Its symptoms often appear when it’s too late to treat it, putting prostate cancer near the top of the male hit list. But it can be beat by early detection and quick treatment
By Dr. R. J. Buckley

Don’t wait until you’ve blown out the candles on your 41st birthday cake. If you’re a man over 40 and someone in your family has suffered prostate cancer, get yourself to your family doctor for annual check-ups. Prostate cancer is the most common cancer in North American males and the second deadliest cause of cancer deaths.

    The prostate is a walnut-shaped gland just below the bladder that secretes ejaculatory fluid. When men age past 45, the prostate is prone to undergo one of two changes. In most men it grows non-cancerous, causing benign prostatic hyperplasia (BPH) and symptoms of increased urinary frequency, urgency, a slowed stream and voiding at night. For one in 11 men over age 50, the gland grows into prostate cancer.

    For some reason prostate cancer is more common in black Americans and it appears that about nine percent of cases are transmitted genetically. The fact that the incidence of prostate cancer is higher in all racial subgroups in North America has led to studies that suggest the continent’s high fat intake is responsible. It’s certainly an excellent reason to cut down on fats. Many recommend vitamin E and selenium as good dietary preventative measures.

    Once they reach 50, all men should visit their family doctors annually for a rectal exam (DRE) and Prostate Specific Antigen (PSA) blood test, regardless of their risk factors. If the prostate feels abnormal or if the PSA in the blood is elevated, the family doctor will likely refer you to an urologist. The urologist will recommend one of three actions: running a series of DRE and PSA tests, scoping the urinary tract, if indicated, or a transrectal ultrasound (TRUS) and prostate biopsy.

    The TRUS involves an ultrasound probe in the rectum, but, fortunately, the procedure only takes about eight to 10 minutes. Pathological examination may require six to eight prostate biopsies. If results are benign, then the urologist or family doctor will follow the patient closely. If the results are malignant, further testing needs to assess if the cancer has spread beyond the prostate. A nuclear bone scan and a CT scan of the abdomen are the most common tests to see if the cancer has infected either the bones, lymph nodes or areas surrounding the prostate.

    A positive diagnosis often shocks cancer-afflicted men and their families because it can come with no symptoms at all. The good news is that these tumors generally tend to grow slowly and can be treated effectively if the disease is caught early and localized in the prostate. In addition to the family doctor and urologist, many support groups can help answer questions and provide emotional support.
The Internet overflows with useful information, but be aware that it can overwhelm and confuse sufferers.

    Treatment of prostate cancer depends upon whether it’s restricted to the prostate gland or if it has spread. Surgery is often recommended for men under age 70 with localized disease. This surgery, called a radical prostatectomy, removes the lymph nodes and the prostate through an incision in the lower abdomen. Patients often store two units of their own blood ahead of time and have these transfused back to them during surgery. Afterwards, they’ll remain in the hospital for about five to six days and wear a catheter for approximately two weeks. Side effects to surgery can include trouble with urinary control in five to 10 percent of cases, but it can be improved with pelvic exercises. The primary side effect is erectile dysfunction. It occurs in 40 to 60 percent of cases because the nerves and arteries supplying the penis travel along the capsule of the prostate and may be damaged during surgery.

    For men with localized prostate cancer over the age of 70 or men under 70 who don’t wish to undergo surgery, radiation is the option. Two techniques radiate the prostate. In external beam radiation, the more traditional of the two, patients are given a small dose each day, Monday to Friday, for about six weeks. Complications can include temporary diarrhea, bladder irritability and impotence. A new method of radiation called brachytherapy does require an operation to insert radioactive seeds into the prostate, but it may reduce the incidence of impotence.

    Hormone therapy is recommended to treat cancer that has metastasized to other areas of the body or has recurred after radiation or surgery. For over 50 years, the male hormone testosterone has been recognized as the food for prostate cancer cells. Removing or interfering with testosterone in hormone therapy sends these cancer cells into remission. Therapy involves either a series of pills and injections or removal of the testicles; side effects include breast tenderness, weight gain in the middle, loss of hair and sexual desire. It works well in the majority of patients but eventually the cancer cells may become resistant to this therapy and continue to spread. In this circumstance, the next step may be either conventional chemotherapy or palliative therapy.

    There are many exciting new advances in prostate cancer research. In the future, genetic testing, gene therapy and angiogenesis will likely play a large role in the detection and treatment of prostate cancer.

Dr. R. J. Buckley is an urologist based in Toronto.