PROSTATE CANCER - CAUSES, SYMPTOMS AND TREATMENT OPTIONS - Anthony's Library and Resources

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Monday, 16 March 2015

PROSTATE CANCER - CAUSES, SYMPTOMS AND TREATMENT OPTIONS

Prostate Cancer is the cancer of the prostate gland. The prostate gland is part of the male reproductive system. Unusual and uncontrollable growth of cells within the prostate gland cause prostate cancer. In some cases, prostate cancer can spread very slowly from the prostate to other body parts.

It might start around the age of fifty, but detection may not occur until the patient is about the age of seventy or eighty. The incidence of prostate cancer is not the same among men in all parts of the world. It is less common in South and East Asia. The highest incidence of prostate cancer is in the USA, followed by Europe. It is responsible for the most deaths among American men after lung cancer. Black men have the highest incidence while Asians record the lowest incidence.

Genetic factors also seem to play an important role. If your father, brother, grandfather or uncle has had prostate cancer, you may have a higher than average risk of developing prostate cancer, even possibly before the age of fifty. Identical twins have twice the risk of developing prostate cancer compared to other men. However, there is no single gene that has been directly linked with prostate cancer. Many genes work in different combinations and research is continuing to try to locate any specific gene that might cause prostate cancer.  Prostate cancer is more prevalent in men over the age of fifty. It occurs very rarely in men below the age of forty-five.  The average age for diagnosis of prostate cancer is seventy.

The Prostate gland is a small walnut-shaped gland, about three centimeters long and weighing around twenty grams in the male reproductive system. It makes and stores seminal fluid. This gland is in the pelvic region in front of the rectum and under the urinary bladder. It surrounds the urethra - the tube that carries urine during urination and semen during ejaculation.  Prostate cancer is the growth of abnormal cells in the prostate gland. Prostate cancer is one of the most common types of cancer in men.

Normally, cancerous cells grow very fast. However, prostate cancer grows slowly and, initially, remains within the prostate gland.  If prostate cancer is detected while it is within the prostate gland, treatment can often be fast and most effective. The prostate starts developing before birth and continues to grow until adulthood, due to male hormones or androgens. This gland produces the seminal fluid that nourishes and transports sperm.  The growth of prostate cancer may be very slow. As its early development does not have any signs or cause major problems for a while, maybe years, and detection can be difficult, it is often detected very late.

Normally, prostate cancer has hardly any symptoms. Diagnosis is often through routine checkups. In cases of benign prostatic hypertrophy, symptoms that may be present include: increased urination, with greater frequency at night blood in the urine difficulty starting and maintaining a steady stream of urine, and painful urination.

Occurrence of prostate cancer can affect your sexual function with painful ejaculation or difficulty achieving erection. The mixing of prostate gland secretions and semen may cause problems during sexual intercourse.  Advanced prostate cancer is the stage where it spreads to other body parts. Prostate cancer in the spinal cord could compress the spinal cord. This could cause additional symptoms like vertebral pain and pain in the bones of the pelvis and ribs, and maybe fecal and urinary incontinence and extreme weakness in the patient’s legs.

Types of Prostate Cancer
Prostate cancer is cancer of the cells of the prostate gland. There are different types of cells within the prostate gland. The most common form of prostate cancer is adenocarcinoma, cancer of the glandular tissue of prostate gland. Around 95% of prostate cancer is adenocarcinoma. This cancer is at the surface of the prostate and can be felt through a digital rectal examination. 

Another type of prostate cancer can come from an abnormal change in the prostate cells, which later turn malignant. This is prostatic intraepithelial neoplasia or PIN. In advanced stages, prostate cancer can spread to surrounding tissue and fatty cells, the neck of the bladder, seminal vesicles or to lymph nodes in the pelvic region. Sometimes it could also spread to the bones of pelvis, spine, chest and hip.

