men 55 years and older. This drug is currently used to control prostate gland enlargement and hair loss in men. However, finasteride has also been shown to contribute to increasing sexual side effects and to slightly raise the risk of developing higher grade prostate cancer. At this time, this drug isn't routinely recommended to prevent prostate cancer.
_______________________________________________________________________________________________________
Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
<<Previous (Home Page) Next>>
