Yasmin Williams - HEALTH-WISETHE PROSTATE gland is at the base of the bladder surrounding the upper part of the urethra which is the tube that runs along the length of the penis facilitating the passage of urine from the bladder as well as semen from the testes, seminal vesicles and the prostate gland. The prostate gland forms the fluid for the sperms.
After skin cancer, prostate cancer is reported as the most common cancer in men in the USA while in Jamaica, it is the most common cancer in men. Jamaica is said to have an extraordinarily high rate of prostatic cancer. In Kingston and St. Andrew, the incidence has been cited as 304/100,000 men/year.
Factors influencing the development of cancer include race (more common in men of African descent); age (occurs in men over 50 years, but most are over 65 years); family (having two first degree relatives affected has been said to increase the risk by as much as 10 times).
ROLE OF DIET IN PREVENTION
Fat increased fat intake appears to increase risk.
Soya protein may prevent prostate cancer. Soya contains antioxidants called isoflavones and antioxidants work at the level of the cells in the body to prevent damage which may lead to cancer.
Tomatoes high intake appears to be associated with a lower incidence of prostate cancer. Lycopene is the active agent in the tomato.
Green tea said to be associated with decreased risk. Likely due to its antioxidant properties.
Vitamin E associated with a decrease in incidence of prostate cancer.
Selenium supplements possibly useful in prevention. Currently there is a study funded by the National Cancer Institute in the USA called "The Selenium and Vitamin E Cancer Prevention Trial" (SELECT). In this study 200ug of selenium and 400IU of Vitamin E are given to eligible men who will be followed up for seven to 12 years to further investigate the prevention role of these specific antioxidant agents. Earlier studies in 1996 and 1998 had suggested a role for these agents. Selenium is found in seafoods, meats, brazil nuts while Vitamin E is found in egg yolk, nuts and vegetable oils.
Studies have suggested that exercise and increased physical activity is associated with a lower likelihood of prostatic cancer as well as colon cancer, another common cancer occurring in black males over 50 years. There is no association between prostate cancer and sexual activity or sexually-transmitted diseases.
TREATMENT FOR
PROSTATIC CANCER
1. Watchful waiting may be done if cancer is in the early stage. Would need regular follow up with testing. This would be done to avoid possible side effects from therapy for example, impotence and incontinence (difficulty with controlling urine).
2. Surgery
3. Radiation
4. Hormone therapy
5. Chemotherapy
SEX AFTER TREATMENT FOR PROSTATIC CANCER
Surgical treatment and radiotherapy may cause damage to the nerves running beside the prostate gland. These nerves are necessary to obtain a penile erection. Early-stage disease lends itself to less invasive treatment and more likelihood of preservation of these nerves. In the event that the nerves are damaged, the sensitivity of the penis remains intact and therefore a man can still experience orgasm.
SYMPTOMS AND SIGNS OF
PROSTATIC CANCER
May be asymptomatic
May present with generalised symptoms for example, poor appetite, weight loss, weakness.
May present with signs and symptoms of metastatic spread (spread to other organs) for example, patient may have low back pain because of spread to vertebral bone.
It is known that there are microscopic areas of prostate cancer in many men. It has been said that as much as 30 per cent of all men who are age 50 years and over have these minute areas but only a small percentage of these men will progress to become cases of clinically significant prostatic cancer. The dilemma is that there is no way to ascertain who will progress.
TAKE HOME MESSAGE
The take home message today is that we should look at preventing cancer of the prostate at two levels:-
1) Primary prevention have a healthy lifestyle with appropriate diet and adequate physical activity.
2) Secondary prevention early detection of prostate cancer by digital rectal examination, PSA blood test and ultrasound and biopsy of the prostate if indicated.
Dr. Yasmin Williams is a Family Doctor and Public Health Specialist.
