What is Prostate Cancer?
In many cases, prostate cancer is slow growing. It can typically take several years to become detectable and can take even longer for the cancer to spread outside of the prostate. Men with prostate cancer in the very early stages typically have no symptoms.
Prostate cancer affects every 1 in 6 men. Additionally men are 35% more at risk to develop prostate cancer than woman are to develop breast cancer.
CAUSES & RISK FACTORS
Identifying a true cause for prostate cancer is still unknown. Some say it’s a freak of nature. Some say stress. Others will look towards science and try and find a more accurate conclusion.
There are a couple of major factors that can influence one’s risk of developing prostate cancer – those are age, race, family history, and place where one lives.
However, it cannot be overstated, there is no definitive cause or causes of prostate cancer. This is exactly why early detection and screening is imperative.
The risk of prostate cancer can be reduced by maintaining a healthy a diet and weight, pursuing an active lifestyle by exercising several days a week, and regular visits and physicals with your doctor.
With respect to maintaining a healthy diet and weight consider the following:
- Choose a low fat diet
- Eat more fats from plants than animals
- Eat more fruits and vegetables each day, especially broccoli and tomatoes for lycopene
- Eat more fish
- Eat less red meat
- Drink green tea and other antioxidants such as pomegranate and cranberry juice
- Add soy to your diet
- Drink alcohol in moderation, or not at all
- Discuss taking vitamins and supplements with your physician
With respect to physical examinations with your doctor:
- Go to the doctor regularly
- Ask for a yearly rectal examination and PSA test
- Mention any symptoms, complaints, or discomforts you may have to your doctor – know your body!
- Get a second and third opinion if your doctor refuses to conduct a yearly rectal examination and/or PSA Test
MOST IMPORTANTLY AND MOST DEAR TO THIS ORGANIZATION,
“WHEN A DOCTOR TELLS YOU ‘YOU ARE TOO YOUNG FOR A PSA TEST’, WALK OUT OF THE OFFICE AND GO TO ANOTHER DOCTOR WHO WILL CONDUCT THE TEST FOR YOU!” – Peter Latos
WHO DOES IT AFFECT & LIFESTYLE CHANGES
Usually, prostate cancer affects 65% of men over the age of 65 and older. However, as was the case with Peter Latos, prostate cancer does not care how old you are. More men today are being diagnosed between the ages of 38 and 65.
Once diagnosed with prostate cancer, men are affected in a myriad of ways, usually depending on what treatment they have undergone. For example, if a man’s prostate did not get removed as a result of the cancer, they will likely have full continence and erectile function.
If a man with prostate cancer had to undergo radiation, or surgery to remove metastasized cancer into the nerve endings surrounding the penis, then his chances of erectile function and/or sex are greatly reduced. Urination also becomes an issue. Some men can regain their urination function, while others are forced to wear adult diapers.
While a prostate cancer diagnosis at whatever stage can be scary, a man should not give up his right to erectile function and full continence. For example, when initially diagnosed, men may ask the doctor to cure them at any cost – for fear for their life; however, all too often, doctors will warn men to take a more conservative approach since aggressive measures are sometimes not necessary, and men don’t listen. A successful treatment regimen that yielded positive outcomes can make a man regret taking drastic decisions and measures during the time of his initial diagnosis
Men are the not the only ones who suffer from prostate cancer. The disease also affects women tremendously especially when there is a marriage, serious relationship, or family member involved.
Women whose partner has been diagnosed with prostate cancer may be affected sexually, emotionally, and spiritually. Following a nerve-sparing radical prostatectomy, recovery from impotence generally happens slowly over time. A man will have dry orgasms because the prostate and seminal vesicles have been removed.
While there are treatments for men such as erectile dysfunction drugs, vacuum pump devices, urethral pellets, penile implants, and natural remedies, couples must understand things will never be the same. Understanding that will help women understand what their partner is actually going through.
HOW CAN PROSTATE CANCER BE DETECTED?
Not every man experiences symptoms from prostate cancer. All too often, a doctor first detects signs of prostate cancer during a routine check-up.
However, some men will experience indications of the presence of prostate cancer with changes in urinary or sexual function. Some symptoms include:
- The urge to urinate frequently; especially at night
- Difficulty starting or stopping the flow of urine
- Weak or interrupted flow of urine
- Painful or burning urination
- Difficulty getting an erection
- Ejaculation accompanied by pain
- Blood in urine or semen
- Frequent pain or stiffness in the lower back, hips, or upper thighs.
