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The Long Version

Prostate Cancer Awareness Week (pcaw.org) has compiled information on the issue of Prostate Cancer.

The Long Version:

Prostate Enlargement (Benign Prostatic Hypertrophy)

Prostate Cancer

Impotency

 

What is the prostate?


The prostate is a doughnut-shaped cluster of glands located at the bottom of the bladder about halfway between the rectum and the base of the penis. It encircles the urethra, the tube that carries urine from the bladder out through the penis. The walnut-sized gland produces most of the fluid in semen. Contraction of the muscles in the prostate squeeze fluid from the prostate into the urethral tract during ejaculation. It makes up the bulk of the ejaculate and nourishes and transports the sperm.

Cancer of the prostate is the leading cause of cancer death among non-smoking American men and African-American men are 2 ½ times more likely to get the disease than any other ethnic group in the world. It is still unknown exactly why African-American men have the highest incidence of prostate cancer in the world. Research has shown, though, that they typically develop the disease earlier than white Americans, but are diagnosed with it later, so their mortality rate is much higher than that of whites. One of every eight African-American men will develop the disease in his lifetime. It is primarily a disease of aging. Men in their thirties and forties rarely develop prostate cancer, but the incidence increases steadily after the age of fifty-five. Approximately 80 percent of all cases occur in men over the age of sixty-five and by the age of eighty, 80 percent of all men have prostate cancer to some degree. The American Cancer Society estimates that more than 381,000 new cases of prostate cancer will be diagnosed in 1998 and over 41,000 men will die of the disease. A male baby born today has a 13 percent change of developing prostate cancer at some time in his life, and a 3 percent change of dying from the disease. Many experts feel that every man will eventually develop prostate cancer if he lives long enough.

The three most common prostate problems are: infection (prostatitis), prostate enlargement (benign prostatic hupertrophy), and prostate cancer.

Currently, both the American Urological Association and the American Cancer Society recommend annual rectal exams as part of a man’s annual health checkup for all men from ages 40 to 70, and beginning at age 40 for men at high risk (African-American men and those with a family history of the disease)and all men 50 and over add a PSA blood test every year as well. According to Dr. Crawford, these guidelines might need to be redefined. When prostate cancer is detected and treated in its early stages, it has a high cure rate. They encourage discussing the options with your medical care practioner.

Based on past screenings conducted during Prostate Cancer Awareness Week, Dr. Crawford and his colleagues have observed that in men ages 50 to 59, the prostate cancer detection rate was the same regardless of whether they were screened every year or every two years. For men between the ages of 60 and 70, thought, the prostate cancer rate was higher if they only were screened every two years versus annually. Therefore, it may only be necessary for normal-risk men in their 50s to be screened every other year. Dr. Crawford also suggests that high-risk men between the ages of 35 and 39 and normal-risk men between the ages of 45 and 49 should get a baseline PSA test. This recommendation is based on PCAW data revealing that the majority of positive biopsies in high-risk men screened between the ages of 40 and 49 were detected in their first year of screening. Further studies indicated that 95 percent of all prostate cancers among high-risk men were found in the first two years of a man’s screenings. "Because we have no cure for advanced prostate cancer, early diagnosis and treatment are essential," Dr. Crawford said. "Asymptomatic men can ‘choose to know’ if they have prostate cancer so that they can ‘know to choose’ from treatment alternatives that can cure their cancer." Because early prostate cancer usually does not have any symptoms, it is extremely difficult to detect without testing. In fact, screenings using both PSA and DRE tests have proven to be the only reliable method of identifying the disease when it can be cured most easily. Currently, 58 percent of all cases are discovered while the cancer is still localized and at its most curable stage. You doctor can detect prostate cancer by digital rectal examination (don’t die from embarrassment) and by a PSA (prostate-specific antigen) blood test.

Prostate infection (Prostatitis)

Prostatitis, common in men of all ages, is the inflammation of the prostate gland. The usual cause is infectious bacteria that invade the prostate from another area of the body. Hormonal chances associated with aging may also be a cause. The inflammation can result in urine retention. This causes the bladder to become distended, weak, tender and itself susceptible to infection. Infection in the bladder is in turn early transmitted up the urethras to the kidneys.

There are two types of prostate infection, acute and chronic. Acute infections come on suddenly and have some or all of the follow symptoms: Fever and chills, pain and burning on urination and ejaculation, strong and frequent urge to urinate while passing only small amounts of urine, lower back or abdominal pain, blood in the urine (occasionally). Symptoms of chronic prostatitis are usually milder than those of an acute infection and fever and chills are usually not present. Either infection may occur with a urinary tract infection.

Sometimes, men will have painful urinary symptoms without infection. This condition may be called prostatodynia and is often related to stress or anxiety. Prostate infections usually respond well to home care and antibiotic treatment. If the infection recurs, long-term antibiotic treatment may be needed.

