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Have you been diagnosed with prostate cancer? If so, you join the 200,000 other men that are diagnosed with prostate cancer annually in the United States. Another 5 million men are living with the disease. The good news is that prostate cancer when detected early is very curable. And even when it is not curable, it can still be treated, giving a man many more years of life. Authors Arthur Centeno, M.D., and Gary Onik, M.D., are specialists in prostate health and prostate cancer, and understand the anxiety that often accompanies a cancer diagnosis. They have treated thousands of patients, and understand your concerns and the questions you have about treatment. In Prostate CancerA Patient's Guide to Treatment, they answer such questions as: How is prostate cancer diagnosed? What are the surgical treatment options? What is nerve-sparing surgery? What is involved with radiation therapy? What is the newer cyroablation (freezing) treatment? Do all treatments result in impotence? When is chemotherapy recommended? What is hormonal therapy
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About the Author
Arthur Centeno, MD is a certified urologist with a private practice and is an assistant professor of urology at the University of Texas Health Science Center. He lives in San Antonio, Texas. Gary Onik, MD, is the medical director of Surgical Imaging. He is known as the father of ultrasound-guided radio-frequency ablation and is the author of Percutaneous Prostate Cryoablation. He lives in Orlando, Florida.
Read an Excerpt
A Man's Guide to Treatment
By Arthur Centeno, Jack Kusler
Addicus Books, Inc.Copyright © 2014 Arthur Centeno, M.D.
All rights reserved.
Prostate Cancer: An Overview
If you, or someone you love, have been told that you have prostate cancer, your first reaction might well have been panic, numbness, despair, or a combination of these feelings. Many people experience a dizzying whirl of emotions after receiving a cancer diagnosis — anger, depression, concern for family and loved ones, fear of the unknown, and sometimes a nameless dread that comes and goes in those first days and weeks.
All this is natural and normal. You'd be less than human if you didn't grieve, at least briefly, for the loss of your "old" life.
Even so — though you might find this hard to believe right now — there are thousands and thousands of prostate cancer survivors who will tell you the diagnosis was one of the best things that ever happened to them. Once they got over the initial shock and started looking for answers and finding support, they saw life as the wonderful gift it truly is. They educated themselves about the disease and the many ways of dealing with it. They discovered that knowledge is power and learned to use that power for their own health and well-being. They forged new relationships, strengthened existing ones, and shared — perhaps for the first time — their deepest feelings and greatest fears.
Through this process, these survivors learned that prostate cancer is curable — yes, curable — when found in the early stages. And they saw how their own decisions and actions could help them stay healthy for many years to come.
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. Part of the urinary and reproductive systems, it is located in the pelvis below the urinary bladder and sits just in front of the rectum. The urethra, which carries urine and semen out of the body through the penis, runs through the prostate like a straw through a doughnut hole.
Because it is actually several small glands encased in the prostate capsule, the prostate is sometimes described as having two lobes, three lobes, or several zones. Of these, the peripheral zone, or outer zone, where most prostate cancer begins, is the largest; the muscular central zone prevents semen from backing up into the bladder during ejaculation; and the transition zone, which surrounds the urethra, is the only site for a common noncancerous disorder called benign prostatic hyperplasia (BPH).
The Prostate and Reproduction
Your prostate gland is small but mighty. It weighs between 20 and 40 grams. By comparison, a first class letter weighs 30 grams. Small as it is, the prostate is essential for normal human reproduction. It adds important fluid and nutrients to sperm during ejaculation. Among these nutrients are citric acid, potassium, calcium, and zinc.
To function properly, the prostate depends on male hormones (androgens), chiefly testosterone. Testosterone is responsible for the traits usually associated with men — body hair, deep voice, musculature, and so on. The prostate converts testosterone to another, more potent male hormone, dihydrotestosterone or DHT.
Of course, the prostate alone does not fuel the reproductive process. The testicles or testes manufacture sperm and most of the testosterone upon which the prostate depends. The adrenal glands also produce small amounts of androgens. A small gland, the epididymis, sits next to the testes, and stores sperm until they mature. Just before the male orgasm, numerous muscles work together to produce semen and pump it out of the body. These muscles squeeze seminal fluid from the prostate and from the adjacent seminal vesicles through small pores into the urethra, where two 12-inch tubes called vasa deferentia deposit sperm. The vasa deferentia and the ducts of the seminal vesicles join in the prostate to form the ejaculatory duct. During ejaculation, sperm and seminal fluid — the components of semen — travel through the urethra and exit the penis.
The Prostate and Urination
Prostate illness can interfere with your ability to urinate and in some cases can damage your kidneys and other urinary tract structures. Because the prostate surrounds the urethra, prostate enlargement can squeeze and eventually choke the urethra and make simple urination an agonizing chore.
