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Talk to Your Doctor
The Issue
There is little consensus among leading national prostate cancer organizations on whether screening and treatment of early stage prostate cancer reduces mortality.
Researchers are working to determine the extent to which prostate cancer screening saves lives, versus the potential negative side effects of unnecessary treatment for men whose cancer would not become clinically meaningful in their lifetimes. These studies will help determine whether a man who is screened regularly is less likely to die from prostate cancer than a man who does not get screened. A January 2006 report on CNN suggests experts will have better answers to these questions in 2009 when results are expected from large studies in nearly 300,000 U.S. and European men. Results will help clarify the extent to which screening for prostate cancer decreases the risk of death from prostate cancer.
Argument For Screenings
Those who encourage regular screening believe that finding and treating prostate cancer early, when treatment is recommended, saves lives and provides patients with more treatment options. They agree with the American Cancer Society's recommendation that all men be offered the PSA test and DRE annually beginning at age 50 if they have a life expectancy of at least 10 years.. Some also recommend earlier screening tests for high-risk groups, such as African-American men and those with close family relatives with prostate cancer.
Argument Against Screenings
Some organizations, such as the Center for Disease Control, do not recommend routine screening for prostate cancer because they believe there is no scientific consensus on whether screening and treatment of early stage prostate cancer reduces mortality. In addition, they believe the PSA tests can yield ambiguous results. Most men who undergo a biopsy because they have elevated PSA levels do not have prostate cancer and some men with low PSA levels do have cancer. According to Cancer.gov, based on good evidence, screening with PSA and/or DRE detects some prostate cancer that would never have caused important clinical problems. Thus, screening can lead to some degree of over-treatment.
Gillette's Position
GPCC recommends that men age 50 or older discuss prostate cancer screening with their physicians. African-American men and all men with a close relative with prostate cancer should consider prostate cancer screening after age 40. The Gillette Prostate Cancer Challenge encourages men to know their risks and the pros and cons of screening so they can make an informed decision about their health.
Screening
Remember, early prostate cancer has no symptoms, so it is important for you to check with your doctor to see if screening is right for you. PSA Test and DRE are the most common screenings for prostate cancer. Talk to your doctor to see if either is right for you.
PSA Test (Blood Test)
Prostate Specific Antigen (PSA) is a protein made in the prostate. Normally, very little should be found in the blood. Rising levels of PSA in the blood indicate a problem with the prostate, which could be cancer but could also be an enlarged prostate (BPH). Ejaculation within 48 hours before taking a PSA test can also cause a higher reading of your PSA level.
Some specialists recommend starting annual screening at age 50 for the general population, but the right age to start PSA testing depends on your level of risk.
Efforts are being made to increase the accuracy of the PSA test. Doctors are using new types of PSA tests and new methods to interpret results, in order to better determine who should undergo further testing.
DRE (Physical Exam)
The Digital Rectal Exam (DRE) is a quick and painless physical exam, where the doctor feels for bumps or abnormalities on the surface of your prostate that might be tumor growth. The word "digital" refers to the use of a finger, not a computer. Even if a bump is found, a biopsy is still needed to determine whether it is cancer.
Source: National Prostate Cancer Coalition
Detection: Biopsy
A biopsy is the only way to know whether or not you have cancer.
If your PSA levels are above a certain level, or your DRE reveals a potential tumor, your doctor may recommend a biopsy. Most men who undergo further testing after a PSA test do not have prostate cancer. Before recommending a biopsy, your doctor will probably do other tests to rule out BPH (enlarged prostate) and prostatitis as the source of a rising PSA level.
A biopsy is an analysis of prostate tissue samples taken from the patient.
The most common procedure is the "core needle" biopsy. A tiny needle is used to take cylindrical core samples, about 1/2-inch long and 1/16-inch wide, from the prostate. It is done in about 15 to 30 minutes with a "biopsy gun" tool. Doctors usually take anywhere from 6 to 18 core samples and a minimum of 3 from the left side of the prostate and 3 from the right.
Samples are sent to a pathologist to determine whether there are any signs of cancer cells, and if so, how advanced the cancer may be. The pathologist will determine whether cells are normal, suspicious, or malignant (cancer).
