Cancer
of the prostate is the most common cancer among American
men (excluding skin cancer) and the second leading
cause of cancer deaths (after lung cancer). The survival
rate for all stages of prostate cancer combined has
increased
from
67 percent to 92 percent over the past 20 years, primarily
because more men are being diagnosed at an earlier
stage than in years past. With the combination of
our herbal treatment, many patients have enjoyed a
prolonged time with less side effect of radiation
and hormone, such as impotence.
The Prostate
The
prostate is a gland in a man's reproductive system.
It makes and
stores seminal fluid, a milky fluid that nourishes
sperm. This fluid is released to form part of semen.
The prostate is about the size of a walnut. It is
located below the bladder and in front of the rectum.
It surrounds the upper part of the urethra, the tube
that empties urine from the bladder. If the prostate
grows too large, the flow of urine can be slowed or
stopped.
To
work properly, the prostate needs male hormones (androgens).
Male hormones are responsible for male sex characteristics.
The main male hormone is testosterone, which is made
mainly by the testicles. Some male hormones are produced
in small amounts by the adrenal glands.
Understanding Cancer Process
Cancer
is a group of many related diseases. These diseases
begin in cells, the body's basic unit of life. Cells
have many important functions
throughout the body.
Normally,
cells grow and divide to form new cells in an orderly
way. They perform their functions for a while, and
then they die. This process helps keep the body healthy.
Sometimes,
however, cells do not die. Instead, they keep dividing
and
creating new cells that the body does not need. They
form a mass of
tissue, called a growth or tumor.
Tumors can be benign or malignant:
Benign
tumors are not cancer. They can usually be removed,
and in most cases, they do not come back. Cells from
benign tumors do not spread to other parts of the
body. Most important, benign tumors of the prostate
are not a threat to life.
Benign
prostatic hyperplasia (BPH) is the abnormal growth
of benign prostate cells. In BPH, the prostate grows
larger and presses against
the urethra and bladder, interfering with the normal
flow of urine. More than half of the men in the United
States between the ages of 60 and 70 and as many as
90 percent between the ages of 70 and 90 have symptoms
of BPH.
For some men, the symptoms may be severe enough to
require treatment.
Malignant
tumors are cancer. Cells in these tumors are abnormal.
They
divide without control or order, and they do not die.
They can invade
and damage nearby tissues and organs. Also, cancer
cells can break away from a malignant tumor and enter
the bloodstream and lymphatic system. This is how
cancer spreads from the original (primary) cancer
site to form new (secondary) tumors in other organs.
The spread of cancer is called metastasis.
When
prostate cancer spreads (metastasizes) outside the
prostate, cancer cells are often found in nearby lymph
nodes. If the cancer has reached these nodes, it means
that cancer cells may have spread to other parts of
the body--other lymph nodes and other organs, such
as the bones, bladder, or rectum. When cancer spreads
from its original location to another part of the
body, the new tumor has the same kind of abnormal
cells and the same name as the primary tumor. For
example, if prostate cancer spreads to the bones,
the cancer cells in the new tumor are prostate cancer
cells. The disease is metastatic prostate cancer;
it is not bone cancer.
Prostate
Cancer: Who's at Risk
The
causes of prostate cancer are not well understood.
Doctors cannot explain why one man gets prostate cancer
and another does not.
Researchers
are studying factors that may increase the risk of
this disease. Studies have found that the following
risk factors are associated with prostate cancer:
Age.
In the United States, prostate cancer is found mainly
in men over age 55. The average age of patients at
the time of diagnosis is 70.Family history of prostate
cancer. A man's risk for developing prostate cancer
is higher if his father or brother has had the disease.
Race. This disease is much more common in African
American men than in white men. It is less common
in Asian and American Indian men. Diet and dietary
factors. Some evidence suggests that a diet high in
animal fat may increase the risk of prostate cancer
and a diet high in fruits and vegetables may decrease
the risk. Studies are in progress to learn whether
men can reduce their risk of prostate cancer by taking
certain dietary supplements.
Detecting Prostate Cancer
A
man who has any of the risk factors described in the
"Prostate Cancer: Who's at Risk" section
may want to ask a doctor whether to begin screening
for prostate cancer (even though he does not have
any symptoms), what tests to have, and how often to
have them. The doctor may suggest either of the tests
described below. These tests are used to detect prostate
abnormalities, but they cannot show whether abnormalities
are cancer or another, less serious condition. The
doctor will take the results into account in deciding
whether to check the patient further for signs of
cancer. The doctor can explain more about each test.
Digital
rectal examination--the doctor inserts a lubricated,
gloved finger into the rectum and feels the prostate
through the rectal wall to check for hard or lumpy
areas.
Blood
test for prostate-specific antigen (PSA)--a lab measures
the
levels of PSA in a blood sample. The level of PSA
may rise in men who have prostate cancer, BPH, or
infection in the prostate.