The urinary tract begins at the kidneys, located at the base of the ribs on either side of the spine. These amazing organs are the body's main filters, cleansing impurities from about 45 gallons of water every day. Most of this water is recirculated through the body, producing only two quarts of waste, in the form of urine, in most men.
Urine travels to the urinary bladder through tubes called ureters. The bladder, located above the prostate, holds about a pint of urine. It 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 contain the flow of urine.
For this marvelous internal cleansing system to help you stay healthy, every mechanism must be in working order. Prostate disorders can harm this delicate balance and keep the structures of the urinary tract from doing their jobs.
Noncancerous Prostate Disorders
While we're discussing the urination process, let's examine two common noncancerous prostate conditions that can interfere with urination. These conditions are benign prostatic hyperplasia and prostatitis. These conditions usually do not affect younger men, but often develop after a man has reached his 40s. It is important to note that these two conditions do not cause prostate cancer, nor do they place you at greater risk for it.
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is an enlarged prostate. The enlargement comes from small noncancerous (benign) growths (hyperplasia) inside the prostate. In a man with BPH, the prostate might grow from the normal walnut size to apricot size after age 40 and lemon size by age 60.
As the prostate grows, it squeezes the urethra and makes it difficult to pass urine. BPH symptoms include urinary irregularities — frequent or urgent urination, a weak urinary stream, or difficulty urinating, for example. Even so, only about half of men with BPH require treatment. Sometimes, however, symptoms become more than a nuisance. If the bladder is unable to empty properly, urine can back up into the kidneys and impair their essential function, straining impurities from body fluids.
There are drugs on the market for treatment of BPH, but many doctors believe that medication is just a stopgap measure that postpones the inevitable. When BPH is severe, surgery may be needed, usually transurethral resection of the prostate (TURP), which requires no skin incision. Surgeons remove the overgrown prostate tissue with an instrument attached to a slender tube that is inserted through the urethra.
Prostatitis is inflammation of the prostate. Its symptoms include frequent, difficult, or painful urination. Other symptoms include pain in joints, muscles, the lower back, and the pelvis; pain during ejaculation; aches, fever, chills, and blood in the urine.
Acute bacterial prostatitis, caused by bacteria, afflicts many men between 40 and 60 years of age. Chronic bacterial prostatitis, different from the acute form by being recurrent and longer lasting, is more often found in men between 50 and 80. Bacterial forms of prostatitis are sometimes referred to as prostate infections.
Nonbacterial prostatitis, which is of unknown cause, occurs most often in men from 30 to 50. Though antibiotics are usually effective against bacterial prostatitis, the nonbacterial form has no known cure. Like arthritis and other chronic ailments, however, nonbacterial prostatitis is treatable with anti-inflammatory drugs.
Cancer is a collection of cells that are growing out of control. How does this happen? Healthy cells have predictable growth limits and life spans. Not only do cancer cells grow past normal limits, they don't die when they're supposed to. Instead, they divide and spread, sometimes uncontrollably.
A mass of cancer cells is called a tumor, but not all tumors are cancerous. A benign tumor might grow and squeeze nearby organs, but it does not spread in an aggressive or life-threatening way. Cancer cells, however, can break away from a primary malignant tumor site and spread, or metastasize, to nearby organs or to distant sites through blood or lymph vessels. Cancer destroys normal tissue and creates new tumors as it spreads.
How does cancer spread through the lymph system? Lymph is a fluid that bathes every living cell in the body. You sometimes see this clear fluid escaping when you skin your knee, for example. Lymph fights cancer by draining waste from cells, carrying it through vessels and into lymph nodes, which filter the fluid and remove harmful substances. Sometimes, however, there are more cancer cells than the lymph nodes can handle, and the lymph vessels themselves become vehicles for spreading cancer.
In the United States, prostate cancer is second to skin cancer as the most common cancer among men and the second most common cause of cancer death among men after lung cancer. One out of six men will be diagnosed with prostate cancer during their lifetime and one in 36 will die from it. In 2010, an estimated 217,730 new cases will be diagnosed More than two million Americans are living with diagnosed prostate cancer right now.
However, not all cancers offer the potential for cure that prostate cancer does. And of more than 100 types of cancer that occur in the United States, prostate cancer is comparatively slow growing. Many men with microscopic prostate cancer never know they have it and eventually die from unrelated causes. In fact, most men with prostate cancer do not die from prostate cancer.
This doesn't mean you should ignore symptoms or delay seeking treatment, however. Untreated, prostate cancer can spread within the prostate capsule and outward to seminal vesicles, lymph nodes, bones, lungs, liver, and elsewhere in the body.