Sometimes prostate tissue samples are obtained from a transurethral resection of the prostate or TURP, a procedure sometimes used to remove part of the prostate in order to relieve symptoms of an enlarged prostate (BPH).
Source: National Prostate Cancer Coalition
Treatment and Research
The following are some of the treatment options available. Talk to your doctor to determine the best treatment option for you.
Deferred Treatment
It is often said more men die with prostate cancer than from it.
In some cases, prostate cancer grows so slowly that a man can reach his full life expectancy before the cancer becomes a serious threat.
Depending on the situation, deferring treatment for a while may be the best choice. This is often referred to as active surveillance, watchful waiting, or expectant therapy, or sometimes just observation.
It's not the same as doing nothing.
Deferred treatment involves monitoring the situation closely. It is important that patients get frequent PSA testing, repeat biopsies, and are regularly scanned for any signs that the disease is advancing.
This approach can be combined with dietary changes and other efforts to keep the cancer from growing. More information about prevention can be found on our Diet and Living section, and on the Complementary and Alternative Medicine page in this section.
Men can always begin another form of treatment if the cancer shows any signs of becoming a threat.
This method is most often recommended for men in their 70s and older with non-aggressive localized cancers.
Surgery
Surgery, or radical prostatectomy, involves removing the prostate and some surrounding tissue, including local lymph glands, while trying to spare the surrounding nerves and muscles. It is the most common option for men under 70 with cancers confined to the prostate.
Approximately 75% of men who undergo surgery never experience a recurrence of prostate cancer. However, surgery always has risks, and this type of surgery can cause significant side effects.
Incontinence is common following surgery, but most men recover within a few weeks or months. As many as 35% of men have permanent, mild but treatable stress incontinence, such as passing a little urine while coughing.
Erectile dysfunction (ED) is more common and more difficult to treat. The nerves along the side of the prostate control erections. Sometimes they need to be removed to catch all of the cancer. They can be partially removed or damaged during surgery.
Nerve-sparing surgical techniques can improve the odds of recovering erections, from around 30% for men under 60 with one nerve spared, to about 76% for men under 60 with both nerves spared. Even if one nerve is sacrificed, one may be able to regain potency over time with the remaining nerve. Some patients regain potency over time with the use of ED drugs or medical devices. Sometimes patients are given ED drugs in advance of surgery, to support the system.
Radiation
Radiation therapy involves the use of high-energy rays or radioactive particles to kill prostate cancer cells by damaging their DNA and limiting their ability to reproduce.
Radiation is the second-most commonly used treatment for prostate cancer, and is often recommended for older men and those who face higher risks from undergoing surgery. Rates of success are similar to those for surgery, but depend largely on the cancer's stage.
Side Effects
Long-term erectile dysfunction (ED) develops in 10-40% of men during the 2 years following external radiation (EBRT), and about 10-60% of men following internal or brachytherapy. These variations largely depend on the patient's age. About 50% of men suffering from ED as a result of radiation treatment respond well to treatment with ED drugs.
Most men suffer some urinary problems during radiation treatment. These usually disappear within a few months. Only about 5% suffer severe or permanent symptoms. Temporary rectal problems occur for less than 10% of men, but it is normal to find some blood in the bowel after treatment.
Hormone Therapy
Prostate cancer is initially dependent on male sex hormones, or androgens, for growth. The primary androgen is testosterone.
Hormone therapy, or androgen suppression therapy, is used for patients whose prostate cancer has spread outside the prostate or has recurred after initial treatment.
By blocking androgens, hormone therapy causes prostate cancer to shrink, or to grow more slowly. It does not "cure" the cancer, but can keep it at bay, or "in remission" for several years.
Hormone therapy blocks androgens from feeding the growth of prostate cancer by blocking either the production of testosterone, or the cancer cell's ability to use it.
About 90% of men undergoing hormone therapy suffer from impotence and loss of sexual appetite. Other side effects are similar to those in women undergoing menopause, and may include hot flashes, growth of breast tissue, weight gain, and reduction in muscle and bone mass.
Sometimes hormone therapy is combined with surgery or radiation, either to shrink tumors in advance of treatment or to inhibit the growth of cancer cells in men with high risk of recurrence.
As most testosterone is produced in the testicles, surgical removal of the testes, or orchiectomy, is also an effective way to block hormone production. Most men prefer to use hormone blockade drugs, even though they can be more expensive, as they work just as well as surgery and the effects are reversible.
