Prostate cancer is one of the most common types of cancer in men in many countries, including Anguilla. Some patients with prostate cancer have a very slow growing cancer, while in others the cancer is very aggressive and can lead to complications and death within a short period of time.
The prostate gland
The prostate is a gland in the male reproductive system. It makes most of the semen that carries sperm. This gland is located beneath the bladder and surrounds the upper part of the urethra, the tube that carries urine from the bladder.
What causes prostate cancer?
It is not clear at this time what causes prostate cancer. Doctors know that prostate cancer begins when some cells in the prostate become abnormal. Mutations in the abnormal cells’ DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumour that can grow to invade nearby tissue. Some abnormal cells can break off and spread (metastasize) to other parts of the body. Diet and genetics may be factors in prostate cancer development, but they are not the only ones.
What are some risk factors for prostate cancer?
Prostate cancer can occur in any man, but some men are at greater risk of getting this cancer if they have certain risk factors. Factors that can increase your risk of prostate cancer include the following:
• Older age. The risk of prostate cancer increases with age. Prostate cancer is most common in men older than 65.
• Being black. Black men have a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced. It is not clear why this is.
• Family history of prostate or breast cancer. If men in your family have had prostate cancer, your risk may be increased. Also, if you have a family history of the BRCA1 or BRCA2 gene mutation, or a very strong history of women with breast cancer, your risk for prostate cancer may be higher.
• Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease that is more difficult to treat.
Screening for prostate cancer
Whether to test healthy men with no prostate symptoms for prostate cancer is controversial. Medical organizations do not agree on the issue of screening and whether it has benefits.
Some medical organizations recommend men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer. Other organizations advise against screening.
Discuss your particular situation and the benefits and risks of screening with your doctor. Together you can decide whether prostate cancer screening is right for you.
Prostate screening tests might 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 is naturally produced by your prostate gland. It is 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, but studies have not proved that these tests save lives. For that reason, there is debate surrounding prostate cancer screening.
Despite controversy, I feel that in Anguilla, the prostate-specific antigen (PSA) blood test remains an important and necessary diagnostic tool in the fight against prostate cancer.
What are some signs and symptoms of prostate cancer?
Prostate cancer may not cause signs or symptoms in its early stages. Prostate cancer that is more advanced may cause signs and symptoms such as:
• Trouble urinating
• Decreased force in the stream of urine
• Blood in the urine
• Blood in the semen
• General pain in the lower back, hips or thighs
• Discomfort in the pelvic area
• Bone pain
• Erectile dysfunction
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you. Discuss prostate cancer screening with your doctor. Together, you can decide what is best for you.
Diagnosing prostate cancer
If an abnormality is detected on a DRE or PSA test, your doctor may recommend tests to determine whether you have prostate cancer, such as: ultrasound scan of prostate, and a prostate biopsy. The tissue sample from the biopsy is analyzed in a lab to determine whether cancer cells are present.
When a biopsy confirms the presence of cancer the next step, called grading, is to determine how aggressive the cancer is. More-aggressive cancer cells have a higher grade. The more aggressive the cancer, the more likely it is to spread quickly.
Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, various imaging tests may be recommended such as bone scan, Computerized tomography (CT) scan, Magnetic resonance imaging (MRI) and Positron emission tomography (PET) scan. Not every patient requires all these scans.
Once testing is complete, your doctor assigns your cancer a stage. This helps determine your treatment options.
Treatment
Prostate cancer treatment options depend on several factors, such as how fast the cancer is growing, how much it has spread, your overall health, as well as the benefits and the potential side effects of the treatment.
For men diagnosed with a very early stage of prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance.
Various forms of treatment are available. Some are used alone, while others are used in combination. Treatment options include the following: hormone therapy, surgery, freezing prostate tissue, heating prostate tissue, chemotherapy and immunotherapy. Prognosis will depend on a number of factors, but generally the earlier the cancer is diagnosed and the least aggressive cancers have the best prognosis.
Can I prevent prostate cancer?
There is no evidence that you can prevent prostate cancer, but you may be able to lower your risk. You can reduce your risk of prostate cancer if you:
• Choose a healthy diet full of fruits and vegetables. Avoid high-fat foods and instead focus on choosing a variety of fruits, vegetables and whole grains. One nutrient that is consistently linked to prostate cancer prevention is lycopene, which can be found in raw or cooked tomatoes.
Whether you can prevent prostate cancer through diet has yet to be conclusively proven. Eating a healthy diet with a variety of fruits and vegetables can improve your overall health.
• Choose healthy foods over supplements. No studies have shown that supplements play a role in reducing your risk of prostate cancer. While there has been some interest in vitamins and minerals, such as vitamin E and selenium, to lower prostate cancer risk, studies have not found a benefit from taking supplements to create high levels of these nutrients in your body. Instead, choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of vitamins in your body.
• Exercise most days of the week. Exercise improves your overall health, helps you maintain your weight and improves your mood. There is some evidence that the men who get the most exercise have a lower incidence of prostate cancer when compared with men who get little or no exercise.
Try to exercise most days of the week. If you have a medical disorder, see your doctor prior to starting a new exercise programme.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it by exercising most days of the week. If you need to lose weight, add more exercise and reduce the number of calories you eat each day.
• Talk to your doctor about increased risk of prostate cancer. Men with a high risk of prostate cancer may consider medications or other treatments to reduce their risk.
Conclusion
Prostate cancer is a leading cancer in men in many countries including Anguilla. Many individuals have prostate cancer that are slow growing and have few or no symptoms. Men are encouraged to have regular checkups with their doctors so that this cancer, and many other health conditions, can be detected at an early stage when early treatment options are more successful in preventing complications and even death.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
