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Dealing with Prostate Cancer

The Complete Guide to Prevention, Symptoms,

Diagnosis, Treatment and Care

By Norman Falconer

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"Dealing with Prostate Cancer" by N Falconer Page 2 of 69

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This Electronic book is Copyright © 2008. All rights reserved. No part of this

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The advice contained in this material might not be suitable for everyone.

The author only provides the material as a broad overview by a layperson

about an important subject. The author obtained the information from

sources believed to be reliable and from his own personal experience, but he

neither implies nor intends any guarantee of accuracy.

All claims made for any product, treatment or other procedure that is

reported in this book is only the author's personal opinion. You must do you

own careful checking with your own medical advisor and other reputable

sources on any matter that concerns your health or that of others.

Research is constantly changing theories and practices in this area.

The content is not intended to be a substitute for professional medical

advice, diagnosis or treatment. Always seek the advice of your physician or

other qualified health care provider with any questions you may have

regarding a medical condition. Never disregard professional medical advice or

delay in seeking it for any reason.

The author, publisher and distributors never give legal, accounting, medical

or any other type of professional advice. The reader must always seek those

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The author, publisher and distributors particularly disclaim any liability, loss,

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contained herein. All readers must accept full responsibility for their use of

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"Dealing with Prostate Cancer" by N Falconer Page 4 of 69

Table of Contents

Please Read this First.........................................................................................2

Terms of Use ...............................................................................................................................2

Table of Contents................................................................................................4

About the Author ................................................................................................7

Prostate Cancer – An Overview.........................................................................8

What is Prostate Cancer? ..........................................................................................................9

Types of Prostate Cancer ........................................................................................................10

Stages of Prostate Cancer.......................................................................................................10

Who Gets Prostate Cancer? ............................................................................ 13

Predisposing Factors for Prostate Cancer ............................................................................13

Overall Analysis....................................................................................................................19

Diagnosis........................................................................................................... 20

How is Prostate Cancer Diagnosed?..................................................................................21

Prostate Cancer Diagnosis Tests ...........................................................................................21

Gradation of Prostate Cancer..............................................................................................27

Is It Possible to Find Prostate Cancer Early?....................................................................28

Signs and Symptoms of Prostate Cancer....................................................... 29

Treatment .......................................................................................................... 32

Treatment Options for Prostate Cancer .......................................................... 34

Prostate Cancer Treatment Options .......................................................................................34

(I) Radiation Therapy ............................................................................................................34

(a) 3-D conformal radiation therapy with CT......................................................................35

(b) Intensity-Modulated Radiotherapy (IMRT)....................................................................36

(II) Radioactive Seed Implants.................................................................................................36

Permanent Brachytherapy (Low Dose Rate or LDR) ........................................................36

Temporary Brachytherapy (High Dose Rate or HDR) .......................................................36

(III) Chemotherapy ....................................................................................................................37

(IV) Radical Prostatectomy ......................................................................................................38

(V) Laparoscopic Prostate Surgery ........................................................................................39

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(VI) Hormone Therapy ..............................................................................................................40

Orchiectomy..........................................................................................................................41

(VII) Active Surveillance ...........................................................................................................41

(VIII) Other Treatment Options ................................................................................................42

(IX) Emerging Therapies ..........................................................................................................42

Coping with Prostate Cancer – The Action Plan ............................................ 43

Coping Help Sources ...............................................................................................................43

Counselors ............................................................................................................................43

Social Workers......................................................................................................................43

Support Groups ....................................................................................................................43

Financial Counselors ...........................................................................................................44

Gather Information ...................................................................................................................44

Family ....................................................................................................................................44

Home......................................................................................................................................44

Personal Strategy .....................................................................................................................45

Prostate Cancer Treatment and Stress........................................................... 46

How to Prevent Prostate Cancer ..................................................................... 48

Prevention .................................................................................................................................51

Complementary and Alternative Therapies .......................................................................51

Herbal Treatments for Prostate Cancer .......................................................... 54

Cernilton ................................................................................................................................54

Flavonoids.............................................................................................................................54

Lycopene ...............................................................................................................................54

Pygeum..................................................................................................................................55

Saw Palmetto ........................................................................................................................55

Selenium................................................................................................................................55

Zinc-Rich Foods....................................................................................................................55

Recommendations....................................................................................................................55

The Immune System and Prostate Cancer ..................................................... 56

Eating Right and Maintaining Good Nutrition ................................................ 58

Maintain a Basic Calorie Intake...........................................................................................58

Take Protein each day..........................................................................................................58

Drink Enough Fluids ............................................................................................................58

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Enough Vitamins ..................................................................................................................59

Foods that are Rich in Lycopene and Quercetin...............................................................59

Get a Dietician’s help ...........................................................................................................59

Nutritional Recommendations ................................................................................................59

Prostate Cancer and Regular Exercise ........................................................... 61

Doctor’s Advice ........................................................................................................................61

The Right Exercises .............................................................................................................61

Recommendation..................................................................................................................62

Prognosis of Prostate Cancer.......................................................................... 63

Prognosis of Prostate Cancer Stages ....................................................................................64

Survival Rates .......................................................................................................................64

Prostate Cancer – Frequently Asked Questions ............................................ 66

What is prostate cancer?.....................................................................................................66

What is advanced prostate cancer? ...................................................................................66

How common is prostate cancer? ......................................................................................66

Does prostate cancer afflict elderly men more? ...............................................................66

Is there a cure for prostate cancer? ...................................................................................66

What are the symptoms of prostate cancer? ....................................................................66

Are specific men at a higher risk for prostate cancer? ....................................................67

Does prostate cancer make a man impotent?...................................................................67

Is it possible to father children after prostate cancer treatment? ...................................67

A Reminder from Norman Falconer. ............................................................... 68

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"Dealing with Prostate Cancer" by N Falconer Page 7 of 69

About the Author

Norman Falconer only realized the level of risk that men of his age faced

from prostate and other cancers when a close friend was diagnosed with the

disease.

