For many men a diagnosis of prostate cancer can be frightening not only because of the threat to their lives, but because of the threat to their sexuality. In fact, the possible consequences of treatment which include bladder control problems and erectile dysfunction (ED) or impotence can be a great concern for some men.
Prostate cancer is cancer of the prostate gland. This is the small, walnut-shaped gland that surrounds the bottom portion (“neck”) of a male’s bladder and about the first inch of the urinary tube (urethra), the channel that drains fluid from the bladder. It’s located behind the pubic bone and in front of the rectum. The prostate’s primary function is to produce seminal fluid, the fluid that nourishes and transports sperm.
This type of cancer is the most common cancer in American men. The American Cancer Society estimates that about 230,000 men are diagnosed with prostate cancer annually in the United States and that about 29,000 men die of the disease.
If prostate cancer is detected early when it’s still confined to the prostate gland you have a better chance of successful treatment with minimal or short-term side effects. Successful treatment of cancer that has spread beyond the prostate gland is more difficult. But treatments exist that can help control the cancer.
Prostate cancer often doesn’t produce any symptoms in its early stages. That’s why many cases of prostate cancer aren’t detected until they’ve spread beyond the prostate.
When signs and symptoms do occur, they may include the following:
Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:
Prostate cancer frequently doesn’t produce symptoms. The first indication of a problem may come during a routine screening test. Screening tests include:
There’s more than one way to treat prostate cancer. For some men a combination of treatmentsn such as surgery followed by radiation or radiation paired with hormone therapy works best. The treatment that is best for each man depends on several factors. These include how fast your cancer is growing, how much it has spread, your age and life expectancy, as well as the benefits and the potential side effects of the treatment.
The most common treatments for prostate cancer include the following:
You can receive radiation therapy via external beams or using radioactive implants:
When you have prostate cancer, male sex hormones (androgens) can stimulate the growth of cancer cells. The main type of androgen is testosterone. Hormone therapy either uses drugs to try to stop your body from producing male sex hormones, or involves surgery to remove your testicles, which produce testosterone. Hormone therapy can also block hormones from getting into cancer cells. Sometimes doctors use a combination of drugs to achieve both.
In most men with advanced prostate cancer, this form of treatment is effective in helping to slow the growth of tumors. Because it’s effective at shrinking tumors, doctors use hormone therapy in some early-stage cancers often in combination with radiation and sometimes with surgery. Hormones shrink large tumors so that surgery or radiation can remove or destroy them more easily. After these treatments, the drugs can inhibit the growth of stray cells left behind.
Some drugs used in hormone therapy decrease your body’s production of testosterone. The hormones known as luteinizing hormone-releasing hormone (LH-RH) agonists can set up a chemical blockade. This blockade prevents the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Viadur) and goserelin (Zoladex). They’re injected into a muscle or under your skin once every three or four months. You can receive them for a few months, a few years, or the rest of your life, depending on your situation.
Other drugs used in hormone therapy block your body’s ability to use testosterone. A small amount of testosterone comes from the adrenal glands, and won’t be suppressed by leuprolide or goserelin. Certain medications known as anti-androgens can prevent testosterone from reaching your cancer cells. Drugs typically used for this type of therapy include flutamide (Eulexin), bicalutamide (Casodex) and nilutamide (Nilandron). They come in tablet form and, depending on the particular brand name of drug, are taken orally one to three times a day. These drugs typically are given with an LH-RH agonist.
Simply depriving prostate cancer of testosterone usually doesn’t kill all of the cancer cells. Within a few years, the cancer often learns to thrive without testosterone. Once this happens, hormone therapy is less likely to be effective. However, several treatment options still exist.
To avoid such resistance, intermittent hormone therapy programs have been developed. During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady. You resume taking the drugs if your PSA level rises again.
Side effects of hormone therapy may include breast enlargement, reduced sex drive, impotence, hot flashes, weight gain and reduction in muscle and bone mass. Some of these drugs can also cause nausea, diarrhea, fatigue and liver damage.
Because most testosterone is produced in your testicles, surgical removal of your testicles (castration) also can be an effective form of therapy especially for advanced prostate cancer. The procedure can be performed on an outpatient basis using a local anesthetic.
Surgical removal of your prostate gland, called radical prostatectomy, is another option to treat cancer that’s confined to your prostate gland. During this procedure, your surgeon uses special techniques to completely remove your prostate and local lymph nodes, while trying to spare muscles and nerves that control urination and sexual function.
Two surgical approaches are available for a prostatectomy, retropubic and perineal:
During your operation, a catheter is inserted into your bladder through your penis to drain urine from the bladder during your recovery. The catheter will likely remain in place for one to two weeks after the operation while the urinary tract heals.
