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Man's Hidden And Common Cancer

By: Ian Maclean Smith, M.D.

You probably don't know about the sex gland called the prostate. You know about the testicles. There are also other sex glands called the seminal vesicles, two pouches attached to the back of the bladder. All these glands produce the ejaculate at the time of male orgasm. The milky fluid component of this comes from the prostate. The prostate gland, about the size of a walnut, surrounds the tube that leads out of the bladder into the penis.

First some facts. Cancer of the prostate is often without symptoms and is frequently diagnosed first of all by routine rectal examination and a blood test Prostate Specific Antigen (PSA). The exam should be repeated yearly. The cancer is often microscopic and stays that way or develops slowly over a period of years into a cancer that can be felt by rectal examination.

One of every 9 men will develop prostate cancer in their life time; Afro-Americans more often than white Americans and the average age of detection was 72, but is now less because of PSA. The symptoms are very like those of benign enlargement of the prostate. The two diseases have no connection with each other but can occur together in the same prostate gland. Unfortunately, for lack of the habit of yearly examination, 50% of the cancers present themselves to the doctor late in the disease. The rectal examination is a very important single test, and is also a screen for rectal and colon cancer. We were taught in medical school, "If you don't put your finger in the rectum, you'll put your foot in it".

Prostate cancer is the most common cancer in men (except for skin cancer). It is the second most common cause of cancer deaths in men, after lung cancer. There will be 220,900 new patients diagnosed this year and 28,900 deaths from this kind of cancer. The risk factors for developing it are these: maleness, age, and being a member of the black race. In many cases, there may be a familial tendency to develop prostate cancer, particularly if found in primary relatives such as a father or a brother. We know for sure that the male hormone testosterone is needed to develop it and a high fat, lower fiber diet and smoking contribute. An intriguing fact is that cancer of the prostate is very uncommon in Japanese males, but, when they immigrate to the United States, they begin to develop the higher rates of native-born Americans.

How do you know you have prostate cancer? Sometimes you have no symptoms but many will develop symptoms of urine obstruction with a weakened urine flow. You may have to urinate more often, and may dribble after you've finished urinating. You may have burning or bloody urine. If the prostate cancer isn't diagnosed early, the cancer may spread, causing pain in the lower back, hip girdle, or thighs. Later you may lose weight and become pale with anemia from too little blood.

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The good news is that if the prostate cancer is detected early, it is almost 90% curable. The crucial message to you is to go your doctor for a check up if you have any of these symptoms or go routinely yearly over age 50. The initial clue could be an elevated blood PSA or the rectal examination when the prostate, felt through the gloved finger, is enlarged, lumpy and hard in certain areas. This abnormal prostate has to be differentiated from the non-cancerous benign prostatic hypertrophy and a few less common diseases. If the urologist has reason to suspect cancer, he or she will do a transrectal ultrasound image and then take a needle biopsy through the rectum. The diagnosis can then be made and the degree of malignancy can be assessed. This requires a very sophisticated microscopic system by which the cancer is classified into very well organized or poorly organized cells. The former is less likely to spread. A bone scan and CT scan may be used to rule out spread.

The treatment options depend on the stage of the tumor.

If the tumor is localized to the prostate, surgery is done through the area between the scrotum and the anus (perineal) or through the lower abdomen (retropubic). Radiation therapy uses high energy rays or tiny radioactive gold pellets directly implanted in the tumor.

The pellets are so small that they don't cause any discomfort. The advantage of radiation may be that it less commonly causes loss of urinary control and it leads to impotence less frequently than surgery. If the tumor has spread, hormone therapy slows the cancer's growth and reduces the size of the tumor and helps relieve symptoms. The primary goal of hormone treatment is to decrease the production of testosterone which can be done by giving female hormone or by surgical removal of the testicles. Another way is to use luteinizing hormone, releasing hormone agonist, or LHRH analogue, which is given by injection once a month. An anti-androgen, that is a drug that cancels out the effect of testosterone, may be given with this and is called flutamide. This is given by mouth. Chemotherapy may be an additional means to get relief in patients with advanced prostate cancer.

Not all the facts are in yet about cancer of the prostate. For example, at least 30% of men over 50 have evidence at death of cancer of the prostate if a careful autopsy is done, but less than 2% of men die of this cancer.

Make sure that you do not die of prostate cancer. Have a yearly rectal examination with appropriate blood tests to make sure that if you are one that has the disease that it is discovered early and eradicated promptly. A decision to go to the doctor is worth more than 10,000 excuses.