The effect on his friend and, especially, the trauma and other problems that

it brought to his family, gave Norman the incentive to learn as much as he

could about the disease and the current methods of detection and treatment.

Norman feels it’s very important that every man knows about the benefits of

being tested for this deadly affliction.

He discovered that there was a lot of mis-information being spread about

prostate cancer.

Norman hopes that his book will help get the right information to as many

men and those close to them as possible, and perhaps even save a few lives.

Copyright © 2008 All rights reserved

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"Dealing with Prostate Cancer" by N Falconer Page 8 of 69

Prostate Cancer – An Overview

Prostate cancer is the cancer of the prostate gland.

The prostate gland is part of the male reproductive system. Unusual and

uncontrollable growth of cells within the prostate gland cause prostate

cancer. In some cases, prostate cancer can spread very slowly from the

prostate to other body parts.

It might start around the age of fifty, but detection may not occur until the

patient is about the age of seventy or eighty.

The incidence of prostate cancer is not the same among men in all parts of

the world. It is less common in South and East Asia. The highest incidence of

prostate cancer is in the USA, followed by Europe.

It is responsible for the most deaths among American men after lung cancer.

Black men have the highest incidence while Asians record the lowest

incidence.

Genetic factors also seem to play an important role. If your father, brother,

grandfather or uncle has had prostate cancer, you may have a higher than

average risk of developing prostate cancer, even possibly before the age of

fifty. Identical twins have twice the risk of developing prostate cancer

compared to other men.

However, there is no single gene that has been directly linked with prostate

cancer. Many genes work in different combinations and research is continuing

to try to locate any specific gene that might cause prostate cancer.

Prostate cancer is more prevalent in men over the age of fifty. It occurs very

rarely in men below the age of forty-five.

The average age for diagnosis of prostate cancer is seventy.

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What is Prostate Cancer?

The Prostate gland is a small walnut-shaped gland, about three centimeters

long and weighing around twenty grams in the male reproductive system. It

makes and stores seminal fluid.

This gland is in the pelvic region in front of the rectum and under the urinary

bladder. It surrounds the urethra - the tube that carries urine during

urination and semen during ejaculation.

Prostate cancer is the growth of abnormal cells in the prostate gland.

Prostate cancer is one of the most common types of cancer in men.

Normally, cancerous cells grow very fast. However, prostate cancer grows

slowly and, initially, remains within the prostate gland.

If prostate cancer is detected while it is within the prostate gland, treatment

can often be fast and most effective.

The prostate starts developing before birth and continues to grow until

adulthood, due to male hormones or androgens. This gland produces the

seminal fluid that nourishes and transports sperm.

The growth of prostate cancer may be very slow. As its early development

does not have any signs or cause major problems for a while, maybe years,

and detection can be difficult, it is often detected very late.

Normally, prostate cancer has hardly any symptoms. Diagnosis is often

through routine checkups. In cases of benign prostatic hypertrophy,

symptoms that may be present include:

increased urination, with greater frequency at night

blood in the urine

difficulty starting and maintaining a steady stream of urine, and

painful urination.

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Occurrence of prostate cancer can affect your sexual function with painful

ejaculation or difficulty achieving erection. The mixing of prostate gland

secretions and semen may cause problems during sexual intercourse.

Advanced prostate cancer is the stage where it spreads to other body parts.

Prostate cancer in the spinal cord could compress the spinal cord. This could

cause additional symptoms like vertebral pain and pain in the bones of the

pelvis and ribs, and maybe fecal and urinary incontinence and extreme

weakness in the patient’s legs.

Types of Prostate Cancer

Prostate cancer is cancer of the cells of the prostate gland. There are

different types of cells within the prostate gland.

The most common form of prostate cancer is adenocarcinoma, cancer of the

glandular tissue of prostate gland. Around 95% of prostate cancer is

adenocarcinoma. This cancer is at the surface of the prostate and can be felt

through a digital rectal examination.

More rarely, prostate cancer occurs in the tissue surrounding the prostate

gland. These types of prostate cancer include leiomyosarcoma and

rhabdomyosarcoma.

Another type of prostate cancer can come from an abnormal change in the

prostate cells, which later turn malignant. This is prostatic intraepithelial

neoplasia or PIN.

In advanced stages, prostate cancer can spread to surrounding tissue and

fatty cells, the neck of the bladder, seminal vesicles or to lymph nodes in the

pelvic region.

Sometimes it could also spread to the bones of pelvis, spine, chest and hip.

Stages of Prostate Cancer

There are two main stages of prostate cancer. These are clinical staging and

pathological staging.

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"Dealing with Prostate Cancer" by N Falconer Page 11 of 69

Doctors conduct a digital rectal examination (DRE) and provide information

about the status of prostate cancer. This is clinical staging.

