10 Things You Should Know About Prostate Cancer

It’s a disease that will kill more than 30,000 this year alone, yet most men over 40 seem oblivious to the potential threat. Here, ET educates you on a health risk you can’t afford to ignore.

By Susan Weiner, Energy Times

If you were to compile a top ten list of things men would rather just avoid, prostate exams might even rate above taking out the garbage, doing dishes and going shopping. But there’s no good excuse to ignore this walnut-sized gland located between the bladder and the penis and in front of the rectum. Confused by the debate surrounding nearly every aspect of prostate cancer and embarrassed to request a physical exam, many men ignore prostate health, only to discover that the benefits of screening far outweigh its risks. As women openly talk about breast and ovarian cancers, prostate health remains a difficult and controversial topic for men to discuss, forcing many to forgo the manual exam that could lead to early detection and straightforward treatment.

Though most males eventually develop some cancerous cells in their prostates, many prostate cancers develop so slowly that men often die of other causes. Indeed, it’s often said that most men die with prostate cancer, not from it. But the fact remains that prostate cancer kills more men who don’t smoke than any other cancer: The American Cancer Society reports that more than 232,000 men will be diagnosed with prostate cancer in 2005 and 30,350 will die from it. These statistics seem fairly overwhelming when you consider that one in six men will be diagnosed with prostate cancer in his lifetime, while one in eight American women will develop breast cancer in her lifetime.

Despite the ongoing debate about whether the results of a prostate screening may cause unnecessary treatment, growing evidence suggests that testing for prostate cancer saves lives. The number of men who died of the disease fell by 26% from 1991 to 2001, with a five-year survival rate for men diagnosed with early-stage prostate cancer of nearly 100%; the 10-year survival rate for all prostate cancer patients stands at 92%, while the 15-year survival rate fell to 61%.

Energy Times evaluated some of the key issues surrounding prostate cancer, including screening misconceptions, risk factors and lifestyle choices that can influence the likelihood of developing this potentially deadly disease. We hope they help you, or your significant other, make well-informed health decisions.

1. A prostate-specific antigen (PSA) blood test can help detect prostate cancer, as well as other prostate conditions.

A routine blood test, the prostate-specific antigen (PSA) test measures the level of a protein produced by the cells of the prostate gland. When the prostate gland enlarges, PSA levels can rise due to cancer or other medical conditions. However, a high PSA reading is not a cancer diagnosis.

An elevated PSA level can point to common benign conditions such as prostatitis, inflammation of the prostate, or benign prostatic hyperplasia (BPH), enlargement of the prostate.

While the PSA blood test is currently the best tool for monitoring the status of prostate cancer, the test alone does not determine if a cancer is present. Many men with high PSA levels do not have cancer, while nearly 25% of men with a low PSA do have the disease. Studies indicate that it is even possible for patients with healthy PSA levels to have cancer that has spread to the bones. An abnormal PSA level should always be verified by repeating the test, and every PSA test should be accompanied by a digital rectal exam. If a nodule or abnormality is detected on the prostate, a biopsy can determine if cancer is present.

2. The benefits of a manual exam for prostate cancer far outweigh any embarrassment.

While women routinely visit the GYN for yearly or even bi-yearly exams, many men find the idea of being examined so intimately to be disconcerting. “It’s not their favorite exam, but it’s not that painful,” admits Dr. E. Roy Berger, MD, FACP, Director of North Shore Prostate Cancer Consultation and Treatment Service at North Shore Hematology/Oncology Associates in East Setauket, New York. “There is no speculum involved. It’s just a finger.” Education and understanding are the key to men overcoming their anxiety. It’s also an opportunity for women to reassure their significant others that this type of exam is vital to good health and a gratifying love life. “Patients should actually ask their primary care doctor for a digital rectal exam,” suggests Berger. “It’s a matter of mindset.”

3. More men under 65 are being diagnosed with prostate cancer.

More than 75% of prostate cancers are diagnosed in men over 65, but the disease is now found more frequently in men in their 50s. While doctor recommendations for prostate cancer screenings vary, many encourage yearly screening for men over 50. For those with high risk factors, such as race (see the next item), having a father or brother with the disease or eating a diet high in animal fat, screening should start at age 45. Ongoing studies are evaluating whether yearly screening to detect prostate cancer will decrease a man’s chance of dying from the disease.

4. Prostate cancer is more common among certain ethnic groups.

African-American men are more likely to be diagnosed with prostate cancer than men of any other racial or ethnic background, and they are twice as likely to die of the disease. “Genetics and poverty are two things that may contribute to the numbers of African-Americans who have prostate cancer,” says Berger. “They also tend to have a more advanced stage when they are diagnosed.” White men, who are more likely to be diagnosed at an early stage, rank second in prostate cancer prevalence. Hispanic men are at a lower risk of being diagnosed with the disease than either African-American or white men, but it is still the most commonly diagnosed cancer among Latino men. Prostate cancer is least common in Asian and Native American men.

