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.