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.

Don’t Go Breaking Your Heart
Stressed about work? Depressed about a relationship? Bummed about life in general? Well, snap out of it! Because ifyou don’t, it will be your heart that snaps.

By Susan Weiner, Energy Times

Two years ago, I decided to make a radical life change. With my two dogs, nearly a dozen cats and three chickens in tow, I drove a rented van 280 miles to a new home in a small town in upstate New York. But about halfway through the trip, I became despondent, emotional and panic-stricken.

And my passengers, howling and crying behind me, didn’t sound like they were handling the move any better. My mind raced uncontrollably. I had spent months planning and preparing for this move.

Why on earth, I asked myself, was I leaving behind a comfortable house in the New York City suburbs, a steady job, a pleasant lifestyle, and friends and family I loved?

The feelings of guilt, apprehension and uncertainty caused a resounding sadness that ran so deep it hurt to breathe. And weeks after settling into my new life, I still found it difficult to function. I had trouble sleeping and eating, I lost weight and I felt overwhelmed by the simplest tasks. I had to come to grips with the fact that, officially, I was clinically depressed.

I already knew what most people know about the factors that define depression—sadness, pessimism, anxiety, lack of energy, sleep disorders, disinterest in sex, and appetite and weight fluctuations. I even knew that the combination of such depressive symptoms triggers spikes in blood pressure and can hamper the immune system. What I didn’t know, and what millions of other people also don’t know, is that a high level of stress and clinical depression can lead to heart disease.

Losing Heart

Here’s a depressing statistic: Nearly one in 20 American adults experiences major depression in a given year. Add to that stat the one in three people who suffer from depression after being diagnosed with heart disease or surviving a heart attack. Despite enormous advances in the understanding of brain chemistry and societal acceptance of the condition, depression often goes undiagnosed and untreated, with only about one-third seeking help, reports the National Institute of Mental Health (NIMH).

In a domino effect, the emotional distress that causes depression can set off considerably more serious physical symptoms, such as irregular or rapid heartbeat, high blood pressure, elevated insulin and cholesterol levels, and faster blood clotting (Depression and Anxiety 1998). A depressed individual may feel just slightly apathetic and sluggish, yet internally his or her stress hormones could be soaring, increasing the heart’s workload. The combination of these risk factors is a potential recipe for a cardiac catastrophe.

A six-year study of 4,500 heart-healthy people 65 and older suggested that the mental stress which accompanies depression could encourage the blockage of blood vessels and help create a hospitable climate for heart disease. As the study progressed, participants who struggled with depression were 40% more likely to develop cardiac disease than those who were more lighthearted (Circulation 10/00).

More so than men, women are prone to depression, and heart disease is the number-one killer of women. More than 70% of the women polled felt “depressed, stressed, anxious or sad” within the past year, according to a 2004 survey by Harris Interactive. A woman who experiences just one significant episode of depression has increased odds of developing metabolic syndrome, a cluster of conditions—including abdominal obesity, high blood pressure, and elevated blood sugar and cholesterol levels—that set the stage for heart disease, reports Psychosomatic Medicine (5-6/04).

According to the American Heart Association (AHA), men beset by depression face the same heart hazards as women, and those afflicted with the blues may be twice as likely to die of a stroke.

The Psychic Connection

Even though research supports a connection between depression and the physiological responses that may encourage cardiovascular disease, the link is not a direct one. The more likely scenario, say experts, is that depression causes the behaviors that lead to heart problems.

“People who are depressed don’t always take care of themselves very well and that can cause them to develop heart disease, especially if there are genetic factors involved,” says Lloyd Fallowes, MD, creator of the cardiac stress test (with Stuart Rosner, MD) at Long Island Jewish Medical Center in 1967. This heart-health test, which measures physical condition, blood flow and heart function, remains the gold standard used today.

Depressed persons, says Dr. Fallowes, may be more likely to engage in behaviors that predispose them to heart disease, such as smoking, eating poorly, leading a sedentary life and neglecting genetic factors. “But just because an individual is depressed,” says Fallowes, “it does not mean he or she will develop heart disease or that he or she is going to die. They have a choice of doing the right thing for themselves. We all have the choice to do the right thing.”