Predisposing Factors for Prostate Cancer
Every man is susceptible to prostate cancer. As the prostate gland is exclusive to the male reproductive system, this cancer affects only men. One in every six men could develop prostate cancer. However, only one in every thirty-four could die of it.  Age is another contributing factor. Men over the age of sixty to eighty have the highest incidence of prostate cancer.  It seldom affects men below the age of forty-five.  Prostate cancer is presently the most common cancer among American men. It is also the second most important cause for death among American men. The trend is predicted to increase with increase in population. Prostate cancer is fast becoming a major public health problem in the United States. Some men are at a higher risk of contracting prostate cancer. There are various predisposing factors for the occurrence of prostate cancer like race, genetics, family history, and many others. These factors may contribute to the incidence and development of the disease, either individually or collectively.

Age: This is by far the most important factor for development of prostate cancer. This cancer is most common in men from the age of fifty to sixty. The highest incidence is among men aged sixty-five. Prostate cancer, in comparison to other cancers, increases faster with age although no specific reason has been found.

As the average mortality rate increases, there is every possibility of more cases of prostate cancer coming to the fore in the coming decades. The aging process causes various biochemical reactions which may encourage abnormal cell growth. Autopsy studies from different countries indicate that 15% to 30% of men older than 50 years have histological evidence of prostate cancer. Hence, by the age of eighty, around 60% to 70% of men depict carcinoma at autopsy. But, more elderly men die of other causes, while only about 3% die of prostate cancer.

Heredity: Heredity is believed to have a direct influence over the occurrence of prostate cancer. If your father or brother has been clinically diagnosed with prostate cancer, chances of you developing it are more than three times the average. You could even contract the cancer in your youth. This factor may be more important if your close relatives developed prostate cancer by the age of sixty or if more than one male family member has had this disease. Another indicator may be that if female family members have had breast cancer, you may have a higher risk than average of developing prostate cancer sometime in your life. The onset of prostate cancer is quite early in such cases in comparison to the normal onset of the disease. Men as young as forty can develop prostate cancer if their direct relatives have had it.

(III) Genetics: Studies have indicated the presence of various genes that increase prostate cancer risks. Genetic factors account for five to ten percent of the total prostate cancer cases. Very recent reports as of 11 Feb, 2008 indicate a major genetic breakthrough into the cause of prostate cancer. Australian and British scientists have discovered seven areas in human genome that could offer linkage to prostate cancer.

Genetics: Genetic defects could cause prostate cancer. Scientists are investigating certain genes like Hereditary Prostate Cancer Genes 1 and 2 (HPC1, HPC2) and HPCX. It is also held that genetically caused prostate cancer is different from that caused due to other factors. If women in your family develop breast cancer by the age of forty, it indicates certain genetic flaws. Such faulty genes could cause prostate cancer among male members of your family. Only 5% to 10% of cases could be due to an inherited altered gene running in the family.

Obesity: Obese men have a higher risk of getting prostate cancer. Rather, obese men record a higher incidence of advanced prostate cancer and often die of it. Regular physical exercise and high levels of physical activity can lower the risk of advanced prostate cancer.

Inflammation of the Prostate: Inflammation of the prostate gland could cause prostatitis. In some cases, sexually transmitted infections can increase the risk of prostate cancer.

Ethnic groups: People belonging to some specific race may show increased incidence of the disease while some other races show lower occurrences.  African-American men show higher incidence of prostate cancer while its incidence is less among Asian-American and Hispanic or Latino men.  Non-Hispanic whites and African-Caribbean men may also have an increased risk of prostate cancer.

Prostate cancer is more common in America and north-western Europe and less common in China, India, and Japan. Scandinavian men report higher rates of prostate cancer than Asian men do.  The incidence of prostate cancer is highest among Blacks and the lowest among Asians.  Japanese and Africans living in their native countries seem to have a very low incidence of prostate cancer.

African-American men have a higher incidence of prostate cancer than do black men in Africa or Asia. However, the other races show a tendency to develop prostate cancer once they immigrate to the United States. There is no specific reason to explain this occurrence. Some theories suggest the influence of environmental factors, socio-economic factors, diet, and lifestyles.

Diet: Prostate cancer occurs more in countries with a staple food of meat and dairy products than in countries with a staple food of rice, vegetables, and soybean products. Research also indicates that high dietary fat could be a major contributing factor for prostate cancer. Fruits and vegetables contain antioxidant lycopene in high levels. Studies indicate that presence of lycopene reduces risks of prostate cancer.  Suggested vegetables and fruits include tomatoes, watermelon, and pink grapefruit.

