Prostate Cancer – The Male Cancer

By Marcia Iris Baum, LCSW

 

Cancer is a disease that has been around since ancient times when it was first

detected in the bones and skulls of Egyptian and Peruvian mummies embalmed in 3000 B.C.  Hippocrates, around 400 B.C. first used the term “carcinoma” from the Greek, meaning crab. He compared the disease to a crab because of its claw like extensions of a spreading cancer.

          There are over 200 diseases (types of cancer) all characterized by the uncontrollable growth and spread of abnormal cells. Researchers theorize that we have cancer cells forming in our bodies throughout our lives and our immune system is on constant alert to detect and/or eliminate these abnormal cells. Only when the immune system is incapable of destroying these malignant cells will cancer develop.

          Cancer is not a death sentence, it is an illness. With early detection, cancer cells can be cured if they stay localized to a specific area of the body and do not spread or metastasize to other organs and tissue. Nearly half of all persons diagnosed with cancer can be cured. Many cancers are not curable, but they are treatable. A person’s cancer will rarely disappear or go into remission without treatment.

          Cancer is not contagious, you cannot catch it or give it to someone by close contact. Stress does not cause cancer. People of all ages, social classes, and ethnic backgrounds can get cancer, but it is more common in people advancing in age. We still do not know what causes cancers. Many foods and dietary habits have been linked to an increased cancer risk. Dietary fat has a significant impact on the occurrence of cancer in the United States of America. It is relevant in breast and colon cancer, and possibly cancer in the prostate and uterus. Cancer risk can be considerably reduced by reducing overall exposure to known carcinogens in food, alcohol, tobacco and drugs as well as occupational and radiation hazards. With the ozone layer damaged the rays of the sun create basal carcinomas on our skin and can be effectively treated with early detection.

 

Cancer of the Male Reproductive System

 

The most common sites of cancer of the male reproductive system are the prostate, the testes and the penis in that order. Each of these cancers effect men of all ages including men in young adulthood; however, cancers are more frequent in men after the age of fifty (50) years. While prostate cancer is the most common cancer in men, penis cancer occurs very rarely; testicular cancer is most common in young men between the ages of  fifteen and thirty-four (15-34) years. It is believed that ten million males in this country have a silent form of prostate cancer in hidden or latent form. It is a slow growing cancer that is often present for years before symptoms appear.

          Prostate cancer  is increasing at alarming rates for men, as is breast cancer for women. During the last decade it has become the most commonly diagnosed cancer in men. Before 1900, prostate cancer was a rare illness; this could be due to shorter life expectancy and men did get old enough to manifest these symptoms. Now it is the second most common cause of cancer death in men, second only to lung cancer. Colon cancer ranks third. Death due to prostate cancer is between 40 to 50% higher in African-American males than in Caucasian males in the United States. Also of interest is the statistical fact that prostate cancer mortality rates of Japanese immigrants to the United States against those in Japan show substantially higher mortality among Japanese-American males. Such changes in risk suggest that external, rather than hereditary factors may play the major role in causing the disease.

 

Prostate-Definition

 

The prostate is a gland in the male reproductive system that lies in the male pelvis just below the bladder and surrounds part of the canal that empties the bladder. About the size of a walnut, the prostate is an organ that loosely attaches to the bottom of the bladder and encircles the top of the urethra-the tube through which urine and male ejaculation leave the body.

          One function of the prostate gland is to mix  the white seminal fluid and male ejaculate with sperm just before ejaculation. Another function of this gland is to serve as a valve so that sperm and urine flow in the correct direction.

 

Risk Factors and Possible Causation of Prostate Cancer

 

There is no known cause of this form of cancer; however, the most popular hypotheses indicate that major contributing factors include genetic or hormonal predisposition, viral, sexual, environmental and dietary factors. The Center for Disease Control (CDC) indicates that 70 % of men diagnosed with prostate cancer are 65 years of age or older. Age is a factor and men 50 years of age and older should consider screening on a regular basis.

          Prostate tumors grow and feed on the male hormone testosterone. Men with higher levels of testosterone may be at increased risk of tumor growth. Demographic studies indicate that men with prostate cancer have had more marital partners as well as more premarital and extramarital sexual partners. Suffice it to say, greater coital frequency has been reported in men with this cancer. Speculation suggests that higher levels of testosterone may be a contributing factor to both increased sexual intercourse and increased tumor growth. Increased hormonal levels feed tumors; this is consistent for female estrogen production in women with breast cancer and testosterone production in men with prostate cancer.

          Longitudinal studies of twenty years or more also link dietary health to prostate cancer deaths in men who consumed more dietary fat, more beef and more dairy products. Seventh-Day Adventists have very low rates of this cancer and it may be related to their vegetarian diet that is free of meat, poultry and fish. Diets high in fat are linked to an increased testosterone production. It is prudent to reduce fat in one’s diet, especially animal fat that is found in most meat and dairy products.

