Ask Dr. Noordin
Prostate Cancer

Dear Dr. Noordin,
I am male aged 48. I would like to get more information about prostate cancer which is the most common cancer among men, after skin cancer. This is because my relative is having this problem. I hope you can provide the information about who are the people at high risk to get this cancer and the latest treatment available for prostate cancer patients. Please assist.

Thank you.
William of Kuching

Dear William,

The prostate is a gland about the size of a walnut that is situated below the urinary bladder and in front of the rectum. The urethra (a long tube that carries urine out of the body) passes through the prostate.

The prostate gland produces a fluid that serves as the vehicle for sperm. Although there will be implications if the prostate gland is removed, it is not an essential organ and the body can function without it.

Many men, especially as they age, are affected by an overgrowth of prostate tissue. At times, this tissue overgrowth is benign, meaning that the cells do not contain cancer. This prostate condition is called BPH or benign prostatic hypertrophy. Other times, abnormal cancerous cells characterize the overgrowth of tissue and this is referred to as a malignancy or cancer of the prostate.

Early prostate cancer often has no warning signs. Since there is no known cure for the disease early detection is our best bet for increasing the life expectancy of those men who develop the disease.


Who is at risk?
Researchers still do not know what causes prostate cancer. They have however been able to identify risk factors (something that increases the likelihood of developing the disease) that have consistently been associated with prostate cancer. The role that some of the identified risk factors play in the development of prostate cancer is less clear, because research studies have provided conflicting results in some areas.

Age: After age 50 the chance of developing prostate cancer begins to increase. Over 80% of all prostate cancers occur in men 65 years and older.

Race: Prostate cancer is twice as prevalent among African-American males as it is among their white American counterparts.

Ethnicity: Prostate cancer is most common in North America and northwestern Europe. It occurs less frequently in Asia, Africa, Central America and South America.

Diet: The results of most studies show that men who eat a high fat diet have an increased chance of developing prostate cancer. Some research has shown that men who eat higher fat diets tend to eat less fruits and vegetabies and more dairy products. These factors may also play a part in the development of prostate cancer.

Recent studies have shown that a diet high in lycopenes (found in higher levels in fruits and vegetabies) and selenium may lower the risk of developing prostate cancer'

Exercise: Maintaining a healthy weight along with regular physicai activity may reduce the risk of prostate cancer.

Family History: Prostate cancer appears to have a genetic link. Having a father or brother with the disease doubles a man's risk of developing it. The risk gets even higher if several relatives have been affected, especialiy if they were young at the time of diagnosis. The recent discovery of the HPC1 gene will soon give more information about the inherited risk of prostate cancer. Tests to find abnormal prostate cancer genes may one day become available to help identify men at increased risk ,for developing prostate cancer,


How is Prostate Cancer treated?

Many options are-available to treat prostate cancer. The treatment that will work best depends on several factors. These include your overall health status, age, and the grade and stage of the prostate cancer'when it is first diagnosed.

Take the time to;Tesearch all of your treatment options. Get a second opinion before making a final decision. The most common treatment options for prostate cancer includb watchful waiting, surgery, radiation, and hormone therapy.

Watchful Waiting
Since prostate cancer often grows very slowfy; older men who have the disease may not need treatment. Your physician may suggest taking a wait and see attitude. This course of treatment will involve periodic examinations to determine if the cancer has become more aggressive. If it does, active treatment can then be initiated. 

Surgical Treatments
Surgical treatment are used when the goal is to remove the cancer. A radical prostatectomy involves the removai of the e e prostate giand and surrounding tissue. This operAion is perfoimed oniy if the cancer is confined to th4o ostate gland itself. The surgery involves making an incision into the abdomen tb gain access to the prostate-gland. A urinary catheter will be in place after surgery so that urine can be drained from the body. The catheter is left in place for a few weeks. Once it is removed there may be problems with dribbling and incontinence. This usually improves over time and can sometimes be corrected with medication or other procedures. Impotence or the inability to sustain an erection may result after radical prostate surgery due to impairment of the nerves that control erection. This condition may also be temporary or in some cases permanent. Discuss these issues with your doctor before consenting to this type of treatment.

Transurethral resection of the prostate (TURP) is another surgical option that may be used for men who are not candidates for radical prostate surgery. During this procedure an instrument is inserted through the urethra and into the prostate where tissue is removed through cauterization. No incision is needed and a catheter will be left in place for a few days until any urinary bleeding resolves. Incontinence and impotence are not generally associated with a TURP. The surgery however will not cure the patient since the prostate gland is not removed.

Cryosurgery
Cryosurgery is a relatively new treatment for prostate cancer that involves killing the cancer cells through
freezing.

Radiation Therapy
Two types of radiation treatments can be used to treat prostate cancer. They involve external beam radiation,, which is similar to getting an x-ray. Treatments, given on a daily basis, last several minutes and the entire course of therapy may take six or seven weeks to complete.

Internal radiation uses radioactive pellets placed directly into the prostate gland. The pellets emit radiation for a few months and then are no longer active.

Radiation therapy does have side effects. Many patients complain of fatigue during the treatments. Others report gastrointestinal symptoms like diarrhea and nausea. Some patients may have difficulty with urination and maintaining erections.

Hormone Therapy
Since prostate cancer is dependent upon the male hormone testosterone to grow, reducing the amount of testosterone can cause the tumor to shrink or grow more siowly. Testosterone levels can be reduced through surgery to remove the testicles, since most testosterone is manufactured here. Hormone pills can also be given to reduce testosterone levels.

Hormone therapy is not a cure for prostate cancer but rather a way to slow its development. Hormone treatments may have side effects. They can cause infertility, decreased libido, hot flashes, and impotence.

Chemotherapy
The administration of cancer fighting drugs that kill cancer cells within the body is used only in cases of advanced prostate cancer when the disease has already spread to other organs. The goal of therapy is to reduce pain and hinder the tumor's growth.

Finally, below are the several developments in prostate cancer treatment.

HPC1 gene. Soientists have only recently discovered a gene called HPC1 that they hope will soon give additionai information about the inherited risk of prostate cancer. One day there may be tests available to identify men at high risk of developing prostate cancer. Screening procedures could then be implemented early on.

Angiogenesis. New drugs are being tested that may be able to halt the spread of prostate cancer by interfering with the tumor's blood supply.

Prostate Cancer Vaccines. Several types of vaccines that boost the body's immune response to prostate cancer cells are now being tested in clinical trials

Please take a positive action starting today and please remember monitoring your health situation now will help you to prevent the situation tomorrow.