Doctors usually conduct a more thorough examination after removal of the

prostate or the lymph nodes. This helps doctors deliver an accurate

prognosis. This is pathological staging.

Staging refers to the evaluation of the current stage that the cancer is at

and whether it is likely, at its present stage, to travel to other parts of the

body. Doctors do this staging in consultation with the pathologist that

examines the sample(s).

Gradation of prostate cancer is according to the TNM system.

The T refers to tumor, N refers to lymph node and the M refers to metastasis (the process by which a cancer spreads to different parts of the

body).

T1 and T2 indicate early stages of cancer.

T3 and T4 indicate advanced stages.

The notation N indicates metastasis to the lymph nodes and M indicates

distant metastasis.

Doctors use a complex form of prostate cancer staging. Staging of prostate

cancer is essential to detect the spread of prostate cancer and about how

much it has affected other body organs.

The course of treatment for prostate cancer depends on these findings.

Therefore, doctors use blood and imaging tests to detect location and spread

of prostate cancer.

Doctors use either the Roman numbers I to IV or the letters A to D. The

stages are:

Stage I (A) prostate cancer: The cancer is too small and cannot be felt by

digital rectal examination. The cancer has not spread. Detection of prostate

cancer might occur during surgery for another reason.

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"Dealing with Prostate Cancer" by N Falconer Page 12 of 69

Stage II (B) prostate cancer: The cancerous growth is felt by digital

rectal examination. However, it is within the prostate and it has not spread.

Detection could be during a biopsy done due to high PSA level.

Stage III (C) prostate cancer: The cancer has spread outside the

prostate to nearby tissues.

Stage IV (D) prostate cancer: The cancer has spread to lymph nodes

and/or to other body parts.

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"Dealing with Prostate Cancer" by N Falconer Page 13 of 69

Who Gets Prostate Cancer?

There is no conclusive evidence to suggest that a specific factor is the main

cause for prostate cancer. However, there are certain risk factors. Some of

these risk factors like diet and gaining weight can be controlled. Yet, family

history, genetics, and race factors cannot be controlled or changed. Again,

having a risk factor does not necessarily mean you will develop prostate

cancer. Some men with many risk factors do not ever develop prostate

cancer while some men with very few risk factors develop prostate cancer.

Predisposing Factors for Prostate Cancer

Every man is susceptible to prostate cancer. As the prostate gland is

exclusive to the male reproductive system, this cancer affects only men. One

in every six men could develop prostate cancer. However, only one in every

thirty-four could die of it. Age is another contributing factor. Men over the

age of sixty to eighty have the highest incidence of prostate cancer. It

seldom affects men below the age of forty-five.

Prostate cancer is presently the most common cancer among American men.

It is also the second most important cause for death among American men.

The trend is predicted to increase with increase in population. Prostate

cancer is fast becoming a major public health problem in the United States.

Some men are at a higher risk of contracting prostate cancer.

There are various predisposing factors for the occurrence of prostate cancer

like race, genetics, family history, and many others. These factors may

contribute to the incidence and development of the disease, either

individually or collectively.

Age: This is by far the most important factor for development of prostate

cancer. This cancer is most common in men from the age of fifty to sixty.

The highest incidence is among men aged sixty-five. Prostate cancer, in

comparison to other cancers, increases faster with age although no specific

reason has been found.

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As the average mortality rate increases, there is every possibility of more

cases of prostate cancer coming to the fore in the coming decades.

The aging process causes various biochemical reactions which may

encourage abnormal cell growth.

Autopsy studies from different countries indicate that 15% to 30% of men

older than 50 years have histological evidence of prostate cancer. Hence, by

the age of eighty, around 60% to 70% of men depict carcinoma at autopsy.

But, more elderly men die of other causes, while only about 3% die of

prostate cancer.

Heredity: Heredity is believed to have a direct influence over the occurrence of prostate cancer. If your father or brother has been clinically diagnosed

with prostate cancer, chances of you developing it are more than three times

the average.

You could even contract the cancer in your youth. This factor may be more

important if your close relatives developed prostate cancer by the age of

sixty or if more than one male family member has had this disease.

Another indicator may be that if female family members have had breast

cancer, you may have a higher risk than average of developing prostate

cancer sometime in your life. The onset of prostate cancer is quite early in

such cases in comparison to the normal onset of the disease.

Men as young as forty can develop prostate cancer if their direct relatives

have had it.

(III) Genetics: Studies have indicated the presence of various genes that

increase prostate cancer risks. Genetic factors account for five to ten percent

of the total prostate cancer cases. Very recent reports as of 11 Feb, 2008

indicate a major genetic breakthrough into the cause of prostate cancer.

Australian and British scientists have discovered seven areas in human

genome that could offer linkage to prostate cancer.

Dr. Ros Eeles has studied the genetic make-up of more than 10,000 men and

has concluded that a specific gene, MSMB, could prove helpful in the

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"Dealing with Prostate Cancer" by N Falconer Page 15 of 69

detection and screening of prostate cancer. Gene LMTK2 from another

genome can provide deeper insight into better treatment options. Although

these recent findings can offer a better approach into the occurrence and

treatment options of prostate cancer, it would definitely take many years for

these treatments to materialize and be available for use.