 

Prostate Cancer and Benign Prostate Hyperplasia (BPH)

 

Prostate cancer is a malignant tumor in the prostate. The prostate often enlarges as men age and it may block the urethra or bladder, which may cause difficulty in urinating or may interfere with sexual function. An enlarged prostate gland is not always a sign of cancer, instead it may be BPH, another prostate problem that can be corrected by surgery. BPH may be a precursor to cancer, but it is unknown at this time.

 

Symptoms

 

The symptoms of prostate cancer are mainly problems of urination caused when the gland, enlarged by cancer, begins to block the urethra, the tube that carries urine through the penis. The blockage causes the bladder to retain urine, thus the frequent urge to urinate, especially at night. The back-up urine in the bladder may become infected, causing burning, painful cloudy and sometimes bloody urination.

          The following symptoms do not necessarily indicate cancer, but it is recommended by the American Cancer Society that you consult a doctor at the earliest onset of these changes

          -Frequent urination, especially at night

          -Difficulty starting urination or holding back urine

          -Inability to urinate

          -Weak or Burning urination

          -Blood in urine

          -Painful ejaculation

          -Continuing pain in the lower back, hips, or upper thighs

 

Screening

 

The majority of men with prostate cancer have no symptoms at all which is why annual routine screening is highly recommended. Early detection does save lives. There are two physician-administered in office tests for diagnosis of this cancer. Combination of these two tests are vital for early detection of cancer in this organ.

          The Annual Digital Rectal Exam by a physician or urologist is recommended for men after the age of 40 years. The physician inserts a gloved finger into the rectum to feel for lumps of the prostate. An annual blood test can determine the presence of a marker of prostate cancer called prostate specific antigen or PSA. Following the results of a positive PSA test, a biopsy is done. Urologists are now using ultrasound which are sound waves that take pictures of the bladder.

 

Stages of the Disease

 

Once cancer is diagnosed more tests will be conducted to see if cancer cells have spread from the prostate to other organs, body parts, or surrounding tissue. This is called, “staging” and it is important to determine prognosis, treatment planning and response to therapy.  A speedy evaluation is essential because everyday that treatment doesn’t occur, cancer cells continue to grow.

Treatment

 

Cancer of the prostate has a good prognosis with early detection and can be cured. Optimum treatment depends on several factors, such as a patient’s age, lifestyle, health, genetics, and willingness to seek timely treatment and compliance with treatment. The urologist is the physician who will review your options regarding least restrictive approaches and more aggressive ones. The four most common forms of intervention are surgical removal of the prostate, radiation, hormonal therapy, chemotherapy. Alternative therapies use nutrition, juicing, body detoxification and some men opt to use holistic approaches for early stage cancer. Effectiveness of shrinking tumors through biological therapy (using the body’s immune system to fight disease) are still being researched and studied under clinical trials.

          Surgery and/or radiation are options if the cancer is localized and has not spread. Surgery often requires the removal of the entire prostate gland and some of the surrounding tissue, however there are cases where the entire gland is not removed. Radical prostatectomy can cause complications such as incontinence and impotence.

          An alternative to surgery or a supplement to surgery is radiation therapy of either or both the prostate and the lymph nodes in the pelvis. The radiation specialist, in conjunction with the urologist decides which tests to run in order to determine how extensive and far the cancer has spread. These tests might include bone scans, CAT scans, or MRI scans. These scans show the location of organs and tissue in the body where cancer cells may be growing.

          Once the radiation oncologist has the test results you will want to discuss the results and findings of the tests, set goals for intervention, review the risks with each recommended procedure, understand side-effects from medications or treatment options. It is important to have a partner or good friend or family member accompany you to the appointment so they can ask questions, take notes and provide support. You do not need to make immediate decisions in the doctor’s office if you feel psychologically overwhelmed. At least sleep on it and think about what has been discussed before you commit to a plan of action.

          Radiation therapy uses high energy x-rays to kill cancer cells and shrink tumors. Radiation can reach parts of the body that surgery cannot. Radiation can come from a machine or from putting materials that produce radiation (radioisotopes) through thin plastic tubes  in the area where the cancer cells are found. Usually x-rays are prescribed for a small part of the body. X-rays do not hurt but the skin may become tender, turn pink and burn. Patients report that it feels like a moderate to severe sunburn. Side effects usually take two to three weeks to show up and areas of the body that are affected are the areas that received the radiation therapy. Fatigue is often a common side effect that develops during the first week of treatment. Hair loss and nausea are not as common a side effect from radiation. It is reported that in 30 to 40% of cases impotence may occur as a result of this treatment. Potency can be restored with a variety of medical interventions and can be discussed with the doctor.

