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Overview
Product Details
| ISBN-13: | 9781943886845 |
|---|---|
| Publisher: | Addicus Books |
| Publication date: | 10/15/2018 |
| Pages: | 170 |
| Product dimensions: | 5.40(w) x 8.40(h) x 0.40(d) |
About the Author
Read an Excerpt
CHAPTER 1
Prostate Cancer: An Overview
If you have been told that you have prostate cancer, your first reaction might well have been panic, numbness, or despair. Many people experience a whirl of emotions after receiving a cancer diagnosis. It's normal to react this way. However, men who have had prostate cancer will often talk positively about how their diagnosis and recovery affected them emotionally.
Even though you might find this hard to believe right now — there are thousands of prostate cancer survivors who will tell you that having had prostate cancer eventually had a positive effect on them. They educated themselves about the disease and treatments, and they discovered that knowledge is power. They learned to use that power for their own health and well-being. They forged new relationships and strengthened existing ones. They spoke to loved ones about their deepest feelings and greatest fears. They came to develop a greater appreciation of life.
The Prostate Gland
To better understand prostate cancer, let's first examine the role of the prostate gland itself. The prostate is a muscular gland about the size and shape of a walnut. It is part of the urinary and reproductive systems and is located in the pelvis below the urinary bladder, just in front of the rectum. The urethra, a tube that carries urine and semen out of the body through the penis, runs through the prostate.
Prostate Gland
Because the prostate is actually several small glands encased in the prostate capsule, it is sometimes described as having zones. Of these, the peripheral zone, or outer zone, is the largest and is where most prostate cancer begins. The central zone surrounds the ejaculatory ducts; less than 5 percent of prostate cancers originate here, but are usually more aggressive tumors. The transition zone, or innermost zone, surrounds the urethra; this is the area of the gland that grows as men age, often causing obstruction symptoms.
The Prostate and Urination
The health of the prostate can affect your ability to urinate. Because the prostate surrounds the urethra, prostate enlargement can squeeze the urethra, making urination difficult.
The urinary tract begins at the kidneys, the body's main filters. They cleanse impurities from about forty-five gallons of water every day. Most of this water is recirculated through the body, producing only about two quarts of waste in the form of urine.
Prostate Gland Side View
Urine travels to the urinary bladder through tubes Called ureters. The bladder, located above the prostate, holds about a pint of urine. Urine empties into the urethra, which carries it through a muscle called the urinary sphincter and out through the penis. The urinary sphincter is responsible for continence, your ability to control the flow of urine.
The Prostate and Reproduction
Your prostate gland is small. About the size of an English walnut, it weighs between twenty and forty grams. By comparison, a first-class letter weighs about thirty grams. Small as it is, the prostate is essential for normal human reproduction. It adds important fluid and nutrients to sperm during ejaculation. To function properly, the prostate depends on male hormones, chiefly testosterone. This hormone is produced starting at puberty and is responsible for the traits usually associated with men such as body hair, deep voice, and muscles.
Prostate Gland Frontal View
The prostate alone does not fuel the reproductive process. The testicles produce sperm and most of the testosterone upon which the prostate depends. Just before the male orgasm, muscles squeeze seminal fluid from the prostate and from the seminal vesicles. During ejaculation, sperm, carried by the seminal fluid, travel through the urethra and exit the penis.
Prostate Cancer
The general term cancer refers to a collection of cells that are growing out of control. Cancer cells grow past normal limits, and they don't die when they should. Instead, they divide and spread, sometimes uncontrollably. Such a growth is said to be malignant. These cancer cells can break away from a malignant tumor site and spread, or metastasize, to other organs. Cancer destroys normal tissue and creates new tumors as it spreads.
Cancer spreads through the body's lymphatic system. Lymph is a fluid that bathes every living cell in the body. The lymphatic system fights cancer cells, killing and disposing of them. Sometimes, however, there are more cancer cells than the lymphatic system can handle, and the lymph vessels themselves become vehicles for spreading cancer.
Typically, prostate cancer starts in the outer zone of the prostate gland. Male hormones, especially testosterone, stimulate growth of both normal and cancerous cells in the prostate.
Stages of Prostate Cancer
When prostate cancer is diagnosed, the stage of the cancer is described as being local, regional, or distant. Local stage means the tumor is "localized" and there is no sign the cancer has spread outside the prostate. Regional stage refers to cancer that has spread from the prostate to nearby tissues. Distant stage refers to cancer that has spread to distant lymph nodes, bones, or other organs.
Survival Rates by Stage
• Local stage: about 4 out of 5 prostate cancers are found in this early stage. The 5-year survival rate for local stage prostate cancer is nearly 100 percent.
• Regional stage: the 5-year survival rate for regional stage prostate cancer is approximately 98 percent.
• Distant stage: the 5-year survival rate for distant stage prostate cancer is about 29 percent.
Most men with prostate cancer will live long, full lives. Many will never know they have it and will eventually die from unrelated causes.