Wayne Sotile, PhD, director of psychological services at Wake Forest University’s Cardiac Rehabilitation Program, and author of Thriving with Heart Disease (The Free Press), agrees: “Without question, a person who flounders in untreated depression for many years is more likely to develop heart disease.” In addition to engaging in the poor health behaviors cited above, Dr. Sotile says that depressed people are much less likely to follow medical advice. “Therefore, they are more liable to suffer the effects of untreated conditions like diabetes, high blood pressure or high cholesterol—conditions that can be controlled with medication.”

An unhappy childhood and adolescence may also be a precursor of cardiovascular problems. Not only are troubled kids and teens more likely to indulge in risky behavior such as smoking, and drug and alcohol use, but also they may internalize experiences of abuse. According to the Journal of the American Medical Association (9/04), adults who reported experiencing traumatic emotional, physical or sexual abuse during childhood had a 30% to 70% greater chance of developing ischemic heart disease then those who reported more typical childhood experiences. These same survivors of childhood trauma were more likely to endure diabetes, obesity and hypertension, all contributors to heart disease.

Heart Disease Blues

People who have been told they have heart disease have to deal with an emotional distress that can put additional strain on the heart, dramatically increasing the risk of another heart attack and even predicting an earlier death. Depressed individuals with cardiovascular disease are less prone to adhere to exercise and smoking-cessation programs, far less apt to enroll in cardiac rehabilitation and less likely to follow recommendations to reduce cardiac risk, even finding it difficult to take medications (Archives of Internal Medicine 2000).

“Among heart patients, depression is as good a predictor of imminent death as smoking, obesity or a previous heart attack,” writes Dean Ornish, MD, in Love and Survival: The Scientific Basis for the Healing Power of Intimacy (HarperPerennial). “Study after study shows that people who are lonely, depressed and isolated are three to five times more likely to die prematurely than people who feel a connection to their life.”

Depressive symptoms can affect heart and overall health more than actual heart function, making people with heart disease feel far worse than their tickers would indicate. Within a group of 1,024 adults with heart disease, those who were depressed demonstrated a history of heart attack or diabetes, higher body mass index, a lower capacity for exercise, a lower income and, perhaps most significantly, less close relationships and social support (JAMA 7/9/03).

In addition to depression, an absence of hope for a healthy future can foster depressive and despondent thoughts, coloring a person’s beliefs about his or her health. “Individuals with heart disease become depressed because they are facing the concept that they will have a limited existence in the future,” says Dr. Fallowes. “Having heart disease, or any debilitating disease, will make a person depressed.”

Hearty Therapies and Treatments

When trying to conquer stress and depression, different treatments work for different people. Depending on the severity of depression, a healthcare professional could recommend antidepressant medications or psychotherapy. “Talk” therapy provides a forum for expressing and exploring issues and feelings. Medications may also lessen depressive symptoms, but must be monitored for side effects and possible negative interactions with other medications.

Once dismissed as ineffective, treatments based on non-conventional traditions and practices are working for people who do not respond to conventional therapies. Homeopathy (based on the principle that signs and symptoms of an illness can be treated with a substance that induces the same symptoms), Chinese medicine, Ayurvedic medicine and acupuncture, are garnering interest in the West by qualified professionals. In fact, these treatments have effectively alleviated mild to severe symptoms in depressed individuals.

Herbal remedies have also proven effective in treating depression. In a 2003 study involving 521 doctors and 2,462 depressed patients, researchers concluded that mild to moderately severe depression can be treated successfully with a combination of St. John’s wort extract and valerian.

Exercise is a win-win strategy for anyone dealing with depression. Physical activity reduces the effects of stress and raises “feel good” brain chemicals, improving mood and heart health. Exercise training can provide the same mood-altering effects as an antidepressant medication.

It appears that the line about the “power of positive thinking” is more than just a cliché; that looking at life’s glass as half-full instead of half-empty or that we shouldn’t sweat the small stuff can have direct benefits on the health of our minds, bodies and hearts. Stress management, dietary changes and attention to overall fitness just may put you in a better state of mind, enabling you to lead a heart-healthy, happy life. Out here in the countryside, I’ve come to learn that positive thoughts can accomplish wonders.