Clearly various genetic events help in the growth and development of a fully

malignant prostate cancer cell. The initiation event occurs at the same rate

independent of race or place of birth. This explains the differences in the rate

of promotion or progression of prostate cancer among Japanese and

American men although the initiation rate could be the same.

Genetics: Genetic defects could cause prostate cancer. Scientists are

investigating certain genes like Hereditary Prostate Cancer Genes 1 and 2

(HPC1, HPC2) and HPCX. It is also held that genetically caused prostate

cancer is different from that caused due to other factors. If women in your

family develop breast cancer by the age of forty, it indicates certain genetic

flaws. Such faulty genes could cause prostate cancer among male members

of your family. Only 5% to 10% of cases could be due to an inherited altered

gene running in the family.

Obesity: Obese men have a higher risk of getting prostate cancer. Rather,

obese men record a higher incidence of advanced prostate cancer and often

die of it. Regular physical exercise and high levels of physical activity can

lower the risk of advanced prostate cancer.

Inflammation of the Prostate: Inflammation of the prostate gland could

cause prostatitis. In some cases, sexually transmitted infections can increase

the risk of prostate cancer.

Ethnic groups: People belonging to some specific race may show increased

incidence of the disease while some other races show lower occurrences.

African-American men show higher incidence of prostate cancer while its

incidence is less among Asian-American and Hispanic or Latino men.

Non-Hispanic whites and African-Caribbean men may also have an increased

risk of prostate cancer.

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Prostate cancer is more common in America and north-western Europe and

less common in China, India, and Japan. Scandinavian men report higher

rates of prostate cancer than Asian men do.

The incidence of prostate cancer is highest among Blacks and the lowest

among Asians.

Japanese and Africans living in their native countries seem to have a very low

incidence of prostate cancer.

African-American men have a higher incidence of prostate cancer than do

black men in Africa or Asia.

However, the other races show a tendency to develop prostate cancer once

they immigrate to the United States. There is no specific reason to explain

this occurrence. Some theories suggest the influence of environmental

factors, socio-economic factors, diet, and lifestyles.

Diet: Prostate cancer occurs more in countries with a staple food of meat

and dairy products than in countries with a staple food of rice, vegetables,

and soybean products. Research also indicates that high dietary fat could be

a major contributing factor for prostate cancer.

Fruits and vegetables contain antioxidant lycopene in high levels. Studies

indicate that presence of lycopene reduces risks of prostate cancer.

Suggested vegetables and fruits include tomatoes, watermelon, and pink

grapefruit.

High fat content, specifically animal fat, in diets is the primary cause for

prostate cancer. Consuming fiber-rich food, and a daily intake of lots of

yellow and green colored vegetables, consumption of beans, lentils, peas,

tomatoes, raisins, dates, and dried fruit can reduce prostate cancer risks

substantially. However, the relationship between prostate cancer and dietary

factors is very complex.

Men who consume lots of red meat and dairy products may have a greater

risk of prostate cancer. Normally, men consuming such a diet eat more dairy

products and less vegetables and fruits.

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Consuming a diet rich in vegetables, whole grains, soy, fish, nuts, and seeds

is claimed by some to lower the risk of prostate cancer.

Smoking is another risk factor for prostate cancer. Inhaling of toxic

substances and tobacco may affect the chance of getting prostate cancer.

Cadmium Exposure: Exposure to heavy metals like cadmium is also

believed to be a risk factor for prostate cancer.

This mineral is normally found in alkaline batteries and cigarette smoke.

People in the welding and electroplating occupations are exposed to high

cadmium levels. Cadmium in combination with zinc poses a high risk for

prostate cancer.

The element zinc is present in multiple intracellular metabolic pathways. The

prostate also contains high amounts of zinc. Several enzymes like

polymerases require zinc to function properly. Such combinations may prove

to be a major factor for an increased risk of prostate cancer, although there

is no conclusive medical evidences to support this currently.

Exercise: A sedentary lifestyle due to technological advances and increased

economic and monetary power could be a possible cause for prostate cancer.

If it does not have a direct relation, it may still contribute to increasing your

risk.

That sedentary lifestyle restricts movements and your body slackens due to

absence of any exercise. This in turn causes various changes in hormone and

chemical balances in your body. This could reflect on your prostate gland and

might encourage the growth of cancerous cells.

If you have a sedentary lifestyle with no physical exercise, you may have a

higher chance of contracting prostate cancer.

Regular physical exercise is essential for everyone.

Vasectomy: Observations suggest that vasectomized men report higher

incidences of prostate cancer. Vasectomized men have higher levels of

circulating testosterone. Further, these men have undergone vasectomy one

or two decades before detection of prostate cancer. Therefore, increased

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"Dealing with Prostate Cancer" by N Falconer Page 18 of 69

hormone levels due to a vasectomy might be the cause for prostate cancer in

elderly men. There are conflicting reports on the relation between a

vasectomy and prostate cancer.

Testosterone: High levels of testosterone may fuel the occurrence of

prostate cancer. It does not cause prostate cancer directly, but it may help

the development of existing prostate cancer.

This is the male hormone produced by testicles. Although this hormone does

not directly cause prostate cancer, it could influence the occurrence of

prostate cancer largely. High levels of such hormones are an increased risk.

However, there is no conclusive evidence and scientists are researching into

the possibilities.

Hormones: Dietary factors influence secretion of body hormones. Low-fat

and high-fiber diets affect the male sex hormone metabolism by decreasing

circulating testosterone. Testosterone is essential for growth of normal

prostate epithelium. Rather, early prostate cancer is endocrine dependent.