PSA, the acronym for Prostate-Specific Antigen, is a protein made by both normal and cancerous prostate cells. An elevated PSA does not necessarily mean a prostate cancer diagnosis, however, an elevated PSA level is an indication that more testing needs to be done.
When going for a routine blood test, a patient’s PSA levels are not always checked. The patient must request that his blood work includes PSA testing.
Treatment decisions are not solely based on PSA testing. They must be confirmed through a biopsy, which is, removal of small pieces from the prostate. One removed the pieces are sent to the lab to test for a presence of cancer.
If the biopsy confirms a presence of cancer, PSA levels are then used to classify tumors into low, intermediate, or high-risk of recurrence.
A PSA level of less than 10 is considered low risk, PSA 10-20 intermediate risk, and PSA greater than 20 high risk.
Recent studies have shown that men with PSA levels at or below 4.0 ng/mL can still have prostate cancer present, while males with higher PSA levels do not. So, if a man has a PSA level at or around 4.0ng/mL, physicians will recommend a biopsy.
Generally, the higher a man’s PSA level, the higher likelihood it is that he has prostate cancer. Furthermore, PSA levels that rise continuously over time may be an indication of prostate cancer.
One of the best methods for determining the severity and aggressiveness of prostate cancer is the Gleason Score.
The score is a sum of two scores each ranging between 1 and 5. The pathologist who is examining the cancer under the microscope calculates the score.
The pathologist will take the most common cancer that is found and add that score to the next most common score. A Gleason score sum ranges from 2-10. A normal prostate will score around 2, and an extremely aggressive will score around 10.
Most cancers are classified in stages. The stage of cancer is based on how large the cancer is and how much it has spread. Prostate cancer has four stages:
Alternatively, the prostate cancer can also be found if it is present in one-half or less of one lobe of the prostate. The PSA level is lower than 10 and the Gleason score is 6 or lower.
Lastly, prostate cancer qualifies as Stage I, if it cannot be felt during a digital rectal exam and cannot be seen in imaging tests. Cancer is found in one-half or less of one lobe of the prostate. The PSA level and the Gleason score are not known.
In stage IIA, cancer is detected through a needle biopsy. In this stage, the PSA level is lower than 20 and the Gleason score is 7, (or the PSA level is at least 10 but lower than 20, accompanied by a Gleason scale of 6 or lower).
Alternatively, the prostate cancer can also be found if it is present in one-half or less of one lobe of the prostate. The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower (or the PSA level is lower than 20 and the Gleason score is 7).
Finally, prostate cancer is classified as Stage IIA if it is found in more than one-half of one lobe of the prostate.
In stage IIB, cancer is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10. Alternatively, Stage IIB cancer cannot be felt during a rectal exam and cannot be seen on imaging tests. The PSA level is 20 or higher and the Gleason score can range from 2 to 10 (or the PSA can be any level and the Gleason score is 8 or higher).
In stage III, cancer has spread beyond the outer layer of the prostate and may have spread to the glands that protrude semen (the seminal vesiscles). The PSA can be any level and the Gleason score can range from 2 to 10.
In stage IV, the PSA can be any level and the Gleason score can range from 2 to 10, and the cancer has either spread (a) beyond the seminal vesicles to nearby tissue or organs, such as the rectum or bladder, (b) and/or to the nearby lymph nodes, and/or (c) to distant parts of the body, which may include lymph nodes or bones. More often than not, prostate cancer spreads to the bones.
COMMON DIFFERENTIAL DIAGNOSIS
It is important to address that there are other diseases and disorders that have similar symptoms to prostate cancer. This is where getting a proper diagnosis is KEY! WHY?
Prostatitis (inflammation of the prostate gland) and BPH (Benign Prostatic Hyperplasia – non cancerous enlargement of the prostate gland) are two of the most common disorders that mask similar symptoms to prostate cancer and can also cause a rise in PSA levels. Similarly, a urinary tract infection will also have the same effect on a man’s PSA levels.
EARLY DETECTION METHODS
PROSTATE-SPECIFIC ANTIGEN (PSA) BLOOD TEST
The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced in the prostate, a small gland that sits below a man’s bladder. The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA levels.