Chemotherapy
Chemotherapy is the use of powerful toxic drugs to attack cancer cells. A number of chemotherapy drugs have been effective for prostate cancer, with low side effects. They are usually administered on an outpatient basis.
It was previously thought chemotherapy would not work for prostate cancer. Many early chemotherapy drugs identify cancer cells through their fast rate of growth, and prostate cancer cells grow slowly in comparison to most cancers. Advances in research have found new drugs and new ways for drugs to identify prostate cancer cells.
Chemotherapy drugs are generally reserved for patients with advanced cases of cancer that have become resistant to hormone therapy. They are used to shrink or slow the growth of tumors, and to find and kill cancer cells that have spread to other parts of the body. Other drugs are used to manage symptoms of advanced prostate cancer and alleviate pain.
Some chemotherapy involves harsh side effects and requires careful dosage, as the drugs kill healthy cells too. Side effects can include nausea, loss of appetite, hair loss, tiredness, infection, and more; but most side effects will disappear when the treatment is stopped.
Complementary and Alternative Medicine
Some people believe there are other ways to treat prostate cancer and its effects, either instead of (alternative), or in addition to (complementary) the conventional methods.
When treatments are referred to as complementary or alternative, this usually means that they have not been through the rigorous testing and approval procedures required for conventional treatments. This does not necessarily mean they do or don't work, only that you take them at your own risk.
Complementary and Alternative Medicines (CAM) can include natural medicines and supplements, therapies using the influence of the mind on health, massage, and other physical therapies, or whole medical systems such as the Chinese and Indian systems or those practiced by Native Americans.
Many prostate cancer patients adopt a cancer-fighting diet, high in foods like soy and tomatoes, low in dairy and animal fats, and with appropriate doses of dietary supplements. While this is a form of complementary medicine, the overall health benefits of a high fruit, vegetable, and antioxidant and low-fat diet are well established.
Many claims are made about the benefits of CAM. Make sure you evaluate claims carefully. With the help of your doctor, you can find information such as well-conducted research showing clear benefits from treatment. At the very least, make sure the treatment won't hurt you.
The FDA does not regulate food supplements the way they regulate drugs, so try to find research about the substances, how they work, and what doses are recommended.
Some substances or methods are being tested in clinical trials. You may be able to participate in a research study.
If considering treatment as an alternative to approved methods, be very aware of the risks you are taking by not getting traditional treatment.
If considering treatment that is complementary to approved methods, make sure to check with your doctor before starting. Additional treatment, no matter how minor, may interact with other drugs or have an affect on how your other treatment works.
Source: National Prostate Cancer Coalition
Prevention: Diet and Living
Changing your diet could lower your risk.
American men have the highest rates of prostate cancer in the world. Evidence is mounting that a diet high in fats and red meat, common in America, plays a significant role in increasing the risk of prostate cancer.
Asian men in Asian countries die of prostate cancer at 1/10 the rate of American men, but within one generation of moving to North America, their risk of dying of prostate cancer becomes equal to that of their American counterparts. Many believe diet to be the cause of this rapid change.
Best Foods
A diet high in soy as well as fruits and vegetables may help prevent prostate cancer.
Soy can reduce PSA levels. Soy is a phytoestrogen, which is a plant substance that affects the body similarly to the estrogen found in humans. Scientists believe that phytoestrogen can balance out testosterone levels in men, reducing prostate specific antigen (PSA) in the blood. Studies show that men with prostate cancer experienced a dramatic drop in their PSA level when consuming two grams of soy per day. Keep in mind that soy contains estrogen, and too much of anything can be dangerous, so check with your doctor before dramatically increasing your consumption of any one food.
Men who eat plenty of cruciferous vegetables (broccoli and cabbage) may be reducing their risk of prostate cancer. 3 or more servings a day can reduce risk by as much as 41%.
5 servings or more of fruit per day can cut the risk of prostate cancer in half. Fruit helps, in part, by containing fructose that stimulates the body's ability to create Vitamin D, a nutrient believed to reduce prostate cancer risk.