Research and studies show that young African-American men have 15%

higher serum testosterone levels than their white counterparts. Similarly,

American men have higher levels of the sex hormone binding globulin than

their Japanese counterparts do. These enzymes are responsible for mitotic

activity of the prostate.

A vegetarian diet reduces plasma testosterone levels substantially. This can

be one of the major reasons for the low incidence of prostate cancer among

vegetarian men.

BPH and hormonal activity: The prostate gland develops before birth and

continues to grow until adulthood. This growth is due to male hormones or

androgens. Low hormone levels restrict the growth of the prostate gland.

In some cases, this gland continues to grow even in old men. This causes

benign prostatic hyperplasia or BPH. This could cause problems with

urination. BPH causes extensive changes in the prostate gland and could

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"Dealing with Prostate Cancer" by N Falconer Page 19 of 69

restrict urinary outflow when the urine remains within the bladder and could

cause cystitis.

With age, hormone levels fall and this causes imbalance in androgen and

estrogen levels. Levels of dihydrotestosterone, the main prostatic

intracellular androgen, increase and this could cause inflammation, leading to

prostate cancer.

Infections: More than eighty percent of prostate cancer cases are due to

infection by Escherichia coli. Other causes for infection include Proteus,

Klebsiella, Pseudomonas, Enterobacter, Staphylococcus, or Streptococcus.

These organisms enter the prostate through the bloodstream or through

urethral infection. Sometimes, excessive or very infrequent sexual

intercourse, catheterization, or cystoscopy could cause infections leading to

prostate cancer.

Overall Analysis

Prostate cancer is affected by a combination of factors. Some of these factors

could play a major role.

The factors in play include genetic, environmental, and epigenetic events.

The interrelation and interaction between these factors is important to

research for the better treatment and possible prevention of prostate cancer.

Androgen levels in a man are the effects of interrelations and combinations of

various genes like testosterone, sex hormone binding globulin, and estrogen,

with environmental influences like those of zinc and cadmium. Dietary factors

also play a major role. Again, diet and hormones have a direct bearing and

provide important clues about the development of prostate cancer.

Presently, various universities and cancer societies are undertaking many

experiments. Different men are screened for prostate cancer and their

findings will offer ample guidance. This will enable doctors and scientists to

clarify the relationship between histologic and clinically evident prostate

cancer. It will also help many men to be available for early detection of

prostate cancer.

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"Dealing with Prostate Cancer" by N Falconer Page 20 of 69

Diagnosis

Undergoing screening processes, like a digital rectal examination or prostate-

specific antigen tests, when approaching the age of forty is a good preventive

measure.

The positive aspect is that newer screening procedures, deeper and extensive

research, and growing public awareness have been able to offer a wider

perspective of prostate cancer and educate people about the possibilities and

strategies of disease prevention and better treatment options.

Diagnosis of prostate cancer is through screening of blood tests and/or

through physical examination.

Biopsy, Cystoscopy, and Transrectal ultrasonography are the recommended

tests to diagnose prostate cancer.

Normally, biopsy of the prostate involves removal of a piece of the prostate

and examining it under the microscope.

Prostate biopsy is done in the outpatient department and does not require

any hospitalization. A biopsy gun inserts and removes special hollow-core

needles in less than a second. Normally, there would be around three to six

on each side of the prostate. Men report a little discomfort during a prostate

biopsy.

Cystoscopy is the insertion of a thin, flexible camera tube down the urethra.

It shows the interior of the urethra. Transrectal ultrasonography uses sound

waves to create a picture of the prostate from a probe in the rectum.

Scientists have reported in April 2007 that a new blood test that can detect the presence of a prostate cancer antigen-2 (EPCA-2) in the early stages. It

may indicate the presence and intensity of prostate cancer.

X-rays and bone scans can also detect the spread of prostate cancer into the

bones.

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"Dealing with Prostate Cancer" by N Falconer Page 21 of 69

How is Prostate Cancer Diagnosed?

Prostate cancer does not show any exact symptoms. Detection of prostate

cancer is often through routine screening, or while undergoing tests for any

other ailment.

Men that have relatives with prostate cancer and all other men over the age

of fifty should have prostate cancer screenings.

Doctors would normally question you regarding your ailments; specifically

genital or urinary diseases. They could question you about changes in the

pattern of urinating, including frequency, and if other family members have

any history of prostate cancer.

It is not essential to conduct all the available tests for diagnosis of prostate

cancer.

Doctors would normally suggest various tests and inform you of all the

advantages and disadvantages of these tests.

Doctors commonly use two tests in the initial stages for their patients who

have not shown any symptoms, to detect prostate cancer.

These are the digital rectal examination and prostate-specific antigen

tests. These two tests in combination can provide some clues about prostate

cancer, although it is not always conclusive.

Prostate Cancer Diagnosis Tests

Tests for prostate cancer diagnosis include:

PSA test: PSA refers to the prostate-specific antigen test. This test

measures levels of a specific protein made by the prostate and present in the

blood. Men with prostate cancer report high levels of this protein in their

blood.

The prostate specific antigen is a normal secretion of the cells of the prostate

gland. This is mainly found in the semen. A very small amount is also found

in the blood.