After the catheter is removed, you’ll likely experience some bladder control problems (urinary incontinence) that may last for weeks or even months. Most men eventually regain complete control. Others may experience stress incontinence, meaning they’re unable to hold urine flow when their bladders are under increased pressure, as happens when they sneeze, cough, laugh or lift. In some men, major urinary leakage persists, and secondary surgical procedures may be needed in an attempt to correct the problem.
Impotence is another common side effect of radical prostatectomy because nerves on both sides of your prostate that control erections may be damaged or removed during surgery. Most men younger than age 50 who have nerve-sparing surgery are able to achieve normal erections afterward, and some men in their 70s are able to maintain normal sexual functioning. Men who had trouble achieving or maintaining an erection before surgery have a higher risk of being impotent after the surgery.
This type of treatment uses chemicals that destroy rapidly growing cells. Chemotherapy can be quite effective in treating prostate cancer, but it can’t cure it. Because it has more side effects than hormone therapy does, chemotherapy often is reserved for men who have hormone-resistant prostate cancer, especially if their cancer is causing symptoms.
As new chemotherapy drugs are developed, trials continue using single-drug chemotherapy, multiple combinations of chemotherapy, and combinations of chemotherapy and hormone therapy. Early results are positive, but extensive experience with newer drug agents is still unavailable. In the future, gene therapy or immune therapy may be more successful in treating metastasized tumors of the prostate. Current technology limits the use of these experimental treatments to a small number of centers due to patient safety.
This treatment is used to destroy cells by freezing tissue. Original attempts to treat prostate cancer with cryotherapy involved inserting a probe into the prostate through the skin between the rectum and the scrotum (perineum). Using a rectal microwave probe to monitor the procedure, the prostate was frozen in an attempt to destroy cancer cells. Poor precision in monitoring the extent of the freezing process often resulted in damage to tissue around the bladder and long-term complications such as injury to the rectum or the muscles that control urination.
More recently, smaller probes and more precise methods of monitoring the temperature in and around the prostate have been developed. These advances may decrease the complications associated with cryotherapy, making it a more effective treatment for prostate cancer. Although progress continues, more time is needed to determine how successful cryotherapy may be as a treatment for prostate cancer.
The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose watchful waiting as a treatment option. In watchful waiting (also known as observation, expectant therapy or deferred therapy), regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor for evidence of progression of your cancer.
During watchful waiting no medical treatment is provided. Medications, radiation and surgery aren’t used. Watchful waiting may be an option if your cancer isn’t causing symptoms, is expected to grow very slowly, and is small and confined to one area of your prostate.
Watchful waiting may be particularly appropriate if you’re elderly, in poor health or both. Many such men will live out their normal life spans without treatment and without the cancer spreading or causing other problems. But watchful waiting can also be a rational option for a younger man as long as you know the facts, are willing to be vigilant, and accept the risk of a tumor spreading during the observation period, rendering your cancer incurable.
Prostate cancer can’t be prevented, but you can take measures to reduce your risk or possibly slow the disease’s progression. The most important steps you can take to maintain prostate health and health in general are to eat well, keep physically active and see your doctor regularly.
High-fat diets have been linked to prostate cancer. Therefore, limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods rich in lycopenes, an antioxidant, also may help lower your prostate cancer risk. These foods include raw or cooked tomatoes, tomato products, grapefruit and watermelon. Garlic and cruciferous vegetables such as arugula, bok choy, broccoli, brussels sprouts, cabbage and cauliflower also may help fight cancer.
Soy products contain isoflavones that seem to keep testosterone in check. Because prostate cancer feeds off testosterone, isoflavones may reduce the risk and progression of the disease.
Vitamin E has shown promise in reducing the risk of prostate cancer among smokers. More research is needed, however, to fully determine the extent of these benefits of vitamin E.
Getting regular exercise
Regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren’t as clear-cut, but studies do indicate that regular exercise may reduce your cancer risk, including prostate cancer.
Exercise has been shown to strengthen your immune system, improve circulation and speed digestion all of which may play a role in cancer prevention. Exercise also helps to prevent obesity, another potential risk factor for some cancers.
Regular exercise may also minimize your symptoms and reduce your risk of prostate gland enlargement, or benign prostatic hyperplasia (BPH). Men who are physically active usually have less severe symptoms than men who get little exercise do.
A Mayo Clinic study released in March 2002 suggests that regular use of aspirin, ibuprofen (Advil, Motrin, others) and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help protect against prostate cancer.
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