DIGITAL RECTAL EXAM (DRE)
Your doctor will check for problems with your organs, prostate and pelvis during a digital rectal exam. During a DRE, the doctor is able to check for growths or tumors on the prostate gland.
PROSTATE ULTRASOUND AND BIOPSY
The prostate ultrasound involves a probe that produces harmless high-frequency sound waves that bounce off the surface of the prostate. The sound waves are recorded and transformed to either video or images of the prostate gland. This allows the doctor to estimate the size of the prostate and detect any abnormal growths. The ultrasound is used when a biopsy is needed. Tiny needles are guided through the rectum wall into the prostate where abnormalities are detected. The needles remove tissue from the prostate for analysis. Typically, 12 or more core samples are removed from different parts of the prostate. If cancer is detected, the doctor is able to grade the cancer and determine the aggressiveness of it.
Doctors are now studying a urine test called Progensa, which looks for the level of prostate cancer antigen 3 (PCA3) in urine. The higher the level, the most likely prostate cancer is present.
GENETIC TESTING AND TARGETED THERAPY
There have been various breakthroughs in the field of genetic testing for prostate cancer. Scientists have recently found that a mutation in the gene called HOXB13 has been linked to early onset prostate cancers that run in families; however, the mutation is rare. There are also findings that the product of a gene known as EZH2 seems to be prevalent in advanced prostate cancers.
Scientists are also looking for an abnormal gene called TMPRSS2:ERG. These cells can be found in a urine test. The test is considered very reliable since this gene is rarely found in men without prostate cancer.
It was recently found that a single protein can be used to distinguish aggressive prostate cancer from that which is manageable. High levels of NAALADL2 were especially marked in aggressive cancers and more likely to break out of the prostate and invade healthy tissue and other areas of the body. Finding the level of the protein can help determine the type of therapy needed.
Cabozantinib (Cometriq) is a targeted therapy currently in Phase 3 of a clinical trial for metastatic advanced prostate cancer and bone metastases. It is a small molecule inhibitor of the tyrosine c-Met and VEGFR2, which are both expressed, in prostate cancer. In Phase 2 of the clinical trial, the treatment improved bone scans in 68% of the patients. Cometriq inhibited the growth of prostate cancer in the bone as well as increasing normal bone volume.
Alpharadin also known as Xofigo is radium-223 chloride used on patients with castration-resistant prostate cancer and bone metastases. Bone metastases weaken the bone, cause pain and make the patient more susceptible to fractures. Alpharadin contains an alpha-particle emitting nuclide. Radium-223 naturally targets bone metastases due to calcium-mimicking properties and because alpha radiation has a shorter range than traditional radiation, the surrounding healthy tissue is spared. Furthermore, the body, quickly excretes any alpharadin that is not taken in by the bone metastases.
Hormone therapy also known as androgen deprivation therapy (ADT) is used to reduce the levels of male hormones called androgens to prevent them from reaching the prostate cancer cells. The main androgen testosterone stimulates the cancer cells to grow. By lowering these levels, the cancers will shrink or grow more slowly. However, hormone therapy does not cure prostate cancer and eventually will stop working. The following is some of the common hormone drugs used today:
Lupron (leuprolide) is used to treat advanced prostate cancer. This drug stops the production and release of testosterone in men. It also slows the growth of cancer cells that depend on testosterone.
Xtandi (Enzalutamide) is used for treatment of men with metastatic castration-resistant prostate cancer that has recurred. This drug was approved by the FDA in August 2012, and dramatic results were reported after just a month of use. Xtandi can reduce the PSA level by 89% after a month of taking the medication.
Zytiga (Abiraterone) is also used in patients that have castration-resistant prostate cancer. The FDA approved this drug in April 2011 and used in combination with prednisone and found to reduce PSA levels and shrink tumors.
Casodex (bicalutamide) is used for advanced or metastatic cancer by stopping the production of testosterone. It may also be used in combination with other hormonal therapies.
Avodart and Flomax is used by men to shrink the prostate with benign prostatic hyperplasia. They have also been used when the PSA rises after a prostatectomy.
Zometa and Xgeva is used to treat bone loss or damage caused by cancer and/or associated with ADT. Patients should receive monthly shots of Zometa or Xgeva to help strengthen bones.
