Symptoms appear too late

The American Cancer Society estimates in 2013 there will be approximately a quarter of a million new cases of prostate cancer and about 30,000 deaths resulting from it. One in six men will suffer from prostate cancer in his lifetime.

The National Institutes of Health describes the prostate as a small, walnut-shaped organ in the male reproductive system that produces a uid component to semen. Prostate cancer is a cancer or uncontrolled division of abnormal cells, which originates in the prostate gland.

Dr. Loren Smith is a boardcerti ed urologist at Willis- Knighton Pierremont.

“The prostate is an organ found in men which lies inside the body between the bladder and the penis. Prostate cancer is a disease, which occurs in men, and it becomes more common in men as they age. Prostate cancer tends to act more aggressively in younger men than older, although this is not always the case,” Smith said.

The NIH lists the following groups as having an increased risk of prostate cancer:

• African-American men;

• Men who are older than 60 years of age;

• Men who have a father or brother with prostate cancer;

• Men who use too much alcohol;

• Men who eat a diet high in fat, especially animal fat;

• Men who have had signi cant exposures to cadmium, “agent orange;” and

• Farmers, tire plant workers and painters also have an increased risk.

“Prostate cancer is a very curable disease. Generally, we think of surgery and radiotherapy as treatments with ‘curative intent.’ This means that following treatment, we want the PSA level to remain undetectable or very low. Prostate cancer tends to be a slow-growing tumor in many cases, so although patients want their cancer cured, managing the cancer and keeping it from growing or spreading is often as effective for patients. I tell patients my goal for therapy is to cure or control the cancer so they will die from some other cause. No treatment we have for prostate cancer cures it 100 percent of the time and even with a well thought-out plan and treatment execution men can have a recurrence of the cancer. Because of this, I tell men with prostate cancer to think of this as a disease, which may require us to react and offer additional treatments.”

Smith said, “Most men who have prostate cancer feel ne and would never know they have the disease unless they actively get screened for the disease. This generally includes a prostate-speci c antigen blood test, also known as PSA and a digital rectal exam or DRE. Neither exam is as sensitive as we would like, but combined they are the best tests available for determining a man’s risk for cancer. If either of these is abnormal, we recommend a prostate biopsy to determine if cancer is present on the gland.”

According to the NIH, PSA testing nds most prostate cancers before they cause any symptoms. The symptoms listed below can occur with prostate cancer, usually at a late stage (but individually may indicate problems other than prostate cancer):

• delayed start of urine,

• leakage of urine, usually after urinating,

• slow urinary stream,

• straining and being unable to completely empty the bladder during urination,

• blood in the urine or semen,

• bone pain or tenderness, especially in the lower back and pelvis (indicating that cancer may have already spread).

Smith warned, however, against depending on symptom onset to trigger prostate examination.

“Unfortunately, if a man has symptoms from his prostate cancer, he has advanced disease, which will likely be dif cult to manage. Because of this, we tend to recommend active screening of men for the disease.”

However, Smith also added, “The [American Urological Association] has recently changed its recommendations regarding screening. There is a lot of debate about the effectiveness of PSA testing because we know that we over-diagnose and over-treat prostate cancer in this country.

“Prostate cancer is likely in uenced by genetics as well as an individual’s environment. The best thing a man can do to prevent prostate cancer is live a healthy life. Low-fat diet combined with exercise and maintaining a reasonable weight are important. There has been evidence to suggest that vitamin supplements like zinc and selenium, as well as some of the nutrients found in tomato products, may promote prostate health. Also, taking nasteride, a medicine, which blocks the conversion of testosterone to one of its active forms, may reduce the risk of developing prostate cancer.”

Smith recommends all men ages 55 to 75 be screened and men with a father or brother with the disease start screening earlier – about age 40.