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03.10.2013 Opinion

Prostate Cancer: Men's Killer Disease:

By Daily Guide
Prostate Cancer: Men's Killer Disease:
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The disease had spread throughout his body damaging the liver, attacking the spine and crippling him. He urinated blood, if he could produce any, lost a lot of weight, slipped into a coma and died two days later. This was the gruesome and heartbreaking story of my 55-year-old brother who died of Prostate Cancer in Ghana on November 3, 2012. Because this disease has affected a close family member, I've taken a keen interest in this disease and researched as many sources as I can garner to share the information with my fellow countrymen.

First off, I'm not a medical doctor, nor do I work in the health field. But information is widely available on the internet, magazines, and medical books for lay people with enough curiosity to educate themselves.

I do not know how widely available the public health establishment in Ghana disseminates information on Prostate Cancer as it relates to men 45 years old and above.  But according to American Cancer Society, data available suggest that Prostate Cancer is one of the deadliest causes of death in men, especially black men. If this is a true statement, then it behoves the healthcare sector to educate the general populace about the dangers of prostate cancer and steps taken for early detection and treatment.

As I grew up in the fifties, I heard a nurse talk about prostate cancer and the effects it had on men. Even in those days when Ghana was a young nation there was talk about of this dreadful disease but after almost 60 years of independence, the country seems to have gone mute on this important topic. The healthcare system in my humble opinion is not doing enough to educate and encourage people to do annual physical checkups to determine what could be wrong in their bodies. Instead, most people go to the doctor only when they are ill and in some cases when they are just about to take their last breath. What has become of the old adage of prevention is better than cure?

This is what has prompted me to do a little research and share the information I have garnered with my bothers in Ghana and elsewhere on the continent to enlighten them about Prostate Cancer.

What is the prostate, what are its functions, what causes it to become cancerous and what early detection and treatments are available?

The prostate is a gland found only in men. It is located in the front of the rectum and below the urinary bladder. The size of prostate varies with age, but a healthy one is about the size of a walnut or a small palm nut, but it can be larger in older men. If a prostate grows too large it squeezes the urethra, and this may stop or slow the flow of urine from the bladder to the penis.

The prostate's job is to make some of the fluids that protect and nourish sperm cells in the semen, making the semen liquid. Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the centre of the prostate. It usually stays at about the same size or grows slowly in adults, as long as male hormones are present.

No one really knows what causes prostate cancer, however the chance of developing prostate cancer increases as men age and that it is rare in men younger than 45 years old. Some of the probable causes are attributed to a man's genetics, environment and diet. For example, men from Western European countries have a higher incidence of prostate cancer than men from Asia. But African-American men can have a higher incidence of more aggressive prostate cancer than white men. Additionally, the incidences of prostate cancer significantly increase in men who have a family history of the disease, that is, if their grandfather, father, brother, or uncle, had prostate cancer.

Even though data to date indicate no clear understanding of why the prostate become cancerous, researchers have found some risk factors and are trying to learn just how these factors cause prostate cells to become cancerous. On a basic level, prostate cancer is caused by changes in the DNA of a prostate cell. In recent years, scientists have made progress in understanding how certain changes in DNA can cause normal prostate cells to grow abnormally and form cancers. DNA is the chemical that makes our genes, the instructions for nearly everything our cells do. We usually look like our parents because they are the source of our DNA. However, DNA affects more than how we look.

Some genes control when our cells grow, divide into new cells, and die.  Certain genes that help cells grow and divide are called oncogenes. Others that normally slow down cells division or cause cells to die at the right time are called tumour suppressor genes. Cancer can be caused by DNA changes (mutations) that turn on oncogenes or turn off tumour suppressor genes. DNA changes can either be inherited from a parent or can be acquired during a person's lifetime.

Between the ages of 40 and 45, a doctor can start checking you for prostate cancer before you have any symptoms. Screening can help doctors find and treat the cancer early. Nevertheless, studies have not shown that screening tests reduce the number of deaths resulting from prostate cancer.  There are several types of screening available but the three commonly used are:

1. Digital rectal exams. The doctor inserts a lubricated, gloved finger into your rectum and feels the prostate through the rectal wall. The prostate is checked for hard, enlarged or lumpy areas.

2. Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. PSA is an enzyme that is produced by prostate cells, both normal and cancerous, and secreted into the semen to keep it liquefied. Additionally, a small amount of PSA is continually leaked into the blood stream by prostate cells.

3. Biopsy: The removal of tissue cells from the prostate for a pathologist's examination. The digital examination and PSA tests can detect a problem in the prostate. However, they cannot show whether the problem is cancer or less serious condition. The information in the pathology report tells your doctor how fast your cancer is growing.  The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. The pathologist grades the tissue samples by utilizing Gleason Grading and scoring; 1 through 10. The lower the grade the better and the cancers are usually treatable.