Provenge also known as sipuleucel-T is the first FDA approved therapeutic cellular immunotherapy vaccine to demonstrate prolonged life in those with advanced to late stage prostate cancer. It is an intricate treatment method. First, the patient’s white blood cells are extracted by a leukapheresis procedure. Thereafter, the blood is sent to a factory and incubated with a fusion protein called PA2024 consisting of 1)the antigen PAP (prostatic acid phosphatase) which is present in prostate cancer and 2)an immune signaling factor granulocyte-macrophage colony stimulating factor that helps the antigen-presenting cells mature. The activated blood product that is formulated at the factory is then re-infused to the patient to cause an immune response against cancer cells carrying the PAP antigen.
Another vaccine, which is still in a clinical trial, is showing promising results for improving survival in patients with metastatic castration-resistant prostate cancer. Prostvac uses two viruses and other known immune system stimulators. The first virus is the vaccinia-PSA-TRICOM which is injected once to prepare the immune system for a response to the cancer. The second virus is the fowlpox-PSA-TRICOM which is given multiple times to continuously boost the immune system to fight the prostate cancer.
Intensity Modulated Radiation Therapy (IMRT) is an advanced type of radiation therapy and is most commonly utilized to treat prostate cancer. IMRT was found to cause less side effects than conformal radiation therapy known as CRT due to the shorter, more precise beams used to treat the prostate. The radiation oncologist uses a computer to plan the exact amount of radiation needed by calculating the size, shape and location of the prostate cancer. Your doctor will send you to have one or more imaging tests such as x-rays, CT scans, MRI scans or a PET scan. After the tests, your doctor will use the results to determine where the radiation beams will be aimed. In order to make sure you are in the correct position each time you get radiation, the doctor will mark the treatment area with a tattoo of a tiny dot or create a special mold or cast to help you remain still.
Most recently, doctors are using proton beam radiation which allows them to treat only the prostate gland and avoid damage to normal surrounding tissue. Proton therapy only benefits patients that have tumors with defined borders and not cancers that have spread to other parts of the body.
A new type of treatment known as High-Intensity Focused Ultrasound (HIFU) is now used on early stage prostate cancer by heating the cells with highly focused ultrasound beams. This is used more in Europe and not available outside of clinical trials in the United States.
Doctors are also studying the use of radiofrequency ablation (RFA) to control pain in men with bone metastases. During RFA, a metal probe is guided into the area of the tumor and a high frequency is passed through the probe to heat and destroy the tumor.
Studies have shown that chemotherapy can attack prostate cancer. The most common drugs associated with prostate cancer are Taxotere and Jevtana. Both of these drugs prevent the cancer cells from dividing and growing. Others include, Taxol, Paraplatin, Velban and Novantrone. Studies have shown that the “best” chemotherapy for a patient with metastatic castration-resistant prostate cancer combines these drugs known as taxanes with prednisone.
A prostatectomy is the surgical removal of all or part of the prostate gland. There are several forms of the surgery. The most effective and minimally-invasive procedure is robotic surgery using a computer known as the da Vinci System. It is a computer interface that is state-of-the-art in surgical and robotics technologies and is used in place of traditional laparoscopy. This allows the surgeon to have more dexterity and better vision. It is more precise, there is less pain and blood loss, lower risk of complications, fewer days with a catheter and faster recovery.
Surgery for men with cancer that has spread outside of the prostate gland could mean that the nerves may be affected and need to be removed. This will cause erectile dysfunction and/or incontinence. There is new research regarding the use of nerve grafts for men that need to have their nerves removed and therefore become impotent. The grafts could be from nerves from other parts of the body or artificial.
Doctors believe that maintaining a Mediterranean diet (low-fat diet and vegetables) helps reduce the risk of developing prostate cancer. Those with cancer should avoid sugar, dairy products, refined foods, fried foods, junk foods, caffeine, alcohol, nitrates and food colorings. You should also limit your intake of high-fat foods such as red meat.
There has been research, studies and trials on various foods and supplements used by men with prostate cancer that may help boost their immune systems and prevent reoccurrence. Below is a list of those foods and supplements that were found to slow the cancer:
- Coenzyme Q10 (COQ10)
- Green Tea
- Maitaike mushrooms
- Modified citrus pectin
- Vitamin D
- Vitamin E