High fat content, specifically animal fat, in diets is the primary cause for prostate cancer. Consuming fiber-rich food, and a daily intake of lots of yellow and green colored vegetables, consumption of beans, lentils, peas, tomatoes, raisins, dates, and dried fruit can reduce prostate cancer risks substantially. However, the relationship between prostate cancer and dietary factors is very complex.  Men who consume lots of red meat and dairy products may have a greater risk of prostate cancer. Normally, men consuming such a diet eat more dairy products and less vegetables and fruits.  Consuming a diet rich in vegetables, whole grains, soy, fish, nuts, and seeds is claimed by some to lower the risk of prostate cancer.

Smoking is another risk factor for prostate cancer. Inhaling of toxic substances and tobacco may affect the chance of getting prostate cancer.

Cadmium Exposure: Exposure to heavy metals like cadmium is also believed to be a risk factor for prostate cancer. This mineral is normally found in alkaline batteries and cigarette smoke. People in the welding and electroplating occupations are exposed to high cadmium levels. Cadmium in combination with zinc poses a high risk for prostate cancer.  The element zinc is present in multiple intracellular metabolic pathways. The prostate also contains high amounts of zinc. Several enzymes like polymerases require zinc to function properly. Such combinations may prove to be a major factor for an increased risk of prostate cancer, although there is no conclusive medical evidences to support this currently.

Exercise: A sedentary lifestyle due to technological advances and increased economic and monetary power could be a possible cause for prostate cancer. If it does not have a direct relation, it may still contribute to increasing your risk.  That sedentary lifestyle restricts movements and your body slackens due to absence of any exercise. This in turn causes various changes in hormone and chemical balances in your body. This could reflect on your prostate gland and might encourage the growth of cancerous cells.

If you have a sedentary lifestyle with no physical exercise, you may have a higher chance of contracting prostate cancer. Regular physical exercise is essential for everyone.

Vasectomy: Observations suggest that vasectomized men report higher incidences of prostate cancer. Vasectomized men have higher levels of circulating testosterone. Further, these men have undergone vasectomy one or two decades before detection of prostate cancer. Therefore, increased hormone levels due to a vasectomy might be the cause for prostate cancer in elderly men. There are conflicting reports on the relation between a vasectomy and prostate cancer.

Testosterone: High levels of testosterone may fuel the occurrence of prostate cancer. It does not cause prostate cancer directly, but it may help the development of existing prostate cancer.  This is the male hormone produced by testicles. Although this hormone does not directly cause prostate cancer, it could influence the occurrence of prostate cancer largely. High levels of such hormones are an increased risk. However, there is no conclusive evidence and scientists are researching into the possibilities.

Hormones: Dietary factors influence secretion of body hormones. Low-fat and high-fiber diets affect the male sex hormone metabolism by decreasing circulating testosterone. Testosterone is essential for growth of normal prostate epithelium. Rather, early prostate cancer is endocrine dependent.  Research and studies show that young African-American men have 15% higher serum testosterone levels than their white counterparts. Similarly, American men have higher levels of the sex hormone binding globulin than their Japanese counterparts do. These enzymes are responsible for mitotic activity of the prostate.  A vegetarian diet reduces plasma testosterone levels substantially. This can be one of the major reasons for the low incidence of prostate cancer among vegetarian men.

BPH and hormonal activity: The prostate gland develops before birth and continues to grow until adulthood. This growth is due to male hormones or androgens. Low hormone levels restrict the growth of the prostate gland.  In some cases, this gland continues to grow even in old men. This causes benign prostatic hyperplasia or BPH. This could cause problems with urination. BPH causes extensive changes in the prostate gland and could restrict urinary outflow when the urine remains within the bladder and could cause cystitis.  With age, hormone levels fall and this causes imbalance in androgen and estrogen levels. Levels of dihydrotestosterone, the main prostatic intracellular androgen, increase and this could cause inflammation, leading to prostate cancer.

Infections: More than eighty percent of prostate cancer cases are due to infection by Escherichia coli. Other causes for infection include Proteus, Klebsiella, Pseudomonas, Enterobacter, Staphylococcus, or Streptococcus. These organisms enter the prostate through the bloodstream or through urethral infection. Sometimes, excessive or very infrequent sexual intercourse, catheterization, or cystoscopy could cause infections leading to prostate cancer.