Symptoms of Prostate Cancer
Early prostate cancer has no symptoms. You could be feeling quite well when you are diagnosed. For most men, the diagnosis comes as a complete surprise.
Malignant tumors in the prostate generally start out very small. It usually takes years for prostate cancers to grow large enough to obstruct the flow of urine. Fortunately, modern diagnostic methods can detect prostate cancer long before symptoms have a chance to develop.
Still, one or more of the following symptoms can indicate prostate cancer:
• Getting up at night to urinate
• Frequent urination during the day
• Weak or interrupted urinary flow
• Difficulty starting the urine stream
• Straining to urinate
• Feeling an urgent need to urinate
• Dribbling, leakage
• Pain or burning during urination
• Hematuria — blood in the urine
• Pain during ejaculation
• Less ejaculate (semen) than normal
• Impotence or less rigid erections
Although these symptoms do not always indicate prostate cancer, they should never be ignored. Prostate cancer that has spread beyond the gland itself can cause a range of symptoms, depending on where the cancer has spread. Symptoms may include pain that comes and goes in the back, ribs, hip, or shoulder.
Other symptoms include fatigue, weakness, and generalized aches and pains. Even though these symptoms are vague and could easily be harmless, don't ignore them. Too many men regard their symptoms as "normal signs of aging." It bears repeating: Do not ignore these symptoms. See your doctor right away if you have any of these symptoms.
Risk Factors for Prostate Cancer
Age
The greatest risk for prostate cancer is age. According to the American Cancer Society, prostate cancer is rare in men under age forty, but 60 percent of prostate cancers are found in men over sixty-five. The average age at the time of diagnosis is sixty-six. About 80 percent of men who reach age eighty have prostate cancer cells in their prostate glands, but that does not necessarily mean they will die of the disease.
Race and Ethnicity
In the United States, prostate cancer is more common in African-American men than in white men. White men have the second-highest rate of diagnoses, followed by Hispanic, American Indian/Alaska Native, and Asian/ Pacific Islander men.
Family History
Up to 10 percent of prostate cancers can be linked to a man's family history. Having a father or brother diagnosed with prostate cancer, especially before age sixty, doubles a man's risk.
Occupation and Chemical Exposure
Though the evidence is inconclusive, it appears that employment in some occupations places men at higher risk for prostate cancer than the general population. These occupations include agricultural workers, firefighters, soap and perfume manufacturers, leather workers, mechanics, welders, and white-collar workers.
With the exception of white-collar workers, these occupations involve exposure to chemicals, including pesticides, herbicides, and fertilizers. Depending on the type, degree, and duration of exposure, toxins may damage cells to the point where they mutate and become cancerous. Exposure to the element cadmium, which interferes with zinc absorption, is also a potential risk. Men with prostate cancer tend to have lower levels of zinc in their bodies. For white-collar workers, the risk is linked to inactivity combined with unhealthy lifestyle choices.
Being Overweight
Currently, obesity is not considered a risk factor for prostate cancer; however, men who are obese tend to have more aggressive cancers when they are diagnosed. If you exercise regularly, keep it up; if you don't, ask your doctor to recommend an exercise plan. Exercise helps maintain hormone levels, prevents obesity, and enhances immune function. Men who exercise vigorously three times a week have a lower death rate from prostate cancer compared to men who do not exercise regularly.
Smoking
Studies do not show a definite link between smoking and prostate cancer; however, those who smoke and are diagnosed with prostate cancer often have more aggressive cancers. Former smokers may be at similar risk, depending on the length of time they smoked. Smoking can damage human cells. Health experts agree that stopping a tobacco habit is one of the best things you can do for your immediate and long-term well-being.
Prostate Cancer Statistics
Second to skin cancer, prostate cancer is the most commonly diagnosed cancer among men in the United States. According to the American Cancer Society, one out of nine men will be diagnosed with prostate cancer. Approximately 60 percent of cases are diagnosed in men aged 65 or older, and it is rare in men under age 40. The average age at diagnosis is 66.
Approximately 165,000 men in the United States are diagnosed annually. Compared to other types of cancer, prostate cancer grows slowly and offers a high potential for cure. One in forty-one will die of the disease.
CHAPTER 2Getting a Diagnosis
The cure rate for prostate cancer is high when the cancer is diagnosed early. Fortunately, men are being screened for the disease more than ever before. In the years before prostate cancer screening and early detection were available, up to one-third of the men who were diagnosed were found to have advanced prostate cancer. Today, advanced cancer is found in only about 5 percent of new cases. Simply put, screening and early detection are lifesavers.
Several diagnostic tests help your doctor determine whether you have prostate cancer. These tests typically start with a simple blood test and physical exam in a urologist's office. Then, if necessary, a urologist will conduct more-sophisticated tests to reach a diagnosis.
Digital Rectal Exam
One of the initial examinations a physician will perform is a digital rectal exam (DRE). To perform this exam, a doctor will insert a gloved, lubricated index finger into the rectum, which is right behind the prostate gland. Using his finger, the doctor can feel the surface of the prostate gland; a normal prostate is soft, smooth, and symmetrical. The doctor will check for areas that may feel hard or uneven; he'll also be checking for lumps and enlargement of the gland.
