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Men's Health Month | From The Top

Fight Prostate Cancer Armed With the Facts

June 01, 1998|MARK KAWACHI, MD

Cardinal Roger M. Mahony last week disclosed that he has prostate cancer and will undergo surgery later this month.

Today, Dr. Mark Kawachi, director of the Prostate Cancer Center and a surgeon in the department of urologic oncology at City of Hope Cancer Center, writes about the most common cancer among American men.

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Prostate cancer will strike 185,000 men this year and kill 39,000.

Though staggering, these numbers are significantly lower than those of past years, indicating that the efforts of cancer researchers and others in the health care community are having a positive impact.

When dealing with prostate cancer, men should realize that knowledge is power. Armed with the facts about the disease, men can take measures to prevent the disease; have annual screenings that can lead to an early diagnosis; and if diagnosed, participate in selecting the treatment that is best for them.

What is Prostate Cancer?

The prostate gland is a chestnut-sized organ composed of glands and smooth muscle that wraps around the urethra (urine channel), between the bladder and rectum. During ejaculation, the smooth muscle contracts and squeezes a milky fluid produced by the glands into the urethra. There, the fluid mixes with sperm and other fluids to become semen. Prostate cancer is a malignancy of this organ.

Risk Factors

Age is one of the strongest indications of risk. Prostate cancer is a disease of older men--it is rare before age 50, and much more common by age 80. A man's actual lifetime probability of developing prostate cancer is about 8%.

Certain ethnic factors also play a role in risk. African American men have the world's highest incidence of prostate cancer, almost 66% higher than that of white men. Also, in general, prostate cancer is much more lethal in African American men. Men with a family history of prostate cancer may have more than five times the risk of developing the disease than the general population. The onset of the disease may also occur at an earlier age in men with a family history, and the disease often progresses to a more advanced stage before it is diagnosed.

Prevention and Early Detection

Diet and exercise are lifestyle habits that may have the greatest preventive benefits. Reducing the consumption of saturated fats and increasing the amount of dietary fiber have been shown to reduce the risk of developing prostate cancer. Other foods that may have preventive benefit include soy products, tomatoes, broccoli, cabbage, citrus fruits, parsley, cucumbers, squash, yams, eggplant, peppers, berries, whole grain cereals, nuts, vitamin A, vitamin D and nutritional supplements such as selenium. Moderate regular exercise has also been shown to reduce the risk of prostate cancer.

Early detection of the disease may help prevent serious consequences.

Annual digital rectal examinations (DREs) and Prostate Specific Antigen (PSA) blood tests are proven methods for detecting prostate cancer at an early stage. The American Cancer Society recommends that all men older than 40 have annual DREs.

In addition, men older than 50 with at least a 10-year life expectancy should have annual DREs and PSA blood tests. Men in a high-risk category, such as African American men, or men with a family history of the disease, should begin annual DREs and PSA blood tests at age 40.

Symptoms

Prostate cancer has no symptoms in the early stages when it is most curable, which is why early detection by a DRE and PSA blood test is vital. Frequent urination, nighttime urination, difficulty urinating, painful urination and blood in the urine are symptoms of advanced, possibly incurable, disease.

Treatment Options

Treatment options for prostate cancer vary widely, and new, more effective treatment regimens are always under investigation. It is important that patients work with their physicians to determine which treatment option is best for them.

Watchful waiting is an option for men who are older, who have low-grade tumors and who do not have a life expectancy exceeding 10 years.

Radical prostatectomy, the complete surgical removal of the prostate gland, provides the best cure rates for diseases that have not spread beyond the prostate gland. Skilled surgeons can minimize the risk of incontinence or impotence.

Radiation therapy, in which the physician focuses a beam of radiation on the area of the prostate for a few minutes for each of 35 treatments (seven weeks), is another option.

Brachytherapy, which involves placing temporary or permanent radioactive seeds directly into the prostate gland, is garnering a tremendous amount of interest. Utilizing sophisticated interactive three-dimensional ultrasonography, the seeds are placed with a high degree of accuracy, resulting in good outcomes and fewer side effects, compared with other therapies.

Cryosurgery is another developing treatment option. Liquid nitrogen probes inserted into the prostate can literally freeze the prostate cancer to death.

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