Detecting symptoms of Prostate Cancer

Detecting symptoms of Prostate Cancer

This is the second article in a series of three on prostate
cancer written by Dr. Injil Abu Bakar for The Jakarta Post.

Because the gland is enlarged in both cancer and nonmalignant
conditions, such as Benign Prostate Hypertrophy (BPH), these two
different conditions share many of the same symptoms. You should
contact your physician if you:

- have the urge to urinate frequently, particularly at night

- have difficulty starting or stopping urination

- have a weak or interrupted urinary stream

- cannot urinate

- experience pain or burning when you urinate

- have painful ejaculation

- see blood in your urine

- frequently experience pain or stiffness in your lower back,
hips or upper thigh

Are you at high risk for prostate cancer?

You may have a higher-than-average risk of prostate cancer if
you answer yes to any of these questions:

* Are you 55 years of age or older?

Because prostate cancer is a disease of older men, the risk
increases with advancing age. The average age of onset is 70, and
about 98 percent of cases occur in men over 55. As life
expectancy continues to rise, the incidence of prostate cancer is
likely to increase with it.

* Do you have a family history of prostate cancer?

A man who has a father or brother with prostate cancer has two
to three times the risk of developing the disease as a man who
does not. The risk is ten times greater in a man who has two or
more first degree relatives with prostate cancer.

* Are you African American?

African American men are twice as likely to die from prostate
cancer than Caucasian men. In fact, they have the highest rate of
prostate cancer in the world. Although the reasons are unclear,
researchers suspect a number of variables may be involved. For
example, testosterone stimulates the growth of this cancer, and
on average, African American men tend to have higher levels of
this hormone circulating in their blood than Caucasian men. The
prostate death rate may also be higher in this population because
African-Americans are often diagnosed at a later stage, when a
cure is more difficult.

* Is your diet high in fat?

Although the relationship between nutrition and prostate
cancer is not proven, some evidence suggests that a diet high in
fat, particularly animal fat, increases one's susceptibility to
this disease. One theory is that a high-fat diet increases the
production of sex hormones, which in turn raises the risk of
prostate cancer.

Next step in diagnosis

Doctors will generally advise additional testing if a man's
PSA level is elevated or his DRE reveals a lump. Transrectal
ultrasonography (TRUS) is often used to pinpoint suspicious
areas of the prostate that should be explored further with a
biopsy.

If the inspection of the tissue from the biopsy confirms
prostate cancer, more tests may be ordered to find out if the
cancer has spread beyond the prostate to other parts of the body.
Computerized tomography (CT) or magnetic resonance imaging (MRI)
techniques, which use X-rays and magnetic fields, respectively,
can produce images that help doctors evaluate the spread of
malignant cells to surrounding tissue, including the lymph nodes.

A bone scan can pinpoint areas of bone that contain cancer.
These tests are not always accurate for detecting cancer that has
spread outside the prostate, and not all men need them. However,
they are used by some doctors to help determine the stage of the
cancer.

Ultimately, the prognosis and decisions about treatment depend
on the stage. A four-point scale, ranging from A to D, is often
used to describe how far the cancer has spread.

Stage A and B cancers are still confined to the prostate;
tumors categorized as A are not detectable by DRE, while B
cancers can be detected this way.

Stage C tumors have broken through the prostate's fibrous
capsule to nearby tissue. Stage D cancers have metastasized
(spread) to the pelvic lymph nodes or to distant parts of the
body, such as the bones.

A man's prognosis depends on the stage of the cancer when it
is diagnosed. If it is detected in stages A and B, it can often
be cured, but stage D survival averages only about three to five
years.

Prostate cancer treatment options

The odds of surviving prostate cancer are better than ever,
according to the National Cancer Institute. About 67 percent of
men with the disease in the mid-1970s lived at least five years,
but that figure increased to more than 77 percent in the 1980s.

The odds might be becoming even better due to the availability
of the PSA test, the increased discovery of slow-growing tumors
that can be successfully treated and improvements in therapy.

Although about one in every five men will be diagnosed with
prostate cancer during their lifetime, researchers believe that
most prostate malignancies will never become life-threatening due
to the slow-growing nature of prostate cancer and to the fact
that it develops late in life.

Many men -- perhaps one-third of those over 50 -- have early,
undiagnosed prostate cancer, but again, most of these
malignancies will never pose a significant risk to their
well-being.

A 1992 Swedish study published in the Journal of the American
Medical Association evaluated 223 men averaging 72 years old who
had early-stage prostate cancer but received no initial
treatment. Ten years later, only 19 of them (8.5 percent) had
died from the disease, whereas more than five times as many (105
men) died from other causes.

Watchful waiting

Some men diagnosed with prostate cancer may need no immediate
treatment. These might include men with slowly progressing stage
A or B cancers, particularly if they are ill or have a life
expectancy of less than 10 years.

For them, a wait-and-see approach, or watchful waiting, might
be the most sensible option. This tack involves close monitoring,
but no treatment, of a newly diagnosed cancer.

Many older men, especially beyond the age of 75, are more
likely to die of other conditions before their prostate cancer
becomes troublesome or dangerous, and they may face greater risks
from the rigors of surgery or other treatment than from the
cancer itself.

Watchful waiting, which is also called observation and follow-
up, has created a cauldron of controversy within medical circles,
with critics pointing to the sometimes narrow window of
opportunity in which prostate cancer can be cured.

Once the cancer progresses beyond the prostate, it becomes
extremely difficult to treat. For some men with prostate cancer,
they warn, watchful waiting can be a death sentence.

Virtually all doctors agree that a younger man 55 years or 60
years of age with an aggressive cancer in the early stages
requires treatment. But there are many men in a gray zone, where
age, cancer grade and stage, PSA level, other illnesses and
potential adverse effects of cancer treatment must be weighed
together.

After all, no treatment is risk free, and whether surgery or
radiation is chosen as a therapeutic option, serious side
effects, such as impotency or urinary incontinence, can diminish
the quality of life.

There are a lot of factors to weigh, and no definitive answer
to the question: When is it safe to wait? Although each case must
be evaluated individually, watchful waiting is most often
recommended for older men with small tumors that are unlikely to
grow rapidly.

Until more information is available, some patients may choose
to postpone treatment but continue to have regular DREs to
monitor tumor growth and undergo periodic PSA tests to
check for increases in blood levels that may indicate cancer
progression.

These follow-up tests may be scheduled every four to 12
months, depending on a man's age, biopsy results and anxiety
level.

If PSA readings increase sharply, or if the doctor feels a new
lump during a DRE, then the cancer is probably advancing and
treatment should be started.

A change in urinary habits may also be a good idea for men who
are prone to worry and find it hard to sit back and wait, even if
the tumor is a slow-growing one.