Your guide to prostate cancer

PROSTATE CANCER develops in a man’s prostate, the walnut-sized gland just below the bladder that produces some of the fluid in semen. It is the most common cancer in men after skin cancer. Prostate cancer often grows very slowly and may not cause significant harm, but some types are more aggressive and can spread quickly without treatment.

Many men may have no early symptoms of prostate cancer. Later, symptoms can include frequent urination, especially at night, difficulty starting or stopping urination, weak or interrupted urinary stream, painful or burning sensation during urination or ejaculation, blood in urine or semen, or advanced cancer can cause deep pain in the lower back, hips, or upper thighs.

The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia (BPH). It is not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis, and this inflammation or infection may also cause a fever and, in many cases, is treated with medication.

According to Dr Hope Russell-Dunn, consultant urologist, speaking on the weekly Health Talk Sunday series, growing older is the greatest risk factor for prostate cancer, particularly after age 50.

“After age 70, studies suggest that anywhere from 31 per cent to 83 per cent of men have some form of prostate cancer, though there may be no outward symptoms. Family history increases a man’s risk: having a father or brother with prostate cancer more than doubles the risk. African American men and Caribbean men of African descent are at high risk and have the highest rate of prostate cancer in the world,” Dr Russell-Dunn said.

Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. Dietary fat, particularly animal fat from red meat, may boost male hormone levels and this may fuel the growth of cancerous prostate cells. A diet too low in fruits and vegetables may also play a role.

Screening tests are available to find prostate cancer early, but guidelines do not call for routine testing in men at any age. The tests may find cancers that are so slow-growing that medical treatments would offer no benefit, and the treatments themselves can have serious side effects.

The Jamaica Cancer Society advises men to talk with a doctor about screening tests, beginning at:

• Age 50, for average-risk men who expect to live at least 10 more years;

• Age 45, for men at high risk; this includes those with a father, brother, or son diagnosed before age 65;

• Age 40, for men with more than one first-degree relative diagnosed at an early age.

“If a physical exam or PSA test suggests a problem, your doctor may recommend a biopsy. A needle is inserted either through the rectum wall or the skin between the rectum and scrotum. Multiple small tissue samples are removed and examined under a microscope. A biopsy is the best way to detect cancer and predict whether it is slow-growing or aggressive,” Dr Russell-Dunn said.

Some men may need additional tests to see if the cancer has spread beyond the prostate. These can include ultrasound, a CT scan, or an MRI scan.

The good news about prostate cancer is that it usually grows slowly, and nine out of 10 cases are found in the early stages. Overall, the five-year relative survival rate is 100 per cent for men with the disease confined to the prostate or nearby tissues. Many men live much longer. When the disease has spread to distant areas, that figure drops to 31 per cent. But these numbers are based on men diagnosed at least five years ago. The outlook may be better for men diagnosed and treated today.

keisha.hill@gleanerjm.com

SOURCE: Health Talk Sunday, Jamaica Cancer Society

Staging is used to describe how far prostate cancer has spread or metastasized and to help determine the best treatment:

• Stage I: Cancer is small and still within the prostate;

• Stage II: Cancer is more advanced, but still confined to the prostate;

• Stage III: Cancer is a high grade, or it has spread beyond the outer part of the prostate or into nearby tissues, such as seminal vesicles, the bladder, or rectum;

• Stage IV: Cancer has spread to lymph nodes or distant organs, such as the bones or lungs.