Prostate cancer

Signs and Symptoms

Many people with prostate cancer have no symptoms at all, especially in the early stages.

Some symptoms that may indicate prostate cancer include:

• Difficult and painful urination
• Having to urinate often, especially at night, and feeling that you need to urinate even when your bladder is empty
• Not completely emptying your bladder, which may lead to dribbling of urine
• Decreased force of urine stream
• Blood in the urine
• Hip and back pain

When the cancer has spread to other parts of the body, symptoms can include:

• Bone pain
• Weakness or paralysis caused by compression of the spinal cord
• Weight loss
• Anemia
• Kidney failure

Causes

Experts do not know what causes prostate cancer. Several things, including genes, diet, ethnicity, hormones, and your environment, may play a part.

Some studies have shown a link between a high-fat diet and higher testosterone levels. Testosterone stimulates growth of the prostate. Some doctors think that testosterone replacement therapy might make existing prostate cancer grow faster, and men who use testosterone therapy may be more likely to get prostate cancer than those with lower levels of the hormone.

Genes may come into play because prostate cancer tends to happen in men who are related to one another. In addition, researchers have found a gene that is associated with 30% of family-related prostate cancers.

Asian men tend to have a lower rate of prostate cancer, while African-American men have one of the highest rates in the world.

Risk Factors

These factors may increase a man's risk for prostate cancer:

• Age. Prostate cancer is most common in men over 55.
• Race. African-Americans have a greater risk of developing prostate cancer than Caucasians. Caucasians have a greater risk than Native and Latin Americans.
• Family history of prostate cancer. A man is 4.5 times more likely to get prostate cancer if his brother has it. If his father has it, he is 2.3 times more likely to develop prostate cancer.
• High-fat diet. Foods rich in saturated fat may raise testosterone levels, which stimulates the growth of the prostate.
• Lack of exercise. May increase the risk in men who eat a high-fat diet.

Diagnosis

The American Cancer Society recommends that men talk with their doctors about screening tests for prostate cancer starting at age 50, or age 45 for African-American men, or men with a brother or father who had prostate cancer. Two standard tests are used to find prostate cancer early:

• Digital rectal exam (DRE). In this test, the doctor inserts a gloved, lubricated finger into the rectum in order to feel the prostate for bumps or other problems. Many malignant tumors start in the outer part of the prostate and may be found with this exam. Some men find this test embarrassing. But it is quick, relatively painless, and helps find many prostate cancers.
• PSA test. A blood test measuring the level of prostate-specific antigen (PSA). Prostate cancer cells make higher amounts of PSA, so measuring PSA levels may help find cancer while it is still microscopic. However, finding higher levels of PSA does not always mean that a man has cancer. Benign conditions, such as an enlarged prostate, can also raise PSA levels.

If either the DRE or PSA test suggests that cancer might be present, your doctor may recommend the following tests:

• Transrectal ultrasound. Using a small probe inserted into the rectum, sound waves help provide a visual image of the prostate.
• Biopsy of the prostate. The doctor gets a tissue sample through the rectum and examines it for cancerous cells.

If the biopsy shows the presence of cancer, you may need more tests to see if the cancer has spread:

• Imaging tests. Computerized tomography (CT) or magnetic resonance imaging (MRI) scans may pinpoint the location of cancer that has spread beyond the prostate.
• Bone scans and x-rays. These tests look for spread of cancer to the bones.
• Lymph node biopsy. A surgical procedure to find out if the cancer has spread to the lymph nodes.

Preventive Care

The American Cancer Society suggests men talk with their doctors about the benefits and risks of prostate cancer screening. While the PSA test and the DRE can find cancers early on, they usually cannot tell how dangerous the cancer is.

Some prostate cancers grow very slowly, while others are aggressive. Right now doctors cannot be sure who needs treatment and who does not. That means some men who do not need treatment may get it. Prostate cancer treatments can have unwanted side effects, such as erectile dysfunction and incontinence.

Studies also suggest that the following lifestyle changes may help reduce your risk of prostate cancer:

• Eating a diet low in saturated fat and rich in fruits and vegetables. Cancer-fighting foods include cruciferous vegetables (such as broccoli, cabbage, and cauliflower), those containing the antioxidant lycopene (such as tomatoes and watermelon), and other foods rich in antioxidants (such as berries).
• Exercising regularly
• Not smoking

Treatment

There are several options, depending on how fast the cancer is growing, whether it has spread, how old you are, and the benefits and drawbacks to treatment.