There are no known typical warning signs that an individual has developed prostate cancer. The cancer cells often grow slowly over time, but some of the symptoms are the result of enlargement of the prostate, frequent urination in the early stages and with more advanced stage, you may have fatigue, weight loss and generalized aches and pains.

But in most cases, if the cancer is detected earlier, surgery is the first form of treatment needed according to some experts. The three most common forms of treatments are watchful waiting/active surveillance, surgery and radiation treatment.

Watchful waiting is the decision not to treat the prostate cancer at the time it is diagnosed and it is not aimed at curing it, but rather to institute the palliative treatment for local or metastatic disease progression it occurs. Rather than treatment, the physician monitors your PSA value at various intervals; say every three months to assess whether it is increasing and at what level. Ideally, the patient and the physician identify a point at which therapy would be instituted.

Watchful waiting differs from active surveillance in that active surveillance is followed more closely and the intent is to intervene while the prostate cancer may still be treated definitively. According to some experts, patients younger than 72 years, healthy and those with higher Gleason score are more likely to live longer enough to have symptoms and disease progression in their lifetime and are better suited to more definitive treatment if the cancer is identified earlier at a low stage.

Radical Prostatectomy is surgical procedure to remove the entire prostate, as well as the seminal vesicles, the section of the urethra that passes through the prostate, the ends vas deference, and a portion of the bladder neck. After the prostate and the surroundings structures are removed, the bladder is then reattached to the remaining urethra.

During surgery a catheter, that is, a hollow tube is placed through the penis into the urethra into the bladder before the stitches that attached the bladder to the urethra are tied down. The catheter allows the urine to drain while the bladder and urethra heal together. Because a mild bleeding, lymph drainage and urine drainage may occur after surgery, a small drain is often placed through the skin of the abdomen into the pelvis. This drain is removed when the fluid output decreases. Also during the surgical procedure depending on the method used, the pelvic lymph nodes, which are a common location of prostate cancer metastases, may also be removed. The radical prostatectomy may be performed via three different approaches. The most common among them being the retro pubic method, in which an incision is made that, extends from the umbilicus (belly button) to the symphysis pubis (pubic bone).

Another approach may be performed laparoscopically through several small incisions made in various locations in the abdomen or through a perineal approach, with the incision being made in the area between the scrotum and the anus. In recent times, the radical prostatectomy may be performed with the use of robotic-assisted radical prostatectomy.

The decision as to which surgical method to use for the prostatectomy depends on your urologist's preference and skills, your body characteristics , and whether a pelvic lymph node dissection is planned.

Radiation Therapy There are a number of radiation therapies, most commonly used including external-beam radiation treatment (EBRT), brachytherapy, and temporary radioactive-seed implantation. External-beam radiation therapy is delivered from an external source outside the body to the prostate to kill the cancer and stop it from growing.

This treatment requires the patient to receive treatment from five days a week up to six weeks with each treatment session lasting about 15-30 minutes.

Brachytherapy is another type of radiation therapy delivered from inside the body, in which radioactive seeds or pellets that emit radiation are implanted in order to kill the surrounding tissue including the cancer. Before the seeds are implanted in the prostate, a great deal of time is spent understanding exactly where the cancer is and the precise location of the prostate. There are different types of radioactive seeds that may be used, with Palladium-103 and lodine-125 being the most common. The procedure generally takes one to several hours.

Temporary radioactive-seed implementation involves placing an intense radiation source directly in around the cancer for a short period of time. Done under ultrasound guidance, 12-20 small, flexible plastic is inserted through the perineum and into the prostate. The procedure requires a short stay in the hospital.

After the diagnosis if it is determined that you have cancer, your doctor will ask about your family medical history and discuss various treatment plans with you. According to Dr. William J. Catalona, a leading Urologist of the Northwestern University, Illinois:

Multiple treatment options exist for how to treat prostate cancer.

There is no medical consensus on the one most effective way to treat prostate cancer.

Different physicians specialize in different ways to treat prostate cancer.

Each treatment option has its advantages and disadvantages. Therefore, you should consider what is most appropriate and fits best with your specific cancer characteristics and life-style.

American Cancer, Promoting Wellness for Prostate Cancer Patients by Mark A. Moyad, MD, MPH, What You Need to Know About Prostate Cancer US Department of Health and Human Services (National Cancer Institute), Questions and Answers About Prostate Cancer Second Edition by Pamela Ellsworth, MD.

I will put forward the side effects and complications each treatment poses in my next article.

Thomas A. Djan writes from California, USA
 By Thomas A. Djan

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