Overall Analysis
Prostate cancer is affected by a combination of factors. Some of these factors could play a major role.  The factors in play include genetic, environmental, and epigenetic events. The interrelation and interaction between these factors is important to research for the better treatment and possible prevention of prostate cancer.  Androgen levels in a man are the effects of interrelations and combinations of various genes like testosterone, sex hormone binding globulin, and estrogen, with environmental influences like those of zinc and cadmium.  Dietary factors also play a major role. Again, diet and hormones have a direct bearing and provide important clues about the development of prostate cancer.

Presently, various universities and cancer societies are undertaking many experiments. Different men are screened for prostate cancer and their findings will offer ample guidance. This will enable doctors and scientists to clarify the relationship between histologic and clinically evident prostate cancer. It will also help many men to be available for early detection of prostate cancer.

Diagnosis
Undergoing screening processes, like a digital rectal examination or prostate specific antigen tests, when approaching the age of forty is a good preventive measure. The positive aspect is that newer screening procedures, deeper and extensive research, and growing public awareness have been able to offer a wider perspective of prostate cancer and educate people about the possibilities and strategies of disease prevention and better treatment options.

Diagnosis of prostate cancer is through screening of blood tests and/or through physical examination. Biopsy, Cystoscopy, and Transrectal ultrasonography are the recommended tests to diagnose prostate cancer.  Normally, biopsy of the prostate involves removal of a piece of the prostate and examining it under the microscope.

Prostate biopsy is done in the outpatient department and does not require any hospitalization. A biopsy gun inserts and removes special hollow-core needles in less than a second. Normally, there would be around three to six on each side of the prostate. Men report a little discomfort during a prostate biopsy.

Cystoscopy is the insertion of a thin, flexible camera tube down the urethra. It shows the interior of the urethra. Transrectal ultrasonography uses sound waves to create a picture of the prostate from a probe in the rectum.  Scientists have reported in April 2007 that a new blood test that can detect the presence of a prostate cancer antigen-2 (EPCA-2) in the early stages. It may indicate the presence and intensity of prostate cancer.  X-rays and bone scans can also detect the spread of prostate cancer into the bones.

Signs and Symptoms of Prostate Cancer
Prostate cancer has very few signs or symptoms in the early stages. Early detection of this cancer is rather difficult. Often, you get to know of the existence of prostate cancer when you go for any other medical checkup like a digital rectal examination (DRE) or prostate-specific antigen (PSA) tests. Prostate cancer treatments can cause various side effects like erectile dysfunction or impotence, or bladder control problems, etc.  As you age, the prostate gland enlarges and causes blockage against the urinary bladder or urethra. This is benign prostatic hyperplasia or BPH. BPH is not cancer; however, signs and symptoms of BPH are similar to those of prostate cancer. You need to undergo a thorough medical check-up and testing to confirm the exact diagnosis of your ailment. Growth of the prostate is not always linked to prostate cancer. Some men experience continued prostate growth. Although this could cause urinary problems, it may not be indicative of prostate cancer. This non-cancerous growth of the prostate is not a cause for worry. You may not experience any symptoms at all. Signs and symptoms of prostate cancer depend on the extent and spread of prostate cancer. Signs and symptoms for prostate cancer may include:

Frequent urination: You experience the need to urinate very frequently. This feeling is intensified specifically at night. You may wake up many times to visit the toilet.

Incontinence: Urinary incontinence is your inability to control the urge to urinate. Often, this causes accidents, as you are unable to reach the bathroom in time to urinate.

Difficulty starting urination: Growth of the prostate gland often causes difficulties in starting urination. This growth stresses on the urethra and constricts it. This is the cause for difficulty in starting urination. Further, it also causes difficulty in maintaining the urine stream. Sometimes, you pass blood in your urine.

Discomfort during urination: You may feel uncomfortable or encounter pain or a burning sensation during urination. This condition is dysuria. Although this is not a very common symptom of prostate cancer, it is present in a few cases. However, this is predominant in benign prostatic hyperplasia. You would often feel you are unable to empty the bladder completely.

