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Prostate Cancer

In the literature concerning prostate cancer, it is stated that men characteristically do not talk about their physical changes. Therefore a partner may be the first to learn of warning signs that should be checked out with a health care provider. There is much controversy surrounding prostate cancer:

  • when to begin regular checks
  • whether to screen with the prostate specific antigen or PSA test
  • if diagnosed; when and whether to treat
  • whether to treat with surgery, radiation with the possibility of serious side effects
  • to engage in watchful waiting

Should we be concerned? The answer is definitely yes! The prevalence of prostate cancer and the death rate has been steadily rising for the past thirty years. It is only now that the death rate is slowly declining and it is not known whether this is due to screening or treatment. Even so prostate cancer is the most frequently diagnosed nonskid cancer in males and the #2 cause of death in men, ranking next to lung cancer. The number of American men expected to be diagnosed with prostate cancer in 1998 is 184,500 and 39,200 men are expected to die in the same year.
What and where is the prostate? The prostate is partly glandular and a partly muscular organ whose primary function is to manufacture seminal fluid, commonly called semen. During ejaculation, the prostate gland/muscle contracts to expel this fluid. This small gland surrounds the neck of the bladder and urethra and as the years pass by the prostate hypertrophies (gets bigger). The question is: is it benign prostatic hypertrophy (BPH) or could it be cancer?

It is speculated that we are becoming better at finding prostate cancer and that men are living longer than they used to, so their chances of living long enough to get prostate cancer have increased. The average age of men diagnosed with prostate cancer is still over 60 years; however, diagnosis of younger men is now more common. Cases have been found in men as early as in their twenties. Which brings us to look at risk factors.

If a brother, father or uncle has or had prostate cancer, then there is an increased chance of having prostate cancer. The risk is there as well if there is first or second degree of relatives with prostate cancer on the mother's side. If one's father does have prostate cancer it DOES NOT mean that a son will get it, too. It DOES mean that the more relatives who have it, the risk of incidence is higher.

How does race factor into the risk of prostate cancer. It is interesting to note that Japanese men LIVING in Japan have a lower incidence; however if living in American they have similar risk. By comparison African American men are at very high risk of this disease. The reasons for these facts are unknown.

HOWEVER, these risk are significant as they may factor into when to begin having regular check ups beginning with the digital rectal exam or DRE.

A recent major study has clearly linked prostate cancer risk with saturated fat intake. However it is suggested for all of us that a balanced diet which is high in fruit and vegetables and relatively low in red meaty and fats will be better than one high in red meat and fats. Eating well is good for everyone. There is no known diet that will prevent prostate cancer--and the authors suggest there probably never will be.

They suggest the same of our environment. The cleaner your environment the less likely you are to be at risk of prostate cancer. But then this is true for nearly all cancers and explains why smoking increases the risk as it introduces pollutants directly into your lungs and from there to almost every other organ in the body.

One of the most infuriating problems for men regarding the diagnosis of prostate cancer is the cancers are not equal. For example; out of 100 American men over 50 who could have died in auto crashes and had no clinical sign of prostate cancer, 30 of them would show small areas of prostate cancer upon examination. They could live for years with those small areas (foci) of prostate cancer--or some could have been diagnosed with clinically significant prostate cancer just a few months later if they had lived. ( With the same prostate examination of men over 90 years old, they would find 90% would have microscopic evidence of prostate cancer. ) These small areas that DO NOT develop into clinically important disease are often called "latent" prostate cancer. The average man of 50 years of age with a reasonable life expectancy of another 25 years, will have a 42% chance of developing "latent" prostate cancer. The chance in those same men to develop clinically significant prostate cancer is only 9.5% and of the same 100 men three will actually die of prostate cancer. This is why it is often said that most men are much more likely to die with prostate cancer than because of it.

Another problem is that there are no clear symptoms of prostate cancer which can be easily assessed by one's self. This is different from breast cancer or testicular cancer in which regular self examination can be important in finding early signs of the disease and can make a difference in the outcome.

However, the National Cancer Institute suggest that the following possible indicators of prostate cancer--and many other clinical problems be reason to see a physician:

  • Frequent urination (especially at night)
  • Inability to urinate
  • Trouble starting to urinate or trouble holding back urination
  • Pain during ejaculation
  • A weak or interrupted urine flow
  • Pain or a burning feeling during urination
  • Blood in the semen or in the urine
  • Frequent pain or stiffness in the lower back, hips or upper thighs

What to do about screening or testing for the potential of prostate cancer. This is another area of controversy. The US Preventive Services Task Force indicated in 1995 that there is no current evidence to support annual PSA testing and DRE examinations for men over 50 years of age. This is not to say if men have possible symptoms they should not be tested, but that a large segment of the medical community will not endorse annual PSA tests and DREs for those without symptoms. The Prostate Cancer InfoLink believes they will need proof of an association between early disease detection and increased overall survival to change these recommendations. Note this is not including quality of life issues.