Tomatoes, which contain an antioxidant called lycopene, may have a big impact on prostate cancer. Some studies have shown that a regular intake of lycopene supplements lowers risk by about 15% while other studies show that consumption of tomatoes lowers risk by as much as 26%.
While giving you bad breath, consumption of 10 grams of allium vegetables, garlic, onions, and chives may also reduce your risk of getting prostate cancer. The foods contain flavinoids that have demonstrated reduction in tumor growth in lab studies.
Mushrooms are rich with selenium, a believed cancer fighter in lowering PSA levels and inhibiting tumor growth. While there is a massive study in progress of measuring the impact of selenium and Vitamin E on prostate cancer risk and progression, a large study in the U.K. showed men who regularly took selenium reduced prostate cancer risk by four times.
Consuming about 50 milligrams (75 IU) of Vitamin E can reduce risk of prostate cancer by one-third and the death rate by 41%. Vitamin E, found in food including pecans and sesame seeds, may also stimulate the immune system and sex hormones, which contributes to minimizing the growth and spread of cancer.
Make your tea time. Green tea, in particular, is rich in polyphenols, believed to slow the growth of cancer. Studies are showing that tea reduces the levels of polyamines, a substance associated with cancer malignancy.
Bad Foods
The "Western Diet" or a diet high in fats and red meat may contribute to higher rates of prostate cancer.
Avoid the steak and hamburgers. Eating red meat 5 times per week doubles your risk for prostate cancer, according to studies.
Limit sweets and desserts. Foods high in calories and sugar can lower metabolism and create problems with obesity, which is proving to be a key factor in prostate cancer severity and possibly risk.
An excess of calcium, found in dairy products, may increase the risk of prostate cancer as the calcium reduces the body's levels of Vitamin D, which protects the body from prostate cancer.
Obesity
Men with a body mass index (BMI) of 32.5 or higher are 1/3 more likely to die from prostate cancer.
Men with a BMI of 35 are 60% more likely to have a recurrence of prostate cancer in 3 years. Men with a BMI of 30-39.9 are 20% more likely to have a recurrence of prostate cancer.
Proteins and hormones stored in body fat such as leptin and insulin-like growth factor may promote prostate tumor growth in obese men. Additionally, diets high in fat may promote tumor growth in many cancers.
Further, there are recent studies that indicate doctors may be having a difficult time diagnosing prostate cancer in men who are obese because as the BMI goes up, PSA goes down, masking the aggressiveness of the cancer.
Bad cholesterol may be linked to prostate cancer risk.
Early studies suggest a link between high cholesterol and prostate cancer, as bad cholesterol or low-density lipoprotein (LDL) contributes to increases in dyhydrotestosterone or bad testosterone. High levels of testosterone or bad testosterone may impact the chance of having prostate cancer and prostate cancer severity.
Cholesterol plays a role in cell growth in the body and in cancer. Accumulation of cholesterol within the prostate membrane may stimulate signals that promote cancer progression.
Leading researchers are suggesting that doctors should screen for cardiovascular disease along with prostate cancer because evidence is strong enough to indicate a link.
Exercise is associated with lower metabolism and weight loss, which can contribute to lowering the risk of prostate cancer.
While studies are inconclusive that exercise has a direct impact on prostate cancer risk, exercise results in the temporary reduction in testosterone is the chief contributor to male hormone-dependent cancers such as prostate cancer and helps lower one's weight when applied with a healthy diet.
By lowering your weight through diet and exercise, PSA levels may go down and some studies suggest that tumor growth is slowed by as much as 30%. However, in order to fully determine direct links to exercise and the reduction of prostate cancer, a long and extensive randomized trial is needed.
Sex has yet to be proven to increase the risk of prostate cancer.
In fact, studies show that ejaculation 3 times per week may reduce the risk of getting prostate cancer by 15%.
As prostate cancer is a testosterone-related disease, connections have been sought between it and sexual behavior. High testosterone levels, vasectomy, and history of frequent sexual activity have been studied, but not found to increase risk of prostate cancer.
Smoking and alcohol consumption has no direct link to prostate cancer.
However, smoking certainly does cause lung cancer, which is the leading cause of male cancer death in the United States. Alcohol, while impairing judgment including taking care of one's health, also has no direct link to prostate cancer but can cause a number of other health problems, particularly with liver function.
Source: National Prostate Cancer Coalition
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