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All PSA results are in nanograms per milliliter or ng/ml. A PSA count of 0 to 4

ng/ml is normal or below normal. In some men, this could be the normal

level.

A PSA count of 4 to 10 ng/ml is a little above normal.

A PSA count of 10 to 20 ng/ml is slightly above normal, while anything above

20 ng/ml is seen as a very high level.

Sometimes, men with prostate cancer portray normal PSA levels. Normal PSA

levels are not the same for all men.

Normal levels of PSA in the blood are under 4 nanograms per milliliter. If

there is cancerous growth in your prostate gland, this level goes beyond 4.

If the PSA level in your blood is between 4 and 10, chances of you having

prostate cancer is 1 in 4.

If it is more than 10, chances of prostate cancer are more than fifty percent

and this could further increase.

The normal PSA level for men aged between fifty and fifty-nine is about 3

nanograms per milliliter of blood or lower.

A PSA of 4 nanograms per milliliter of blood or lower is considered normal for

men aged between sixty and sixty-nine.

Men aged 70 or more usually have a normal PSA level of 5 nanograms.

PSA levels of more than five indicate that further tests for prostate cancer

are warranted.

Various factors other than prostate cancer can cause fluctuating or high PSA

levels. These factors might include non-cancerous enlargement of the

prostate or BPH, advancing age, infection, and inflammation of the prostate

and certain medications like finasteride or dutasteride, urine infections,

inflammation, using a urinary catheter, recent prostate biopsies, prostatic

massage, and prostate or bladder surgery.

Doctors may consider other factors and suggest a re-examination after a

certain period to check if the PSA level has fallen. If PSA levels continue to

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rise, doctors would suggest other diagnostic tests to possibly detect the

presence of prostate cancer.

High PSA levels might indicate the existence of prostate cancer. Once you

undergo prostate cancer treatments, your PSA levels would fall.

The PSA test is also used for measuring any progress of the prostate cancer

and the effectiveness of your treatment.

Doctors normally recommend a baseline of the age of forty-five for PSA tests.

They further recommend yearly screenings for all men over the age of fifty.

These screenings are all the more important and essential if there are any

cases of prostate cancer, or any other form of cancer, in your family.

An indicator of prostate cancer is the amount of PSA present as blood

proteins and as a free circulation. The percent-free PSA test indicates the

amount of free-moving PSA in the blood. If the amount of free-moving PSA is

high, it indicates the presence of prostate cancer.

Normally, the percentage of free circulating PSA is lower in men with

prostate cancer. Doctors suggest this test if your PSA results are within the

border level. If your PSA test is within 4, 10, and you have a lower percent-

free PSA, prostate cancer chances are high, and it is best to go for a biopsy.

However, this is not yet available everywhere.

The PSA test has its own limitations. Prostate cancer grows at a very slow

pace. Therefore, coming to conclusions based on PSA tests cannot offer any

discrete solution. Some men could record high PSA levels and undergo

treatment for prostate cancer, although their cancer may not actually

advance to such alarming levels. This is because PSA does not indicate the

extent of aggressiveness of prostate cancer. Undergoing treatments like

radiation and surgery have their own side effects and discomfort.

You should take this test in combination with other tests.

(II) Digital rectal examination (DRE): The prostate gland is just behind

the rectum. Doctors insert a gloved and lubricated finger through the rectum

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to feel for any bumps or hard surfaces suggesting growth of prostate cancer.

This test takes little time and is not painful although a bit uncomfortable.

This suggests the existence of prostate cancer. An enlarged prostate will

remain smooth to touch and therefore does not indicate prostate cancer. This

process may not be painful but it is quite uncomfortable.

A DRE alone cannot deliver conclusive results on prostate cancer, even less

than a PSA test. In many cases, the prostate may feel smooth even in the

presence of prostate cancer. But, it can sometimes detect prostate cancer in

men with normal PSA levels.

The DRE test should be used in combination with PSA and other tests to

confirm prostate cancer diagnosis. However, medical experts are of the

opinion that men over the age of fifty should undergo regular PSA and DRE

tests.

The DRE test is best for detecting the extent to which prostate cancer has

spread to nearby tissues in men diagnosed with prostate cancer.

Accurate early detection of prostate cancer is difficult. Undergoing tests for

detection of prostate cancer is therefore very subjective. You should discuss

with your doctor and consider all possible pros and cons. You should consider

your general health, age, family history, lifestyle and similar associated

factors that could offer a deeper insight into the possibility of prostate

cancer.

Young men with prostate cancer should undergo proper treatment as the

cancer could assume alarming ratios as you age. However, if prostate cancer

is detected in elderly men, there is no great need to undergo serious tests,

as prostate cancer grows very slowly and chances of it assuming alarming

ratios is minimal. Most major medical organizations do not support regular

screening and testing for prostate cancer.

(III) MRI Scan: This is magnetic resonance imaging scan. This scan

produces a computerized image of the prostate with the help of magnetic

fields.

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This image shows a detailed cross-sectional picture of the entire prostate

gland. This helps doctors study and understand the image to detect

irregularities or the extent of growth of cells within the prostate gland.

(IV) Trans-Rectal Ultrasound: This detection method uses sound waves to

detect irregularities in the prostate. Doctors use high frequency sound waves

by passing a sensor over the body surface. This produces a computerized

image.

Doctors may use Transrectal ultrasonography tests to detect prostate cancer.