          For advanced prostate cancer, hormone therapy is used. Male hormones (especially testosterone) can help the cancer grow as it feeds the tumor cells. Urologists can inject pellets or liquid hormones (Eligard, an anti androgen) to reduce testosterone production by the testicles. One common side effect that occurs from lowering the male hormone is hot flashes, that is  similar to menopause for females. Profuse sweats, sometimes followed by chills can last for extended periods of time. There are medications such as Megace, to name one, that can be prescribed to alleviate the severity of these symptoms.  Check with your doctor to find a medication that is right for you. Additional side effects from Eligard include fatigue, dizziness, stomach and intestinal upset, low red blood cell counts, poor sleep and depression.  Megace is a progestin, a female hormone given to counter the side effects from the Eligard injection.

 A few weeks after the first injection, a surgeon will perform a relatively new procedure, implantation of radioactive seeds into the prostate. This procedure has had positive results for many men. The tumor shrinks in size over several weeks and months from these seeds. After this procedure the patient is monitored by their urologist on an outpatient basis with continual PSA tests and intermittent scans to determine how effective the seeds are working. Some urologists recommend regular injections of Eligard to keep male hormone levels low so testosterone stops feeding the tumor.

Sometimes an operation to remove the testicles (orchiectomy) is performed to stop the testicles from making testosterone. This is the most aggressive form of treatment and many men see this as the last alternative for treatment, some men refuse this treatment and see it as extreme. The decision to stop the spread of cancer is a very personal decision and you need to have all the information available to determine risk-benefit factors for your situation. Age and stage of cancer are two significant and determining factors for males in terms of how aggressive treatment options need to be.

 

Legal and Practical Issues

 

If you are unable to make decisions and have not prepared a will or assigned a health care proxy by durable power of attorney, the decision to continue or end treatment will be made by your physician or family. You can complete a durable power of attorney, get it notarized and signed, without an attorney. There are several good websites, i.e.-lawdepot.com, etc. that are useful in structuring such a document. It is best to get it in place before one becomes ill or incapacitated so that the patient’s wishes will be respected and honored.

          On December 1, 1991 the Patient Self-Determination went into effect which requires hospitals, hospices, nursing facilities, home health care and health maintenance organizations (HMO) to give adults information about their rights under state law to accept or refuse treatment as well as to help the patient prepare a living will or appoint a medical proxy if he or she wants to do so. It is advisable to  create a durable power of attorney for health care in order for your decisions to be respected. For gay and lesbians it is vital because it allows your designated partner to have decision making authority and rights, otherwise afforded to married couples or blood relatives.

 

Recommendations for Getting You Through

 

1.     Be your own best advocate, ask questions and take notes, take a friend or loved one with you to medical appointments. Have a journal book for all related information and carry it with you to jot down information. Be an educated consumer and know your options.

 

2.     Good nutrition, vitamins, and fluids will contribute to your sense of well-being. Vitamin E and Selenium are recommended for use. Vitamins and good nutrition help fight infection, cancer, and medication side effects. Eat what you like, when you like and do not focus on breakfast food or lunch food.

 

3.     Keep a written list of all doctor’s names, addresses, telephone numbers, hospitals. You may want to attach business cards that contain relevant numbers including fax numbers. You may need to share this information with your doctors to coordinate care. Do not assume health care providers exchange this information.

 

4.     Keep track of all medications and dosing times by writing it down and posting it in a convenient location such as on a bathroom mirror or refrigerator. Refer to it daily. Some people use a wristwatch with a timer to remind them to take their medications.

 

5.     Ask for help. There are many people who want to help and may feel uncomfortable approaching you, so reach out to others. Give them the opportunity to assist by verbalizing what you need. It is a personal issue and some people are more private then others, but share the diagnosis with those you trust, then reach out for assistance. Do not stay isolated. Depression may result during this medical crisis and you may need to discuss this with friends and family members.

 

6.     Let your feelings, fears and reactions happen and do not try to hold them in and be stoic about this illness. Talk about them and keep a personal journal to help you cope with this crisis. Anger is a normal response and it needs to be acknowledged. Professional counselors can   help you with anger, depression, anxiety and feelings of loss during this crisis. Cancer is an emotional and scary word, but the more you use it and  say it out loud the less scary it feels.

 

7.     Set daily realistic goals. Think of something you want or need to get done, then focus on doing it.

 

8.     Laugh, sing, listen and play music. Allow yourself time to enjoy moments that are free from stress and worry.

 

 

 

Resources

 

www.cdc.gov/cancer/prostate

www.cancer.gov/cancerinfo

www.cancer.gov/publications/

1-800-4-cancer

 

 

 

Dedication: This article is dedicated to my 78 year old father who is being treated for the third time in ten years for prostate cancer. Early diagnosis, medical follow-up, a sense of humor, not too much denial, and courage has facilitated treatment success and expanded his longevity. I still remember dad being rolled into surgery in 1994 and telling the nurses, “it is better to have good friends, than bad enemas”.