Recognizing Symptoms
Early
prostate cancer often does not cause symptoms. But
prostate cancer can cause any of these problems:
A
need to urinate frequently, especially at night;
Difficulty starting urination or holding back urine;
Inability to urinate;
Weak or interrupted flow of urine;
Painful or burning urination;
Difficulty in having an erection;
Painful ejaculation;
Blood in urine or semen; or
Frequent pain or stiffness in the lower back, hips,
or upper thighs.
Any of these symptoms may be caused by cancer or by
other, less serious health problems, such as BPH or
an infection. A man who has symptoms like these should
see his doctor or a urologist (a doctor who specializes
in treating diseases of the genitourinary system).
Diagnosing
If a man has symptoms or test results that suggest
prostate cancer, his doctor asks about his personal
and family medical history, performs a physical exam,
and may order laboratory tests. The exams and tests
may include a digital rectal exam, a urine test to
check for blood or infection, and a blood test to
measure PSA. In some cases, the doctor also may check
the level of prostatic acid phosphatase (PAP) in the
blood, especially if the results of the PSA indicate
there might be a problem.
The
doctor may order exams to learn more about the cause
of the symptoms. These may include:
Transrectal
ultrasonography
--sound waves that cannot be heard by humans (ultrasound)
are sent out by a probe inserted into the rectum.
The waves bounce off the prostate, and a computer
uses the echoes to create a picture called a sonogram.
Intravenous pyelogram --a series
of x-rays of the organs of the urinary tract.
Cystoscopy --a procedure in which a doctor
looks into the urethra and bladder through a thin,
lighted tube.
Biopsy --removing tissue samples
from the prostate to be checked under a microscope
for cancer cells. If cancer is present, the pathologist
usually reports the grade of the tumor.
Staging
If cancer is found in the prostate, the doctor needs
to know the stage, or extent, of the disease. Staging
is a careful attempt to find out whether the cancer
has spread and, if so, what parts of the body are
affected. The doctor may use various blood and imaging
tests to learn the stage of the disease. Treatment
decisions depend on these findings.
Prostate
cancer staging is a complex process. The doctor may
describe the stage using a Roman number (I-IV) or
a capital letter (A-D).
These are the main features of each stage:
Stage
I (A)--The cancer cannot be felt during a
rectal exam. It may be found by accident when surgery
is done for another reason, usually for BPH. There
is no evidence that the cancer has spread outside
the prostate.
Stage
II (B)--The tumor involves more tissue within
the prostate, it can be felt during a rectal exam,
or it is found with a biopsy that is done because
of a high PSA level. There is no evidence that the
cancer has spread outside the prostate.
Stage
III (C)--The cancer has spread outside the
prostate to nearby
tissues.
Stage
IV (D)--The cancer has spread to lymph nodes
or to other parts of the body.
Orthodox Treatment
Treatment for prostate cancer may involve watchful
waiting, surgery,
radiation therapy, or hormonal therapy. Some patients
receive a combination of therapies.
Watchful
waiting may be suggested for some men who have prostate
cancer that is found at an early stage and appears
to be slow growing. Also, watchful waiting may be
advised for older men or men with other serious medical
problems. For these men, the risks and possible side
effects of surgery, radiation therapy, or hormonal
therapy may outweigh the possible benefits. Men with
early stage prostate cancer are taking part in a study
to determine when or whether treatment may be necessary
and effective.
Surgery
is a common treatment for early stage prostate cancer.
The
doctor may remove all of the prostate (a type of surgery
called radical
prostatectomy) or only part of it. In some cases,
the doctor can use a new technique known as nerve-sparing
surgery. This type of surgery may save the nerves
that control erection. However, men with large tumors
or tumors that are very close to the nerves may not
be able to have this surgery.
The
doctor can describe the types of surgery and can discuss
and compare their benefits and risks.
In
radical retropubic prostatectomy, the doctor removes
the entire prostate and nearby lymph nodes through
an incision in the abdomen.
In
radical perineal prostatectomy, the doctor removes
the entire prostate through an incision between the
scrotum and the anus. Nearby lymph nodes are sometimes
removed through a separate incision in the abdomen.
In
transurethral resection of the prostate (TURP), the
doctor removes
part of the prostate with an instrument that is inserted
through the urethra. The cancer is cut from the prostate
by electricity passing through a small wire loop on
the end of the instrument. This method is used mainly
to remove tissue that blocks urine flow.
If
the pathologist finds cancer cells in the lymph nodes,
it is likely that the disease has spread to other
parts of the body. Sometimes, the doctor removes the
lymph nodes before doing a prostatectomy. If the prostate
cancer has not spread to the lymph nodes, the doctor
then removes the prostate. But if cancer has spread
to the nodes, the doctor usually does not remove the
prostate, but may suggest other treatment.
Radiation
therapy (also called radiotherapy) uses high-energy
x-rays to kill cancer cells. Like surgery, radiation
therapy is local therapy; it can affect cancer cells
only in the treated area. In early stage prostate
cancer, radiation can be used instead of surgery,
or it may be used after surgery to destroy any cancer
cells that may remain in the area. In advanced stages,
it may be given to relieve pain or other problems.