If prostate cancer is found early, treatment usually involves either surgery to remove the prostate or radiation therapy. For more advanced cases, or if cancer spreads beyond the prostate, hormone medications may be used.

In some cases, if you have a slow-growing tumor, the doctor may suggest "watchful waiting." Watchful waiting means closely monitoring the situation and giving treatment only if your condition worsens.

Making changes in your diet and considering certain herbs and supplements along with treatment may help either reduce risk of prostate cancer or make treatment work better. If you have prostate cancer, you should not use herbs or supplements by themselves to treat it. Prostate cancer should be treated with conventional medicine. DO NOT take any herbs or supplements without your doctor's supervision, because they can interfere with your treatment.

Acupuncture can relieve pain and the side effects of surgery. Meditation and massage may reduce stress and anxiety.

Medications

Your doctor may recommend hormone therapy or chemotherapy to stop the growth of cancer cells in the prostate. You may also take medications with or before surgery or radiation to shrink large tumors, especially if your prostate cancer has spread.

Hormone therapy causes your body to make less testosterone, or not be able to use it as well. Lowering testosterone levels shrink tumors or slow their growth. It is usually reserved for men whose prostate cancer has spread. These medications include:

Luteinizing hormone-releasing hormone (LH-RH) agonists. LH-RH is a natural hormone made by your body that lowers the production of testosterone. These drugs encourage your body to release this natural hormone. Side effects include hot flashes, weight gain, development of male breast tissue, breast pain, and nausea.

• Leuprolide (Lupron, Viadur)
• Goserelin (Zoladex)
• Buserelin (Suprefact)

Antiandrogens. Stop testosterone from reaching cancer cells by blocking the action of androgens, or male sex hormones. Side effects can include lower sex drive, fatigue, nausea, erectile dysfunction, diarrhea, and hot flashes.

• Flutamide (Eulexin)
• Bicalutamide (Casodex)
• Nilutamide (Nilandron)

Chemotherapy may reduce symptoms in men whose cancer is advanced.

Surgery and Other Procedures

Removal of the prostate (radical prostatectomy): Used to treat prostate cancer that has not spread. There are two types of radical prostatectomy. In retropubic surgery, surgeons remove the prostate and surrounding lymph nodes through an incision in the lower abdomen. In perineal surgery, doctors remove the prostate through an incision made between the anus and scrotum (the perineum). Side effects can include incontinence and erectile dysfunction. In some cases, a technique called nerve-sparing surgery can have fewer sexual side effects.

Robot-assisted laparoscopic radical prostatectomy (RALRP): RALRP is a newer procedure that uses a laparoscope, a long, thin tube with a camera, to magnify the area. Smaller incisions allow a quicker healing time.

Resection of the prostate (called TURP or transurethral resection of the prostate): Removal of prostate tissue to let urine flow freely. It is sometimes used to relieve symptoms of benign prostatic hyperplasia and may be used in men with prostate cancer who cannot have a radical prostatectomy.

Removal of the testes (orchiectomy): Lowers testosterone levels, but side effects can include erectile dysfunction and hot flashes. Most men choose hormone therapy instead.

Radiation: Uses radiation to kill cancer cells. There are two types of radiation therapy:

• External beam radiation therapy (EBRT or ERT). EBRT and ERT uses a machine to send a high-energy beam to the tumor.
• Radioactive seed implants (brachytherapy). Brachytherapy places tiny radioactive seeds in the prostate to deliver radiation over a longer time period. Using irradiated seeds can lower the risk of radiation damage to organs around the prostate.

Nutrition and Dietary Supplements

Preliminary studies suggest that some nutritional supplements may reduce the symptoms of some prostate cancers, or lower your risk of developing it. Ask your team of health care providers about the best ways to use these therapies in your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using. DO NOT try to treat prostate cancer with supplements on your own.