5. Diet and supplements can help reduce the risk of prostate cancer development.

“To reduce prostate cancer risk, the American Cancer Society recommends limiting intake of foods from animal sources, especially saturated fats and red meats,” says Colleen Doyle, MS, RD, director of nutrition and physical activity for the ACS. The ACS also advocates a diet high in fruits, vegetables, grains and beans. In addition, exercise and maintaining a healthy weight are crucial in keeping prostate troubles at bay.

Nutritional supplements may also be a strategic weapon in the war against prostate cancer, and the National Cancer Institute is banking on the ability of selenium and vitamin E to fight off the disease. Previous studies indicate that both nutrients help control cell damage that can lead to prostate cancer, and the Selenium and Vitamin E Cancer Prevention Trial (SELECT) will assess the effects of these supplements on prostate cancer risk. More than 32,000 men from the US, Puerto Rico and Canada are taking part in the long-term study. In addition to SELECT, smaller trials are being conducted on a variety of nutrients and their impact on prostate cancer, including vitamin D, lycopene, licorice root and soy isoflavones.

6. A healthy lifestyle may prevent prostate cancer recurrence.

Based on a breakthrough study of 1,117 men with localized prostate cancer (cancer that is confined within the prostate), researchers discovered that those who kept body weight down, exercised regularly to the point of sweating and underwent routine screenings were less likely to experience a cancer recurrence. Patients with a high risk of progression were more likely to be obese, exercise less than twice a week and avoid annual prostate screenings. The findings, published by the American Association for Cancer Research, are among the first to quantify the risk that lifestyle factors have on whether prostate cancer will recur in patients.

7. Sexual activity influences your risk of developing prostate cancer.

Since research suggests that sexually transmitted diseases multiply cancer risk, men with a high number of sexual partners increase their chances of developing prostate cancer by up to 40%. But on the other side of the bed, researchers have also found that frequent ejaculation prevents carcinogens, such as the chemicals from cigarette smoke, from building up in the prostate gland.

“The more you flush the ducts out, the less there is to hang around and damage the cells that line them,” explains Dr. Graham Giles of The Cancer Council Victoria in Melbourne, Australia. A study of more than 2,300 men concluded that the more men ejaculate between the ages of 20 and 50, the less likely they are to develop prostate cancer. So if you’re in a committed relationship, an active love life may impart significant health benefits.

8. There are many effective treatments for sexual dysfunction resulting from prostate cancer.
Since the prostate produces fluid for semen, cancer patients know all too well that the range of symptoms can include sexual dysfunction. The situation may be either temporary or psychological. “I see a lot of guys who, only after they are diagnosed, begin to experience sexual dysfunction,” says Berger. In other cases, “it’s more the treatment than the disease that causes the dysfunction.” With so many therapies available, it’s likely that function can be regained. The key is to discuss the problem with a healthcare professional, since embarrassment of both patient and provider often means the problem goes untreated.

If aggressive treatment is used to treat the cancer and the unwelcome side effect is more permanent, a surgical procedure called a sural nerve graft can provide cancer control and preserve erectile function. Studies show that 30% to 40% of men regain potency using this technique with no side effects other than a scar on the calf where the section of sural nerve is removed and a numb area the size of a half-dollar coin.

9. Urinary problems are a common sign that prostate cancer has advanced.

In its early, most treatable stage, prostate cancer usually does not cause any symptoms. If prostate cancer develops and is not treated, however, symptoms can include difficult, frequent or painful urination; sexual problems; and pain or stiffness in the lower back, hips or upper thighs. Following a PSA and a manual exam, a physician should order an ultrasound and X-rays to determine the cause of the symptoms, according to the National Institutes of Health. To confirm the presence of cancer, needles are used to remove small tissue samples from the prostate. If a biopsy confirms cancer, a rating system called the Biopsy Gleason score is used to measure the aggressiveness of the cancer before a treatment plan is determined.

10. In men under 65, prostate surgery can save lives.

When it comes to treating prostate cancer, one question prevails: To have surgery or not to have surgery? Since many cancers are slow growing, doctors often suggest that patients take a wait-and-see approach, opting to monitor tumor growth instead. While this gamble can pay off, those with faster-growing cancers may not be so fortunate. A new study, published in the New England Journal of Medicine, determined that when men under age 65 opt for surgery, the odds of surviving prostate cancer increase while chances of the cancer recurring decrease.

At a glance, the findings may seem to contradict research that urges men to watch and wait, but the study targeted patients with localized tumors large enough to be felt during a manual rectal exam. Following radical prostatectomy, when surgeons remove the prostate, surrounding tissue and lymph nodes, cancer was less likely to spread locally or to distant sites. After 10 years, 19.2% of the men in the surgery group had local progression, compared to 44.3% in the watchful waiting group.

Among the surgery group, 15.2% experienced distant cancer progression, while 25.4% of those who eschewed surgery had their cancer spread.

Now that you know the ins and outs of this complex but treatable disease, there’s really no good excuse to avoid getting regular screenings and following prevention guidelines. Being proactive about your prostate could save your life.