These symptoms don't always indicate the presence of cancer. They may be an indication of other prostate disorders such as infection, stones, inflammation, or a noncancerous enlargement. In either case, additional tests will determine a diagnosis.
Digital Rectal Exam (DRE)
The location of abnormalities within the gland is important. Almost three-fourths of prostate cancers start in the gland's outer zone, which a doctor can feel. However, at least one-fourth of prostate cancers occur in an area of the prostate that a doctor cannot reach with a finger. That's why the PSA blood test is so important.
Prostate-Specific Antigen (PSA) Test
One of the most commonly used tests to determine the health of the prostate gland is a test that analyzes the level of prostate-specific antigen (PSA) in the bloodstream. An antigen is a substance that stimulates the body's immune response. These antigens are found in both normal and malignant tissue. Fluctuations of antigens sometimes indicate cancer.
All prostate cells, both normal and cancerous, produce PSA. However, cancerous cells multiply more quickly than normal cells; as a result, more PSA is produced. So an elevated PSA is a warning that something may be wrong and that more studies are needed. That "something" could be a number of things, including inflammation or infection; or it might be caused by recent activity that "massages" the prostate, such as riding a bicycle or motorcycle. Also, sexual intercourse can elevate your PSA by as much as 10 percent.
If your digital rectal exam is normal but your PSA is mildly elevated, your doctor will ask for a urine sample to see if you have a prostate infection (prostatitis). If you do, the doctor will probably prescribe an antibiotic and do another PSA blood test several weeks after you've finished taking the antibiotics.
Some medical experts recommend a PSA blood test starting at age forty for African-American men and men with a family history of prostate cancer. Annual screenings for other men are recommended starting at age fifty.
What Is a Normal PSA Level?
A sensitive blood test is used to measure PSA levels. A "normal" PSA level is not the same for everyone (see guidelines on the following page). The level varies depending on age and ethnicity.
Not all the experts agree on these guidelines. Some say a level above 4.0 is suspicious regardless of the patient's age. Others advise men to have more tests if their first-time PSA is 2.5 or above.
Scientists have found several ways to interpret PSA test results to form a better idea of whether cancer is causing the PSA increase. One of these is called PSA velocity (PSAV) test, which compares PSA levels over time to see how quickly they are rising. Your doctor may suspect prostate cancer if your PSA rises.
Prostate Health Index
If your PSA test results are outside the normal range, your doctor may order a test called a prostate health index (PHI). This simple blood test provides more accurate information than a standard PSA test, and it helps physicians determine whether a biopsy is needed.
If the PSA test or prostate health index test indicates you might have prostate cancer, you'll probably have at least two additional diagnostic procedures — a transrectal ultrasound (TRUS) and a needle biopsy.
Transrectal Ultrasound
For the transrectal ultrasound (TRUS) procedure, a doctor will insert a lubricated ultrasound probe into your rectum, which is just behind the prostate gland. Because ultrasound waves bounce off normal tissue differently than off malignant tissue, the TRUS probe creates a picture of the prostate and abnormalities it might contain. The doctor views the picture on a video screen.
The TRUS procedure shows the size of the prostate, but it can't see all types of tumors. Some prostate tumors are distinct lumps, which often show up on TRUS, but other prostate tumors are spread out, and TRUS seldom shows these. As a result, a normal TRUS could merely mean that you, like most men with prostate cancer, have lesions that are flat, small, and scattered.
For some men, the transrectal ultrasound is uncomfortable. If a man cannot tolerate the procedure easily, he may be given light anesthesia.
Needle Biopsy
A needle biopsy is a procedure that extracts tiny tissue samples with a needle. There are several types of biopsies. Most men tolerate biopsy procedures well, but if you know you have a low pain threshold, talk with your doctor about ways to relieve any discomfort during the biopsy. Don't feel timid about requesting one of the topical or local pain relievers available. If you wish to be given intravenous sedation to make you sleep during the procedure, your procedure will probably be performed in an outpatient surgery center.
Biopsy with Transrectal Ultrasound
This biopsy can find cancer that might be missed by a transrectal ultrasound alone. Therefore, many doctors do an ultrasound and a biopsy at the same time. The ultrasound images that are projected onto a video screen show them where to direct the biopsy needle, making the biopsy procedure more accurate.
(Continues…)
Excerpted from "Prostate Cancer"
by .
Copyright © 2018 Arthur Centeno, M.D..
Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction vii
1 Prostate Cancer: An Overview 1
2 Getting a Diagnosis 10
3 Hormone Therapy 23
4 Surgery for Prostate Cancer 27
5 Radiation Therapy 43
6 Chemotherapy 55
7 Life after Prostate Cancer 68
In Closing 83
Appendix 85
Resources 89
Glossary 93
Index 107
About the Author 119