PROSTATE cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes.
Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.
The term “cancer” refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably. Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process.
Prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumors. A prostate gland is found in male mammals only. It is the most common form of cancer amongst men who are over 50 years old; it causes the second highest number of deaths among men diagnosed with cancer (after lung cancer).
A recent survey demonstrates that men under the age of 40, the chance of getting prostate cancer is about one in 100,000. For men aged between 70 and 74 years old, the chance rises to 1,326 in 100,000.
It is projected that “one man in six men will get prostate cancer during his lifetime” (American Cancer Society – ACS 2008). Of all men diagnosed with cancer each year, more than one fourth has prostate cancer.
“Prostate cancer has no social boundaries” (Desmond Tutu). “One man in 32 will die from this disease”. With all that the earlier prostate cancer is detected, the more easily and effectively it can be treated.
The most common sites for prostate cancer to metastasize are the seminal vesicles, the lymph nodes, the lungs, and various bones around the hips and the pelvic region. Metastasis is the process by which cancer cells travel from one part of the body to another. The effects of these new tumors are what can cause death.
Warning signs
While the warnings for prostate cancer are evident, the symptoms include weak or interrupted flow of urine, inability to urinate or difficulty in beginning to urinate, difficult holding back urine, frequent need to urinate, especially at night, and bed-wetting.
Also urine flow that is not easily stopped, painful or burning urination, burning sensation when urinating, difficulty in having an erection, painful ejaculation, blood in urine or semen, continuing pain in lower back, pelvic, or upper thighs and loss of appetite and weight.
Diagnosis
The first step in diagnosing prostate cancer is usually a digital rectal examination. In a digital rectal examination, a doctor places a gloved, lubricated finger into the patient's rectum. The doctor feels for lumps in the prostate.
If the doctor detects a lump, additional tests may be necessary and the first test may be a blood test. The purpose of a blood test is to search for a particular chemical associated with prostate cancer. This chemical is called prostate-specific antigen (PSA). PSA occurs naturally in the blood, but it occurs in much higher amounts if prostate cancer is present.
Call to screening
Looking at these symptoms many elders become shy, are reluctant to get tested, for fear of stigma as they associate such symptoms with that of sexual transmitted diseases (STD). Many turn to the hospital when the disease has advanced.
It is imperative for men over 50 years of age to undergo testing for prostate cancer at least once per year. And the reality is that the earlier the cancer is detected, the better the chances of making recovery.
Testing for prostate cancer
Two tests which can be performed quickly and easily in a physician’s office are the Prostate-Specific Antigen (PSA) blood test, and the Digital Rectal Exam (DRE).After these tests, in order to really confirm that one has prostate cancer, a physician may require other tests such as ultrasound and needle biopsy.
Treatment
There is no 'one size fits all' treatment for prostate cancer, so each man must learn as much as he can about various treatment options and, in conjunction with his physicians, make his own decision about what is best for him.
Consultation with all three types of prostate cancer specialists, a urologist, a radiation oncologist and a medical oncologist, will offer the most comprehensive assessment of the available treatments and expected outcomes.
The two most common forms of treatment for early prostate cancer are surgery and radiation. Surgery involves the removal of the prostate gland. In addition, a sample of the lymph nodes near the prostate is removed. This sample is then tested to see whether the cancer has spread.
Removal of the prostate also involves removal of the seminal vesicles that lie next to it. The seminal vesicles are the organs that make semen. Since they are usually removed along with the prostate, the patient usually becomes sterile as a result of the operation.
Prevention
There is no way to prevent prostate cancer, however, early detection can dramatically reduce the threat posed by the disease. The American Cancer Society (ACS) recommends that all men over the age of 40 have an annual rectal examination. The ACS also recommends an annual PSA test once a year for men over the age of 50.
The most common serious complications of surgery are loss of urinary control and impotence. Reported rates of both complications vary widely depending on how they are assessed, by whom, and how long after surgery, as well as the setting (e.g., academic series vs. community-based or population-based data).
Risk factor
The risk factors for prostate cancer, including age, family history, ethnicity, diet, alcohol and smoking, bodyweight and physical activity, medications and medical procedures and medications, endogenous hormones and diabetes mellitus.
No modifiable risk factor for prostate cancer has been identified and therefore, at present, there is insufficient evidence on which to base a prevention strategy. The established risk factors are age, family history and ethnicity.
Many other factors have been studied but the evidence is inconclusive. One reason for this may be that different factors are involved in the development and promotion of aggressive disease compared to non-aggressive disease, making epidemiological studies of prostate cancer particularly complex.
Interpretation of prostate cancer risk factors has been further complicated in the PSA era, when identification of many prostate cancers is dependent on a threshold PSA level, which in turn is affected by other exposures such as body mass. This blurs the distinction between ‘cases’ and ‘controls’ leading to the possibility of PSA-detection bias.
Tanzania 50 plus Campaign
This campaign was initiated by the Center for Human Rights Promotion (CHRP) with the primary goal of the campaign which is to reduce the sufferings and deaths caused by prostate cancer.
That will be achieved through education, awareness, dissemination of information on the disease; encourage check-up; extend support, care, treatment and capacity building. As health is a human right issue, the campaign implementation will be a right based approach.
“I am a prostate cancer survivor. The first cancer cell started to develop in my prostate at the age of about 51 (1997). Even though I had a habit to do medical check-up yearly, no doctor asked or suggested to me to do a prostate cancer screening,”says Dr Emmanuel Kandusi who is the Campaign Coordinator of Tanzania 50 Plus Campaign.
He adds: “And even in 2007 when I started getting warning signs such painful and burning sensation when urinating, the doctor ordered for a routine check-up just to be cleared NAD. Of course prostate cancer cannot be detected through urine routine check-ups! It wasn’t until sometime July 2008 when things went to the worse that the doctor ordered for a PSA test which gave a score 100ng/ml (normal is 0-4 ng/ml).”
The doctor says he was alarmed and did a DRE test and later needle biopsy which confirmed” I had an advanced prostate cancer. Most of 2008 was miserable for me. I couldn’t work; I lived through hand-outs from my relative and friends.”
“In pains and agony, hopeless and despair, I had to fly to Indraprastha Apollo Hospital, New Delhi, India. After thoroughly check-ups my really PSA score was found to be 4517 ng/ml and an advanced adenocarcinoma (cancer) of the prostate Gleason’s Grade 8 (4+4).
“The team of doctors suggested two therapies - surgery or hormone therapy by injection. I opted for surgery. After surgery I am now under medication taking one Bicalutamide Tablet 50 gm daily. I wish my prostate cancer was discovered early. The Chinese proverb says, ‘To know the road ahead, ask those coming back’. I am the one coming back and so share my experience”.
“With this testimony I now urge my fellow men if you are approaching or you are over 50 years of age, please see your doctor for medical check-ups which should include prostate screening and urge medical doctor to suggest prostate screening to their 50 plus patients.
“This will lead to the community understanding of prostate cancer and so result to an increase of over 50 years of age male attendance to hospitals for prostate check-ups, care, support and treatment. The campaign will strive to serve prostate cancer survivors enhance the quality of life and at the same time extending counseling to their spouse and families,” says the doctor.