Article - Prostate cancer: the silent killer
David Neiger reports on this life-threatening and all too common condition
According to the Prostate Cancer Foundation of Australia, around 10,000 Australian men will contract prostate cancer every year with more than 2600 dying as a consequence of this disease. To put this figure in perspective, prostate cancer is on par with breast cancer as a killer and is second only to lung cancer, yet the Federal Government spends ten times as much money on breast cancer research and prevention. Perhaps it is because this disease is truly the silent killer (with early stages of the disease being almost symptomless), or because men are more likely to 'tough out' any health problems, that this disease is largely ignored.
However, for men (and their partners) who care about their health, there are many things that can be done to minimise the risk of contracting this disease and to slow or even halt the growth of a tumour if detected.
The prostate is a small organ found only in males located under the bladder and in front of the bowel. It is donut-shaped and goes around the urethra which is the tube that allows urine to leave the bladder. A normal prostate is about the size of a walnut but it can be enlarged in older men, particularly after mid-life when a man's testosterone hormone level drops. The prostate plays an important role in breaking down testosterone and produces fluids that make up 25 per cent of the ejaculate (the creamy liquid containing sperm).
The first sign of prostate problems - when to see a doctor
Since the prostate surrounds the urethra, any enlargement of the gland can squeeze the urethra, a bit like putting a kink in the garden hose. As a consequence, men with enlarged prostates may find it difficult to urinate, have to wake at night to urinate but find that they can't, spend a long time trying to empty their bladders or find that when they do urinate, it's hard to stop. Some men with prostate problems find urination uncomfortable or have blood in the urine or semen. The enlarged prostate may also affect a man's sex drive by lowering the libido, making it difficult to sustain an erection, or causing pain when ejaculating.
Unfotunately, many men simply accept this is a natural consequence of growing old. Prostate problems are not just a 'wee problem', they are something that you need to discuss with your doctor as soon as you become aware of them.
How prostate cancer is detected
In many cases, prostate problems may be due to an inflammation of the prostate (prostatitis) or the cells of the prostate reproducing too rapidly causing an enlargement of the prostate, known as benign prostate hypertrophy or BPH. However, if the prostate cells turn cancerous and break out of the prostate, the cancer can spread to other parts of the body and the disease, known as prostate cancer, can become life threatening.
Symptoms alone are no guide as the early stages of prostate cancer may be symptomless. The only way to know if you have the disease is to have your doctor conduct a rectal examination (where the doctor puts a gloved finger up the rectum to feel for any abnormal growths on the prostate) and to order a PSA (prostate specific antigen) test which looks for an excessive amount of a certain protein in the blood.
According to Dr Paul Cozzi, urologist and senior lecturer in surgery at the University of NSW, the greatest risk factor for contracting prostate cancer is a family history of the disease: "With one male family member affected, the risk increase three times, and with two affected it is seven times the risk."
For these reasons, Cozzi advises that "since the symptoms of prostate problems are not associated with prostate cancer, men over 50 should see their GP and have a blood test and prostate examination annually, and for those with a positive family history of prostate cancer, screening should begin at 40". If the PSA test is positive, a biopsy is then performed to confirm whether, in fact, the growth is cancerous.
Depending upon the stage the disease is at, your specialist may decide to undertake one of three treatment options. If the cancer is detected early, is small and not aggressive, the specialist may decide to carefully monitor the tumour in the hope that it will not become problematic. This option is generally only available to older men since it is believed that ultimately the cancer will not be the person's cause of death, nevertheless ongoing monitoring is vital so that action can be taken if the situation changes.
If the disease has progressed, surgery, known as a radical prostatectomy may be performed to remove the tumour from the prostate gland and surrounding tissue. Like any surgery, there are risks and it does take around four to six weeks before full recovery from the operation. Since the prostate lies next to the nerves and blood vessels important for maintaining an erection and surrounds the urinary tube coming from the bladder, the surgery does carry a risk of impotence and either light or mild incontinence (urinary leakage).
Another treatment option is radiotherapy, which involves irradiating the tumour to prevent its growth. Since there is no surgery, this treatment is less stressful on the body and is often offered to older men. Erectile problems are generally less than after surgery. However, temporary bowel problems may occur during the treatment phase.
According to Cozzi, "Some of the newest forms of drug treatments are intermittent therapies which improve quality of life by reducing the side effects (osteoporosis, loss of libido)".
Darius Ignasiak, the Pharmacist In Charge at National Pharmacies, Middle Brighton in Victoria, describes how some of these drug therapies work. "There are hormonal treatments that are generally used after a diagnosis of prostate cancer or enlargement has been made to stop, minimise or prevent the growth of a tumour. Provided you treat the problem early on, these treatments are very effective because most prostate tumours are hormonally driven by testosterone."
Ignasiak outlines that basically "there are two types of medication available: prescribed medications from your specialist and other medications that can be used prophylactically to prevent potential prostate problems". The prescribed medications include "depot injections which the doctor will inject under your skin every three months or so ... Whereas another treatment involves taking oral doses of medications which oppose the actions of testosterone and are believed to reduce or halt the tumour growth:.
For men who want to help lower the risk of contracting the disease, "natural remedies may be used as a preventative measure and as soon as prostate problems appear". These remedies generally contain extracts of the saw palmetto berry, which may help to relieve the symptoms of an enlarged prostate.
Irrespective of treatment options, Ignasiak still implores men to go to the doctor regularly. "The biggest message I can promote as a pharmacist is that men go to the doctor at the first sign of prostate problems as this is the best way of diagnosing the early signs of cancer and other diseases."
The information supplied at National Pharmacies Online is not intended nor is it implied to be a substitute for medical advice. The information supplied is not intended to diagnose, cure or prevent any disease, ailment, treatment or condition
Associations and Further Information
Australian Prostate Navigator Site Map
A useful site to gain information on prostate health with links to various organisations and GP Information for a referral guide and patient information.
Your pharmacist can provide you with material to help you understand and gain the most from your medications. For more information, try:
- The Prostate Cancer Foundation of Australia - www.prostate.org
- The Mr PHIP project - www.prostatehealth.org.au
- The Cancer Council's help line is on 131 120 (local call) - ask for the booklet Localised prostate cancer - a guide for men and their families
- ABC Health Matters: www.abc.net.au/health/links/Links_All_ProstateCancer.htm
- NSW Health: http://www.health.nsw.gov.au/health-public-affairs/mhcs/publications/3075.html
- myDR: http://www.mydr.com.au/default.asp?Section=mens%60health
- Medline: http://www.ncbi.nlm.nih.gov/PubMed/
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