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Prostate Cancer

 Symptoms   |  Risk factors | Incidence  | PSA and PSAdt  |  TURP | Types  |  Stage |  Grade |  Lifestyle tips and prostate cancer
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Active surveillance |  Complex radiotherapy  | Prostatectomy | Brachytherapy | Hormone therapy | Chemotherapy; taxotere;  cabazitazel;  | Abiraterone |  Enzalutamide  

 

Prostate cancer is a disease in which malignant (cancerous) cells form in the tissues of the prostate - gland  which is located under the bladder and in front of the rectum in men. The function of the prostate gland is to  produces a fluid component of semen which transports sperm during ejaculation. The prostate gland is about the size of a large walnut but and enlarge throughout life in a process called benign prostatic hypertrophy.

Presenting symptoms: Many men, these days are found to have prostate cancer following a routine blood test showing a raised PSA. Many of the urinary are actually caused by an enlarged prostate gland which although could be caused by the cancer is more likely to be caused by a benign swelling of the gland (not cancer).

 Possible symptoms of localised prostate cancer include:

  • Passing water more frequently at night
  • Reduced urine flow,
  • A feeling that you are not emptying the bladder
  • Rarely blood in the urine or semen, 
  • Erectile dysfunction

Rarely cancer can present with signs that it has already spread to other organs or structures:

  • Pain in the bones (metastasis to the bones)
  • Pain in the perineum (area between testes and anus)
  • Swollen legs (caused by enlarged lymph nodes)
  • Nerve pain or even loss of use of the legs (spinal cord compression)

UK incidence: The risk of this condition increases with the age, generally men over the age of 50 are affected. In the UK nearly 32,000 men are diagnosed every year with prostate cancer which causes more than 10,000 deaths every year. Overall, one man in fourteen will get prostate cancer at some point in his life. Of the 2 million people living with cancer at any one time in the UK43% of the men will have prostate cancer.

Types of prostate cancer: Although there are several cell types in the prostate, nearly all prostate cancers start in the glandular tissue itself, called an adenocarcinoma. Other rare cancer are:

  • Primary transitional and squamous cell cancers (mostly direct invasion from adjacent bladder cancers.)

  • Carcinoid and small cell carcinomas (tumours may be sensitive to chemotherapy but are highly malignant with a very poor prognosis) 

  • Sarcomas represent approximately 0.1% of prostatic malignancy. 

  • Rhabdomyosarcomas are described in younger patients. Leiomyosarcomas occur usually after the age of 50. 

  • Non-Hodgkin’s lymphoma may arise within the prostate and both chronic lymphocytic and acute leukaemias may cause prostatic infiltration. 

  • Secondary tumours of the prostate such as malignant melanoma and bronchial carcinoma have been rarely reported

Risks factors for prostate cancer: Most cases of this condition are diagnosed in men over the age of 65. There are usually no predisposing risk factors but there is some evidence of associations with a previous poor diet (high in fat, low in fruits and vegetables), being a black male, men who have a strong family history of the disease are at greater risk. 

Tests to determine a diagnosis and help decide on treatment options: Prostate-Specific Antigen (PSA) blood test, Digital Rectal Examination (DRE), transrectal ultrasound (TRUS), biopsy (find out more)

What determines the treatment options and prognosis:

  • The stage - Whether it is palpable on rectal exam, spread outside the gland, into local lymph nodes or elsewhere (you will need a number of scans to determine this including Rectal ultrasound, CT scan, Bone scan or MRI
  • The type of  cancer cells - mainly adenocarcinomas (originate from glands) 
  • How aggressive they look under a microscope (gleason grade
  • Age and general health of the patient
  • Whether the condition has just been newly diagnosed or has recurred
  • Level and rate of rise of PSA

Treatment options Ideally, treating any type of malignancy should cure the disease as well as be easily tolerated, and cause minimal or no problems. This concept is particularly important in treating prostate cancer. Although some men have an aggressive form that can lead to early spread and death, many have slow growing tumours that would never cause problems during a patient’s natural lifetime.  It is important that medical intervention does not convert this group of healthy men into sufferers from medical care related side effects. Prostate cancer treatment depends on several factors such as the stage, type and grade of the disease as well as on the patient's age, general health and preferences. Before deciding which option is appropriate in your case you may need more than one visit to the clinic to discuss all your concerns and questions.

