Why all the fuss??

Prostate cancer is the most common cancer among males. Although prostate cancer can be slow growing, the disease nonetheless accounts for 10% of cancer-related deaths in males, with thousands of men dying from prostate cancer each year. This form of cancer develops in a gland in the male reproductive system called the prostrate. There are known, well documented cases of aggressive prostate cancers, though most are known to be slow growing. 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.

With the development of Prostate-Specific Antigen (PSA) screening, however, prostate cancer is being diagnosed earlier in the disease course than it was prior to PSA examination. Currently, most cases of prostate cancer are found because of abnormalities in a screening PSA level or findings on Digital Rectal Examination (DRE) rather than because of symptoms.

Rates of detection of prostate cancers vary widely across the world, with Africa and for that matter Ghana detecting it less frequently than in Europe, and especially the United States. Prostate cancer tends to develop in men over the age of fifty and although it is one of the most prevalent types of cancer in men, many never have symptoms, undergo no therapy, and eventually die of other disease causes. This is because cancer of the prostate is, in most cases, slow-growing, symptom-free, and since men with the condition are older they often die of causes unrelated to the prostate cancer, such as heart/circulatory disease, pneumonia, other unconnected cancers, or old age. About 2/3 of cases are slow growing, the other third more aggressive and fast growing.

The PSA test increases cancer detection but does not decrease mortality. Suspected prostate cancer is typically confirmed by taking a biopsy of the prostate and examining it under a microscope. Further tests, such as CT scans and bone scans, may be performed to determine whether prostate cancer has spread.

Treatment options for prostate cancer with intent to cure are primarily surgery, radiation therapy, and proton therapy. Other treatments, such as hormonal therapy, chemotherapy, cryosurgery, and High Intensity Focused Ultrasound (HIFU) also exist, depending on the clinical scenario and desired outcome.

The age and underlying health of the man, the extent of metastasis, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-of between the expected beneficial and harmful effects in
terms of patient survival and quality of life.

It is an important gland to man!
The prostate is a part of the male reproductive organ that helps make and store seminal fluid. In adult men, a typical prostate is about 3cm long and weighs about 20g. It is located in the pelvis, under the urinary bladder and in front of the rectum. The prostate surrounds part of the urethra, the tube that carries urine from the bladder during urination and semen during ejaculation. Because of its location, prostate diseases often affect urination, ejaculation, and rarely defecation. The prostate contains many small glands which make about twenty percent of the fluid constituting semen. In prostate cancer, the cells of these prostate glands mutate into cancer cells. The prostate glands require male hormones, known as androgens, to work properly.

I’ve got this all figured out! Really?
Several risk factors predispose an individual to the development of prostate cancer and these are as follows:

Advancing age: Prostate cancer is very uncommon in men younger than 45, but becomes more common with advancing age. The average age at the time of diagnosis in Ghana is 65.

Family history / Genetic: Men who have first-degree family members with prostate cancer appear to have double the risk of getting the disease compared to men without prostate cancer in the family. This risk appears to be greater for men with an
affected brother than for men with an affected father.

Diet: Evidence from epidemiological studies supports a possible protective role in reducing prostate cancer for dietary Vitamin B6, selenium, vitamin E, and soy foods. Lower blood levels of vitamin D may increase the risk of developing prostate cancer. High cholesterol diet also increase the risk of developing prostate cancer, as studies have shown that obesity and increased blood testosterone levels increase the risk of developing prostate cancer. High alcohol intake may increase the risk of prostate cancer.

Medication exposure: Folic acid supplements have recently been linked to an increase in risk of developing prostate

cancer. Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk.

Infection: Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer while another study shows infection may help prevent prostate cancer by increasing blood to the area. In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk

Comorbidities (Hypertension): Men with high blood pressure are more likely to develop prostate cancer.

Signs & Symptoms
No symptoms
Bloody urine
Bloody ejaculate
Lower back pain
Bone pain
Fractures without any trauma
Spinal cord compression – paraplegia(weakness in limbs or inability to walk)
Urinary and faecal incontinence.

International Prostate Symptom Score(IPSS)
The International Prostate Symptom Score (IPSS) is an 8-question (7-symptom questions +1 quality of life question) written screening
tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the
disease Benign Prostatic Hyperplasia (BPH). It is scored from 0 – 35.

The IPSS was designed to be self-administered by the patient, with speed and ease in mind. Hence, it can be used in both urology clinics as well as the clinics of primary care physicians (i.e. by general practitioners) for the diagnosis of BPH. Additionally, the IPSS can be performed multiple times to compare the progression of symptoms and their severity over months and years. In addition to diagnosis and charting disease progression, the IPSS is effective in helping to determine treatment for patients.

Okay! So now what?
Treatment for prostate cancer may involve active surveillance (monitoring for tumor progress or symptoms), surgery (i.e. radical prostatectomy), radiation therapy, among others. However, the most effective treatment option is bilateral orchidectomy (testes removal) for low grade, early detected prostate malignancy.

Which option is best depends on the stage of the disease and the PSA level. Other important factors are the man’s age, his
general health, and his feelings about potential treatments and their possible side-effects. Because all treatments can have significant side-effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations. Prostate cancer patients are strongly recommended to work closely with their physicians and use a
combination of the treatment options when managing their prostate cancer.

Castration? You must be joking!
Well, there’s never a dull moment in the practice of medicine and controversy certainly comes with the territory. As originally stated, the prostate gland requires male hormones (androgens) to function properly and these androgens are also required for the malignant
transformation witnessed when the prostate gland becomes cancerous. That begs the question. Why not get rid of these androgens especially when a man has had all his children and completed his family? Androgens are mainly produced in the testes (testosterone) and thus CASTRATION REMAINS THE SUREST WAY TO PREVENT PROSTATE CANCER. Never a dull moment, right? Certainly worth a mention!

Written by: Senyo Norgbey


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