Painful erections and ejaculations: Growth or enlargement of the prostate gland affects blood flow into the penis. You may have trouble having erections or they may be less rigid. Constriction of the urethra narrows down the ejaculation channel. Therefore, passage of semen during ejaculation is narrowed and forced. This is the reason for pain during ejaculation.

Impotence: Impotence is the inability to have a satisfactory erection for penetration during intercourse. Sudden occurrence of impotence may be a symptom of the presence of prostate cancer. There could also be less semen during ejaculation as prostatic disease affects the flow of ejaculatory fluid produced by the prostate gland and seminal vesicles.

Blood in the semen: This condition is Hematospermia. The blood in the semen would not be visible to the naked eye.

Urinary Infections: Constriction of urethra by prostate gland could cause formation of cystitis. This leads to urinary infections. Advanced prostate cancer may cause these specific symptoms:

Pain in the lower back and spinal regions: As prostate cancer spreads, it can cause cancerous growth of cells in other body parts. This growth could extend to the bones of the pelvic and spinal region. This gives rise to severe pain in these regions.

Numbness and pain in legs and thighs: Prostate cancer causes severe pain and a numb feeling in the thighs and legs. You may suddenly not be able to move your legs. It could also cause swelling of the legs.

Sudden inability to pass urine: This symptom appears from nowhere. You are unable to pass urine. However, you do not experience any pain.

Bone fractures: Prostate cancer advances into the bone tissue and makes them weak and vulnerable to frequent fractures. Bone pain remains intense.

Treatment
Treatment options for prostate cancer include radiation therapy, surgery, hormonal therapy, proton therapy, chemotherapy, or a combination of all these. As prostate cancer is normally a disease of elderly men, many die of other causes rather than prostate cancer. Surgical removal of the prostate is a treatment option if prostate cancer is in the early stages, or if radiation therapy does not bring any results. Response to initial treatments is often the main determining factor for the outcome of the disease.

Doctors often debate whether to treat localized prostate cancer. They must judge the beneficial and harmful effects of prostate cancer treatments and how they could affect your survival chances and the quality of life. Your diet also plays an important role in development of prostate cancer. A diet rich in red meat, fatty substances and dairy products may encourage the development of prostate cancer. Some claim that a generous intake of vegetables and fruits may lower the incidence of prostate cancer.

Green leafy vegetables and tomatoes are recommended. Tomatoes and tomato products contain high levels of lycopene which may help to protect against prostate cancer. Lycopene is a chemical occurring naturally in tomatoes, watermelons, pink grapefruits, papaya, and guava. Cooked tomatoes are more effective as cooking releases this chemical from their storage spots and helps in easy absorption.  Low intake of omega-3 fatty acids (found in fatty fishes like salmon), insufficient intake of vitamin E (present in green, leafy vegetables) and the mineral selenium may increase the risk of prostate cancer.

Insufficient exposure to ultraviolet (UV) light lowers the vitamin D content in the body which may increase the risk of prostate cancer.  Certain medications may also lower the risk of prostate cancer. Daily use of anti-inflammatory medicines like: aspirin, ibuprofen, or naproxen, and cholesterol-lowering drugs like statins are believed by some to possibly decrease the risk of prostate cancer.  Frequent ejaculation can decrease prostate cancer risks.  Infections and inflammation of the prostate gland are very high-risk factors for prostate cancer. Sexually transmitted infections, like chlamydia, gonorrhea, or syphilis, increase the risk of prostate cancer.  Obesity and high levels of testosterone in the blood may pose higher risks of prostate cancer.

Treatment Options for Prostate Cancer
The choice of any specific prostate cancer treatment option depends on a number of factors.  Some of these include: your age, your general health, your mental stability, the extent of progress of your prostate cancer, side effects of different treatment options, and the effectiveness of the treatment options. It is not easy to make such a difficult decision. You may want to discuss with your family and friends or get opinions of other doctors. You may want to talk with other patients and learn of their experiences. But, it has to be in accord with what the medical fraternity thinks is the best for your situation.

Prostate Cancer Treatment Options
Treatment options normally depend on the extent of your prostate cancer. If your prostate cancer has spread to major body parts, radiation or surgery could be the best options. If it is in the initial stages, active surveillance may be a good option.

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