This requires insertion of a tube or a probe into the rectum. This produces a

good image of the prostate on the screen for complete diagnosis.

This scan can measure size and density of the prostate. The probe would also

collect a sample of the prostate for detailed diagnosis under a microscope.

Although the scanning process is complete within few minutes, it is

uncomfortable.

(V) CT Scan: CT scan refers to computed tomography scan. This is a

sophisticated x-ray with the help of a computer and rotating x-ray beams.

These produce images of soft tissue, bone and blood vessels. These x-rays

also show any areas of dense tissue that might suggest the existence of

prostate cancer.

(VI) Biopsy: This is a very accurate test to detect the existence of prostate

cancer. Doctors take around ten samples of your prostate tissue with the

help of a thin needle. They later examine it under the microscope to detect if

the tissue is cancerous.

Some doctors conduct a biopsy of the prostate through the perineum. The

perineum is the skin between the rectum and the scrotum. The doctor would

place a finger into the rectum to feel the prostate and insert the biopsy

needle through a small incision in the perineum. The procedure involves the

passing of a needle through the rectum into the prostate.

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Doctors give a local anesthetic, as the process is normally painful and very

uncomfortable. They additionally prescribe antibiotics to prevent any possible

infection.

Normally, a biopsy takes only fifteen minutes and can be done within the

doctor’s office. You should drink plenty of fluids over the next twenty-four

hours. You could experience bleeding in your urine, bowels or in semen after

sexual intercourse for a few days after a biopsy for prostate cancer.

Although a biopsy is more effective in detecting prostate cancer than most

other tests, it may not deliver exact results in 5% to 10% of cases. The

biopsy may not detect the presence of prostate cancer if the needles do not

pass through them. Doctors might suggest a second or a repeat biopsy if

results are negative while other factors indicate prostate cancer.

Biopsy results from your pathologist provide various clues as to the extent of

your prostate cancer. The number of biopsy core samples could indicate the

extent of your cancer.

The percentage of cancer in the core samples can indicate the

aggressiveness or intensity of the disease. It also indicates the location of

prostate cancer.

(VII) Bone scan: Prostate cancer, in advanced stages, can spread to

bones; specifically those of the spinal cord, thighs and legs.

You would then experience lot of pain in your thighs, legs and back.

Doctors may conduct a bone scan to detect if your prostate cancer has

spread to the bones.

For a bone scan, doctors inject a small amount of a radioactive substance

into a blood vessel. This substance passes through the blood and collects in

the bones. A scanner detects radiation levels. The scanner also takes

pictures of the bones or depicts them on a computer screen. These images

and radiation levels can help doctors assess the presence and extent of

prostate cancer in the bones.

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Gradation of Prostate Cancer

Tests cannot completely determine or provide conclusive evidence of prostate

cancer.

Prostate cancer investigation requires staging and gradation processes to

show its intensity and the extent of its spread within your body.

Gradation: Pathologists use terms like low, medium, or high grade to

describe prostate cancer findings. They use a specific system, popularly

known as the Gleason system.

This system uses scores of 2 to 10 to indicate the extent of prostate cancer.

Grade 1 refers to the cancerous tissue as being similar to prostate gland

tissue; the chance of prostate cancer is nil.

If prostate gland tissue features are available as a random basis across the

prostate, it is a grade 5 tumor.

The Gleason score is the total of all the stages.

Another system involves gradation of G1 through G4. A higher score refers to

high-grade tumors or cancerous growth. Normally, high-grade tumors grow

faster and spread more than low-grade tumors.

Staging: Staging refers to the extent of prostate cancer. Staging normally

refers to the location and spread of prostate cancer. Stage I and II refers to

localized occurrences; your prostate cancer has probably not spread outside

the prostate gland.

Stage III refers to the locally advanced form of the disease. Your prostate

cancer could be outside the gland and may be in the seminal vesicles.

Stage IV means the cancer has spread beyond the seminal vesicles to lymph

nodes and/or to other tissues or organs.

Medical communities are divided over the beneficial effects of prostate cancer

screening. Those advocating regular screening believe that early detection of

prostate cancer can offer better treatment options and fewer side effects.

However, another section feels that prostate cancer grows very slowly and

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does not cause immediate problems. Therefore, treatment procedures should

be according to your age and other associated factors.

Is It Possible to Find Prostate Cancer Early?

Early detection tests for prostate cancer became common since the nineties.

Such tests include prostate-specific antigen or PSA test and digital rectal

exam or DRE test. These tests can detect prostate cancer in the early stages.

However, they have specific limitations and hence, results are not always

dependable and accurate.

The American Cancer Society (ACS) urges and recommends doctors to advise

all men over the age of fifty to undergo PSA and DRE tests every year. It

further recommends that men with higher risk like African-Americans or men

having first-degree relatives with prostate cancer, undergo these tests from

the age of forty-five.

Rather, such men could have their first test at the age of forty. You can

decide on further tests depending on the results of the initial test. Doctors

and health professionals should offer and allow open discussion of the

possibilities of prostate cancer, benefits of early detection, and treatment

options.

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Signs and Symptoms of Prostate Cancer

Prostate cancer has very few signs or symptoms in the early stages. Early

detection of this cancer is rather difficult. Often, you get to know of the

existence of prostate cancer when you go for any other medical checkup like

a digital rectal examination (DRE) or prostate-specific antigen (PSA) tests.