Typically, prostate cancer starts in the peripheral zone of the gland. Male hormones, especially testosterone, stimulate growth of both normal and cancerous cells in the prostate. Accordingly, testosterone fuels prostate cancer growth.
Symptoms of Prostate Cancer
Early prostate cancer has no symptoms. You could be feeling hale and hearty when you are diagnosed. For many 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.
If prostate cancer grows enough to exhibit symptoms, they are much like those of noncancerous prostate disorders. 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
Pain or burning during urination
Needing to strain to urinate
Less rigid erections than normal
Pain during ejaculation
Less ejaculate (semen) than normal
Though such symptoms may not indicate prostate cancer, they should never be ignored. Almost any disease, no matter how minor it is in the beginning, can be dangerous if left untreated.
Prostate cancer that has spread beyond the gland itself can cause a range of symptoms, depending on where the cancer is located. Such symptoms include pain, sometimes intermittent, in the back, ribs, hip, or shoulder; 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, whether difficulty urinating or intermittent aches and pains, as "normal signs of aging." It bears repeating: See your doctor right away if you're experiencing symptoms you can't easily explain.
Risk Factors for Prostate Cancer
All men are at risk for prostate cancer. The most common risk are listed below.
Age: Rarely are men under age 40 diagnosed with prostate cancer, but the risk increases rapidly after age 50. Two-thirds of prostate cancers are found in men aged over 65.
Family history. Having a father or brother diagnosed with prostate cancer, especially at a young age, seems to indicate an inherited risk for prostate cancer. The risk is three to five times higher for men with several first-degree relatives (father, brothers) with the diagnosis; two to three times higher for men with a father or one brother with the disease; and higher for those whose brothers have prostate cancer than with similarly diagnosed fathers. Genetic research is underway to identify inherited risk factors, however the mutations identified to date account for only a very small percentage of cases.
Race and ethnicity. In the United States, African American men are at higher risk for prostate cancer than any other race. They are also more likely to be diagnosed at a later stage and twice as likely to die of prostate cancer than White men. Asian-American and Hispanic/Latino men are less likely to die of prostate cancer than non-Hispanic White men. Prostate cancer is most commonly diagnosed in men in Australia, the Caribbean, North America, and northwestern Europe. No one is sure why there is a racial disparity; research tends to show it may be due to diet, exercise, and other lifestyle choices. Like men with a family history of prostate or breast cancer, African American and Hispanic men should have annual prostate screenings starting at age 40.
Occupation. Though the evidence is inconclusive, it appears that employment in some occupations place men at higher risk for prostate cancer than the general population. These include: agricultural workers, soap and perfume manufacturers, leather processing and leather workers, white-collar workers, mechanics, and welders. With the exception of white-collar workers, exposure to pesticides, herbicides, fertilizers and other chemicals may subject men them to enough "insults" at the cellular level to cause cells to 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. White-collar workers appear to be at higher risk due to being inactive most of the day combined with other risky lifestyle choices.
Lifestyle: whether or not you have been diagnosed with prostate cancer, lifestyle choices you make can affect the quality of your overall health as well as how long you live.
In 2011, results from an ongoing eighteen-year study showed that exercise significantly reduced death rates in participants diagnosed with prostate cancer. Men reported the average intensity and time per week they exercised. Those involved in vigorous activity (more than three hours per week of running, swimming, cycling, etc.) had a 61 percent lower risk of dying from prostate cancer compared with men who did less than one hour per week of vigorous activity. Those who walked less than 90 minutes per week at an easy to very brisk pace had a 46 percent lower risk of dying from any cause.
Men who smoke have nearly a 55 percent increase in prostate cancer, and even former smokers have higher risks varying on how long they smoked and how much tobacco they inhaled every day. Men who smoked heavily had a 24 to 30 percent increase in fatal cases of prostate cancer.
Research continues in the areas of heredity and environment as the likely cause of most prostate cancers.
Preventing Prostate Cancer
For more than a decade, scientists have known that a high-fat, low-fiber diet greatly increases the likelihood of cancer. Over and over, research has shown that a more healthful diet not only decreases the likelihood of cancer, it may slow cancer's growth. A southern Mediterranean diet emphasizing olive oil and cooked vegetables or a rural Japanese diet — high in rice, fish, soy, vegetables, and green tea — may actually prevent prostate some cancers and help prevent recurrences.
Excerpted from Prostate Cancer by Arthur Centeno, Jack Kusler. Copyright © 2014 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
1 Prostate Cancer: An Overview,
2 Getting a Diagnosis,
3 Surgery for Prostate Cancer,
4 Radiation Therapy,
5 Prostate Cryoablation,
6 Hormone Therapy,
8 Life after Prostate Cancer,
About the Author,