Follow these tips to reduce your risk of developing prostate cancer:

• Eat antioxidant foods, including fruits (such as berries, watermelon, and tomatoes) and vegetables (such as squash and bell peppers).
• Include more cruciferous vegetables (such as broccoli, cauliflower, cabbage, and Brussels sprouts) in your diet. One preliminary study found men who eat three or more servings a week reduced their chance of getting prostate cancer. Another study found that men who ate 28 or more servings of all kinds of vegetables per week were 35% less likely to develop prostate cancer than men who had fewer than 14 servings per week. These foods also seem to kill cancer cells in test tube studies.
• Eat more fish. Some studies show men who regularly eat fish have a lower risk of prostate cancer than those who do not eat as much fish.
• DO NOT eat foods high in saturated fat. High-fat diets may raise your risk of prostate cancer.
• Stay at a healthy weight, and exercise regularly.

These nutrients may have cancer-fighting properties:

• Lycopene, 15 mg, 2 times per day, is an antioxidant found in tomatoes and watermelon. Researchers think it may help prevent prostate cancer, although the studies have been preliminary and at least one study suggested it might not be good for advanced prostate cancer. In one preliminary study, men with prostate cancer got either a lycopene supplement or placebo for 3 weeks before having prostate surgery. Cancer cells did not grow as much in the men who took the supplement, compared to those who took placebo. Lab studies have also found that lycopene stops the growth of prostate cancer cells in test tubes.
• Vitamin E, in one lab test, a specific kind of vitamin E blocked the growth of prostate cancer cells. In men who smoke, vitamin E may also lower the risk of getting prostate cancer. Overall, studies on vitamin E and prostate cancer have been mixed. One study found that men who took a multivitamin more than 7 times a week and also took a vitamin E supplement had a higher risk of prostate cancer. More research is needed to know how vitamin E affects prostate cancer.

Herbs

Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment. DO NOT use herbs by themselves to treat prostate cancer, and do not take any herbs without your doctor's supervision. Some herbs can interfere with cancer treatment.

• Green tea (Camellia sinensis). Green tea is an antioxidant that may lower risk of cancer and heart disease. In one study, green tea extract seemed to help treat some forms of prostate cancer. More research needs to be done. Use caffeine-free products. You may also make teas from the leaf of this herb.
• Pomegranate (Punica granatum). In one study, men who had surgery or radiation to treat prostate cancer that had not spread, and who drank 8 oz. of pomegranate juice every day slowed down the time it took their PSA levels to double. Researchers think that means their tumors may have not grown as fast, either. More research needs to be done. Ask your doctor before drinking pomegranate juice daily because it can interact with some medications.
• Berberine. Preliminary studies suggest berberine inhibits prostate cancer cell growth. More research is needed.

Acupuncture

Acupuncture may provide relief from side effects of orchiectomy, removal of the testes. Studies also support using acupuncture to relieve pain that often happens when cancer has spread, particularly to the bones. Many health authorities also support acupuncture to reduce nausea from chemotherapy.

Evidence suggests acupuncture can be valuable for cancer-related symptoms, particularly nausea and vomiting that often goes with chemotherapy treatment. Studies have also found that acupuncture may help reduce pain and shortness of breath. Acupressure, or pressing on rather than needling acupuncture points, may also help control breathlessness, and it is something people can learn and use to treat themselves.

Massage and Physical Therapy

Studies suggest that massage reduces stress and boosts immune function, so it may help relieve anxiety for men being treated for prostate cancer.

Pelvic floor exercises, tightening and releasing muscles that start and stop the flow of urine, may help with incontinence caused by prostatectomy (removal of the prostate).

Mind-Body Medicine

Meditation

Meditation may reduce stress, ease anxiety, and allow men with prostate cancer to regain a sense of self control.

Other Considerations

Prognosis and Complications

Most complications come from specific treatments. These include:

• Prostatectomy can cause incontinence and erectile dysfunction
• Radiation therapy can cause proctitis, an inflammation of the lining of the rectum; bladder infections; and erectile dysfunction
• Hormone medications can cause loss of sex drive, erectile dysfunction, hot flashes, growth of male breasts, and tenderness in male breast tissue
• Removal of testes can cause impotence and hot flashes

The outlook for a man with prostate cancer depends on his age, the stage of tumor growth, whether he has any underlying medical illnesses, and his PSA levels. The prognosis is good if the cancer has not spread. Most of these cancers are curable, and after 15 years the same number of these men will be alive as those who never had prostate cancer.

If the cancer spreads beyond the prostate and does not respond to hormone medications, the prognosis is poor. Still, most prostate tumors are slow growing, and even men with advanced prostate cancer may survive for 5 years or more.

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