Radiation
may be directed at the body by a machine (external
radiation), or it may come from tiny radioactive seeds
placed inside or near the tumor (internal or implant
radiation, or brachytherapy). Men who receive radioactive
seeds alone usually have small tumors. Some men with
prostate cancer receive both kinds of radiation therapy.
For
external radiation therapy, patients go to the hospital
or clinic, usually 5 days a week for several weeks.
Patients may stay in the hospital for a short time
for implant radiation.
Hormonal
therapy keeps cancer cells from getting the male hormones
they need to grow. It is called systemic therapy because
it can affect
cancer cells throughout the body. Systemic therapy
is used to treat cancer that has spread. Sometimes
this type of therapy is used to try to prevent the
cancer from coming back after surgery or radiation
treatment.
There are several forms of hormonal therapy:
Orchiectomy
is surgery to remove the testicles, which are the
main
source of male hormones. Drugs
known as a luteinizing hormone-releasing hormone (LH-RH)
agonist can prevent the testicles from producing testosterone.
Examples are leuprolide, goserelin, and buserelin.
Drugs
known as antiandrogens can block the action of androgens.
Two examples are flutamide and bicalutamide.
Drugs
that can prevent the adrenal glands from making androgens
include ketoconazole and aminoglutethimide.
After
orchiectomy or treatment with an LH-RH agonist, the
body no longer gets testosterone from the testicles.
However, the adrenal glands still produce small amounts
of male hormones. Sometimes, the patient is also given
an antiandrogen, which blocks the effect of any remaining
male hormones. This combination of treatments is known
as total androgen blockade. Doctors do not know for
sure whether total androgen blockade is more effective
than orchiectomy or LH-RH agonist alone.
Prostate
cancer that has spread to other parts of the body
usually can be controlled with hormonal therapy for
a period of time, often several years. Eventually,
however, most prostate cancers are able to grow with
very little or no male hormones. When this happens,
hormonal therapy is no longer effective, and the doctor
may suggest other forms of treatment that are under
study.
Side
Effects of Treatment
The
side effects of cancer treatment depend mainly on
the type and
extent of the treatment. Also, each patient reacts
differently.
Surgery
Patients are often uncomfortable for the first few
days after surgery.
Their pain usually can be controlled with medicine,
and patients should
discuss pain relief with the doctor or nurse. The
patient will wear a catheter (a tube inserted into
the urethra) to drain urine for 10 days to 3 weeks.
The nurse or doctor will show the man how to care
for the catheter.
It
is also common for patients to feel extremely tired
or weak for a while. The length of time it takes to
recover from an operation varies.
Surgery to remove the prostate may cause long-term
problems, including rectal injury or urinary incontinence.
Some men may have permanent impotence. Nerve-sparing
surgery is an attempt to avoid the problem of impotence.
When the doctor can use nerve-sparing surgery and
the operation is fully successful, impotence may be
only temporary. Still, some men who have this procedure
may be permanently impotent.
Men
who have a prostatectomy no longer produce semen,
so they have dry orgasms. Men who wish to father children
may consider sperm banking or a sperm retrieval procedure.
Radiation
Therapy
Radiation therapy may cause patients to become extremely
tired, especially in the later weeks of treatment.
Resting is important, but doctors usually encourage
men to try to stay as active as they can. Some men
may have diarrhea or frequent and uncomfortable urination.
When
men with prostate cancer receive external radiation
therapy, it is common for the skin in the treated
area to become red, dry, and tender. External radiation
therapy can also cause hair loss in the treated area.
The loss may be temporary or permanent, depending
on the dose of radiation.
Both
types of radiation therapy may cause impotence in
some men, but internal radiation therapy is not as
likely as external radiation therapy to damage the
nerves that control erection. However, internal radiation
therapy may cause temporary incontinence. Long-term
side effects from internal radiation therapy are uncommon.
Hormonal
Therapy
The side effects of hormonal therapy depend largely
on the type of treatment. Orchiectomy and LH-RH agonists
often cause side effects such as impotence, hot flashes,
and loss of sexual desire. When first taken, an LH-RH
agonist may make a patient's symptoms worse for a
short time. This temporary problem is called "flare."
Gradually, however, the treatment causes a man's testosterone
level to fall. Without testosterone, tumor growth
slows down and the patient's condition improves. (To
prevent flare, the doctor may give the man an antiandrogen
for a while along with the LH-RH agonist.)
Antiandrogens
can cause nausea, vomiting, diarrhea, or breast growth
or tenderness. If used a long time, ketoconazole may
cause liver problems, and aminoglutethimide can cause
skin rashes. Men who receive total androgen blockade
may experience more side effects than men who receive
a single method of hormonal therapy. Any method of
hormonal therapy that lowers androgen levels can contribute
to weakening of the bones in older men.