The American College of Physicians published a series of many detailed articles on prostate cancer in the Annals of Internal Medicine in early 1997. The two specific recommendations in their clinical guidelines on screening:

  1. Rather than screening all men for prostate cancer as a matter of routine, physicians should describe the potential benefits and known harms of screening, diagnosis and treatment; listen to the patient's concerns; and then together individualize the decision to screen.
  2. The College strongly recommends that physicians help enroll men in ongoing studies.

The American Urological Association makes the following recommendations regarding regular testing for prostate cancer:

  • All males of 50 years or more should have an annual prostate examination comprising a digital rectal examination and a PSA test.
  • All males of 40 years or more with a family history of prostate cancer should have an annual prostate examination comprising a digital rectal examination and a PSA test.

The American Cancer Society has issued the following guidelines: beginning at age 50, an annual prostate examination, including a digital rectal examination and a PSA test, should be offered annually to men who have a life expectancy of at least 10 years, and to younger men who are at high risk at age 45 years of age.

This presents a look at the difficult questions: How hard must we then search to discover whether a particular person actually has prostate cancer? and then How do we treat his disease when we find it? An option some men consider is annual DRE without the PSA testing. It is a matter to discuss with your physician requiring careful assessment of many factors.

The American College of Physicians has specifically recommended that all men who are considering having a DRE and a PSA should be fully informed as follows:

  • Prostate cancer is an important health problem.
  • The benefits of one-time or repeated screening and aggressive treatment of prostate cancer have not yet been prove.
  • DRE and PSA measurement can both have false-positive and false-negative results.
  • The probability that further invasive evaluation will be required as a result of testing is relatively high.
  • Aggressive therapy is necessary to realize any benefit from the discover of a tumor.
  • A small but finite risk for early death and a significant risk for chronic illness, particularly with regard to sexual and urinary function, are associated with these treatments.
  • Early treatment may save lives.
  • Early detection and treatment may avert future cancer-related illness.

Prostate Cancer Awareness Week September 21 - 27, 1998

With Prostate Cancer Awareness Week one Internet site said the use of informed consent is so important. They claim we can look at it when prostate cancer is detected early and the cancer is confined to the prostate organ, it is potentially curable with a radical prostatectomy plus radiation. The treatment can result in incontinence, impotency and other problems, but the survivable age will equal a man without prostate cancer.

One source says the statistics are similar to breast cancer and yet seven times as much is spent on research for breast cancer versus prostate cancer. The National Prostate Cancer Coalition strongly urge the approval of $175 million for Prostate Cancer research in the 1999 Defense Department Appropriation Bill. They suggest contact be made with Senator Ted Stevens (202) 224-3004 and Representative Bob Livingston (202) 225-3015. They are chairs of their respective Appropriations Committee.

What else can be done about this controversial, life-threatening and quality of life menace? Publications have been arriving at our home with claims "Let us Help you Take Care of Your Prostate Now! Another area or wrinkle of confusion.

It appears that one can investigate as fully as the mind will allow and consult with health care providers that one has decided to trust and work with. One Internet source indicated that urologist, radiation oncologist and patients "with the need to do something" tend toward more aggressive treatment. Those who question the efficacy of the present day treatment are more likely to be the general physicians and oncologist.

Several years ago we researched information with a vengeance on prostate cancer, including the Harvard Special Report, PROSTATE DISEASES and an informative article, "BHP, Treating older men's most common problem" from RN, the July 1991 issue.

We were introduced to THE PROSTATE REPORT, Prevention and Healing by Julian Whitaker, M.D. It is reported to be available by calling 1-800-777-5005 or write Phillips Publishing, Inc., 7811 Montrose Road, Potomac, Maryland 20854. The discovery that my 74 year old partner/husband still stays with and was recently supported by Urologist, Dr. Carlene Benson, is the use of Saw Palmetto, which is Serenoa repens extract. Along with this, a traditional prescription, supplements and Prostex, he has been able to implement a program that is satisfactory for him without ever having a PSA, but a annual DRE.

Written by Lana Rosten-Mahoney, R.N., B.S., Community Health Coordinator

Visit the Health Resource Center at Forks Community Hospital

Stop in the Forks Community Hospital to see the above information on display and also pick up your copies of helpful information to support you in meeting your new goals. May we all have a healthier year filled with many moments that are dear and will be remembered forever!

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