Prostate cancer treatments can cause various side effects like erectile

dysfunction or impotence, or bladder control problems, etc.

As you age, the prostate gland enlarges and causes blockage against the

urinary bladder or urethra. This is benign prostatic hyperplasia or BPH. BPH

is not cancer; however, signs and symptoms of BPH are similar to those of

prostate cancer. You need to undergo a thorough medical check-up and

testing to confirm the exact diagnosis of your ailment.

Growth of the prostate is not always linked to prostate cancer. Some men

experience continued prostate growth. Although this could cause urinary

problems, it may not be indicative of prostate cancer. This non-cancerous

growth of the prostate is not a cause for worry.

You may not experience any symptoms at all. Signs and symptoms of

prostate cancer depend on the extent and spread of prostate cancer.

Signs and symptoms for prostate cancer may include:

Frequent urination: You experience the need to urinate very frequently.

This feeling is intensified specifically at night. You may wake up many times

to visit the toilet.

Incontinence: Urinary incontinence is your inability to control the urge to

urinate. Often, this causes accidents, as you are unable to reach the

bathroom in time to urinate.

Difficulty starting urination: Growth of the prostate gland often causes

difficulties in starting urination. This growth stresses on the urethra and

constricts it. This is the cause for difficulty in starting urination. Further, it

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also causes difficulty in maintaining the urine stream. Sometimes, you pass

blood in your urine.

Discomfort during urination: You may feel uncomfortable or encounter

pain or a burning sensation during urination. This condition is dysuria.

Although this is not a very common symptom of prostate cancer, it is present

in a few cases. However, this is predominant in benign prostatic hyperplasia.

You would often feel you are unable to empty the bladder completely.

Painful erections and ejaculations: Growth or enlargement of the

prostate gland affects blood flow into the penis. You may have trouble

having erections or they may be less rigid. Constriction of the urethra

narrows down the ejaculation channel. Therefore, passage of semen during

ejaculation is narrowed and forced. This is the reason for pain during

ejaculation.

Impotence: Impotence is the inability to have a satisfactory erection for

penetration during intercourse. Sudden occurrence of impotence may be a

symptom of the presence of prostate cancer.

There could also be less semen during ejaculation as prostatic disease affects

the flow of ejaculatory fluid produced by the prostate gland and seminal

vesicles.

Blood in the semen: This condition is Hematospermia. The blood in the

semen would not be visible to the naked eye.

Urinary Infections: Constriction of urethra by prostate gland could cause

formation of cystitis. This leads to urinary infections.

Advanced prostate cancer may cause these specific symptoms:

Pain in the lower back and spinal regions: As prostate cancer spreads, it

can cause cancerous growth of cells in other body parts. This growth could

extend to the bones of the pelvic and spinal region. This gives rise to severe

pain in these regions.

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Numbness and pain in legs and thighs: Prostate cancer causes severe

pain and a numb feeling in the thighs and legs. You may suddenly not be

able to move your legs. It could also cause swelling of the legs.

Sudden inability to pass urine: This symptom appears from nowhere. You

are unable to pass urine. However, you do not experience any pain.

Bone fractures: Prostate cancer advances into the bone tissue and makes

them weak and vulnerable to frequent fractures. Bone pain remains intense.

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Treatment

Treatment options for prostate cancer include radiation therapy, surgery,

hormonal therapy, proton therapy, chemotherapy, or a combination of all

these.

As prostate cancer is normally a disease of elderly men, many die of other

causes rather than prostate cancer.

Surgical removal of the prostate is a treatment option if prostate cancer is in

the early stages, or if radiation therapy does not bring any results.

Response to initial treatments is often the main determining factor for the

outcome of the disease.

Doctors often debate whether to treat localized prostate cancer. They must

judge the beneficial and harmful effects of prostate cancer treatments and

how they could affect your survival chances and the quality of life.

Your diet also plays an important role in development of prostate cancer. A

diet rich in red meat, fatty substances and dairy products may encourage the

development of prostate cancer.

Some claim that a generous intake of vegetables and fruits may lower the

incidence of prostate cancer.

Green leafy vegetables and tomatoes are recommended.

Tomatoes and tomato products contain high levels of lycopene which may

help to protect against prostate cancer.

Lycopene is a chemical occurring naturally in tomatoes, watermelons, pink

grapefruits, papaya, and guava. Cooked tomatoes are more effective as

cooking releases this chemical from their storage spots and helps in easy

absorption.

Low intake of omega-3 fatty acids (found in fatty fishes like salmon),

insufficient intake of vitamin E (present in green, leafy vegetables) and the

mineral selenium may increase the risk of prostate cancer.

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Insufficient exposure to ultraviolet (UV) light lowers the vitamin D content in

the body which may increase the risk of prostate cancer.

Certain medications may also lower the risk of prostate cancer. Daily use of

anti-inflammatory medicines like: aspirin, ibuprofen, or naproxen, and

cholesterol-lowering drugs like statins are believed by some to possibly

decrease the risk of prostate cancer.

Frequent ejaculation can decrease prostate cancer risks.

Infections and inflammation of the prostate gland are very high-risk factors

for prostate cancer.

Sexually transmitted infections, like chlamydia, gonorrhea, or syphilis,

increase the risk of prostate cancer.

Obesity and high levels of testosterone in the blood may pose higher risks of

prostate cancer.

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Treatment Options for Prostate Cancer