The most common options for disease confined to the gland include:

Lifestyle strategies and prostate cancer

There is now a great deal of evidence to show that certain lifestyle factors can help slow the progression of prostate cancer or prevent its relapse after active initial treatments. These have been explained in detail along with the supportive evidence in the book "Lifestyle after Cancer - the facts". In summary, they can be divided into these components:

Smoking. Trials have linked smoking with more aggressive cancers and a higher risk of erectile dysfunction and pelvic damage after radiotherapy - tips to give up smoking

Weight control. A variety of studies have linked obesity with and high rate of prostate cancer, more aggressive forms of cancer and a higher risk of relapse following successful initial therapies - tips to help control a healthy weight

Exercise. Exercise helps to counterbalance the negative effects of androgen deprivation such as weight gain, osteoporosis and mood changes. Exercisers have lower risk of pelvic damage after radiotherapy. Two large international studies have linked exercise with a lower risk of relapse. - more about exercise and local facilities

Diet factors have been linked to a higher risk of prostate cancer particularly those who eat excessively, have a high fat and processed meat intake with a low intake of vegetables, fruit, herbs and spices - read more about diet 

Polyphenols and anti-oxidants.  There are some evidence that certain foods have specific anti-cancer properties via their polyphenol and antioxidant ingredients. They are thought to work in a number of different ways:

By ensuring adequate intake of polyphenol and anti-oxidant rich foods not only is the initial risk of prostate cancer reduced but some evidence suggests that  indolent malignant or pre-malignant cells may not progress into more aggressive types and hence more advances disease especially if combined with other healthy lifestyle strategies (full evidence see - Lifestyle after Cancer - the facts). The foods generally thought of as beneficial include:

Nutritional supplements In general taking additional vitamin and mineral supplements have not been shown to decrease the risk of prostate cancer. In fact, some studies have shown that minerals such as zinc and vitamins such as A and E can increase the cancer risk if taken in excess - Trials which have measured base line vitamins and minerals before supplementation have usually demonstrated a benefit in correcting a deficiency but harm in taking them if pre-intake levels were normal or excess. The trouble is there is no way of knowing what our baseline levels are unless they are measured - see micronutrient testing

There may be a benefit in taking whole food supplements which have been dried and concentrated - these supplement do not increase individual extracted chemicals but a range of natural polyphenols found in the whole food. Some small or non randomised trials have shown a benefit for green tea and pomegranate seed. Definitive data will be available when the pomi-t supplement study is published in 2013. The rationale for combining four different whole foods types (berry, vegetable, spice and leaf) was to provide a wide spectrum of natural polyphenols, avoiding over-consumption of one particular type.

 

Helpful resources and links

Cancernet-UK: What is cancerAbout specific cancers; Breast | Prostate | Bowel.  About cancer treatments; Chemotherapy | Radiotherapy | Hormones | Biological agents | Complementary.  Lifestyle advice; Exercise | Diet | Smoking | Sunbathing | Alcohol.  Cope with symptomsTraveling | Insurance  | Tests for cancer | Clinical trials. ...site map
Micro-nutrient testing Empower yourself to make dietary choices specific to your personal make up. This Cancer Risk Nutritional Profile, analyses your blood profile and recommends specific dietary and supplement advice to ensure you have the best possible nutritional status to fight cancer an aid recovery from treatments....read more
Download a free chapter describing how to avoid cancer forming chemicals (Carcinogens) in our diet and environments  from the new edition of the best selling evidence based book    "Lifestyle after Cancer - the facts"
Make a will (or living will Cancernet has teamed up with a leading UK lawyer to drive down the cost of making a solicitor checked will.  This reliable, easy to use, online resource ensures your assets (money, property, jewellery, etc) go to the person you want and not those you least want such as the taxman. Cancernet-glossLegal wills start from £39....read more
Protect your lips during chemotherapy There is evidence that natural oil based creams are better than petroleum based creams. natureMedical lip balm has been specifically design to soothe and moisturise the lips during and after chemotherapy or after sun exposure. It only contains only natural waxes and essential oils selected for their anti-inflammatory and DNA stabilizing properties...read more/order
Protect your nails during chemotherapy. Nails can become painful and disfigured during and after chemotherapy. We describe the latest nail care guidelines and  number of useful tips to keep them healthy, including cooling and moisturizing ...read more 
Poems and cancer   Cancer is emotional and stressful time not only for the patients but friends and relatives. This emotional can inspire reflection, sentiment and creative writing and poetry. Hundreds of poems have been kindly submitted by users of cancernet. Caution: take a tissue some of these are real emotional bombshells!.. Read poems or...submit your own poem  
Lifestyle and cancer - the facts. This 2011, edition with a foreword from Paula Radcliffe has been extensively re-written with evidence from the latest research from around the world which demonstrates how diet, exercise and lifestyle changes can; help avoid cancer (read chapter 9 free), cope with treatments side effects; slow the rate of progression of cancer and help prevent  relapse.  This comprehensive essential lifestyle guidebook can be ordered online (£8.95), or downloaded via kindle
Prepared for cancer treatments. Patients and professionals, teamed up with Sue Lawley to produce this 21 minute film which explains chemotherapy & radiotherapy while you watch patients, describing their experiences, side effects and methods to alleviate them. Awarded the NHS communication prize ...  read more / order individually or in bulk for your oncology department 
Keep-healthy.com Practical evidence based advice on healthy living including ways to naturally reduce cholesterol, reduce blood pressure, keep healthy eyesight, hearing, maintain a healthy weight and level of fitness. Includes advice on supplements and other useful products...link