Prostatitis Treatment Options

Options for the home treatment:

Other treatment options:

When to call a doctor

It's time to check with your doctor:

Prevention of prostatitis

Ways to prevent prostatitis:

Prostate Enlargement (Benign Prostatic Hypertrophy)

As men age, the prostate may enlarge. This seems to be a natural process and is not really a disease. Benign prostatic hypertrophy is the gradual enlargement of the prostate. It occurs in approximately half of all men over the age of fifty and three quarters of men over seventy years of age - a total of about 10 million American men - and is largely attributable to hormonal chances associated with aging. After the age of fifty or so, a man’s testosterone and free testosterone levels decrease while the levels of other hormones, such as prolactin and estradiol, increase. This creates an increase in the amount of dihydrotestosterone - a very potent for of testosterone - within the prostate. This causes a hyperplasia (overproduction) of prostate cells, which ultimately results in prostate enlargement. While not cancerous, however, as the gland gets bigger, it tends to squeeze the urethra and cause urinary problems. If it becomes too large, it obstructs the urethral canal, interfering with urination and the ability to empty the bladder completely. Because the bladder cannot empty completely, the kidneys also may not empty as they should. Dangerous pressure on the kidneys can result. In severe cases, the kidneys may be damaged both by pressure and by substances in the urine. Bladder infections are associated with both prostatitis and enlarged prostate.

The major symptom of enlargement of the prostate is the need to pass urine frequently, with frequency increasing as time goes on. A man may find himself rising several times during the night to urinate. There can also be pain, burning and difficulty in starting and stopping urination. The presence of blood in the urine is not uncommon.

An enlarged prostate gland is not a serious problem unless urination becomes extremely difficult, or backed-up urine causes bladder infections or kidney damage. Some dribbling is very common and not necessarily a sign of prostate problems.

Surgery is usually not necessary for an enlarged prostate. Although surgery used to be a common treatment, recent research shows that most cases of prostate enlargement do not get worse over time as previously thought. Many men find that their symptoms are stable and some even clear up on their own. In these cases, the best treatment is no treatment at all. Drugs are available that may help improve symptoms in some men. Your doctor can advise you on the various treatment options.

Prostate Enlarement Treatment Options

Home treatment:

Other options:

When to call your doctor

It's time to call your doctor:

Prevention of acute prostatitis and enlarged prostate (BPH)

Ways to prevent acute prostatitis and enlarged prostate:

Prostate Cancer

Although it is relatively common, in most cases prostate cancer is a slow growing cancer. Most prostate cancers arise in the rear portion of the prostate gland; the rest originate near the urethra. Prostate cancers double in mass every six years, on average.

Possible symptoms

The disease often causes no symptoms at all until it reaches an advanced stage and/or spreads outside the gland. Or it could be one or more of the following: Pain or a burning sensation during urination, frequent urination, a decrease in the size and force of urine flow, an inability to urinate, blood in the urine, and continuing lower back, pelvic or suprapublic discomfort. However, these symptoms most often are caused not by cancer but by benign enlargement or inflammation of the prostate. That’s why professional evaluation and diagnosis is so necessary.

The rate of prostate cancer in the U.S. is rising. In part, this is due to the aging of our population. Just a generation ago, the life expectancy for white men was sixty-five years; today, it is close to eighty years. However, the rate of prostate cancer is rapidly rising in all men, even those under fifty. This is significant because, in general, the younger a man is when he is diagnosed with prostate cancer, the worse his prognosis. The increase in prostate cancer among younger men points to the role of diet and exposure to environmental toxins in the development of the disease.

African-American men have the highest incidence of prostate cancer, while Asian-American have the lowest. Men with a family history of prostate cancer also run a higher risk of developing the disease. The incidence is higher among married men that it is among unmarried men. Also at increased risk are men who have had recurring prostate infections, those with a history of venereal disease, and those who have taken testosterone. Researchers have also found a link between a high-fat diet and prostate cancer. This may be due to the fact that heavy fat consumption raises testosterone levels, which could then stimulate growth of the prostate, including any cancer cells it may be harboring. Exposure to cancer-causing chemicals increases risk as well. Some experts believe that vasectomy may increase a man’s chances of developing prostate cancer. And, while it isn’t conclusive, some medical professionals are recommending to have the vasectomy reversed.

Testing

It is believed by most that there is no way to prevent the disease, but early detection can make it possible to catch the cancer before it spreads to other parts in the body. A careful rectal exam of the prostate is the simplest and most cost-effective approach for detecting prostate cancer. The American Urologic Association recommends that ever man have an annual exam beginning at least by age forty. The American Cancer Society no longer recommends testing. They suggest discussing the options with your health care professional. (Wonder what that's all about? When early detection clearly saves lives, who gains from not being tested except those who know they don't have prostate cancer. And, without symptoms, who knows? Maybe the doctors and hospital and funeral homes gain? Families sure don't. Gives one something to think about!) A blood test to detect elevated levels of a substance called prostate-specific antigen (PSA) is an excellent screening test for prostate cancer. PSA is currently the most valuable "tumor marker" available to diagnose and evaluate the effectiveness of therapy for prostate cancer. A PSA test result between 0 and 4 is considered to be within the normal range; a PSA over 10 is assumed to indicate cancer until proven otherwise. High PSA levels can be caused by factors other than cancer, including benign enlargement or inflammation of the prostate, an activity as innocuous as bicycle riding, or even the rectal exam itself. If a man’s PSA level is found to be high, the test should always be repeated, because it does yield false-positive or false-negative results an estimated 10 to 20 percent of the time. Having the test repeated every year may help a physician to better interpret the results; in healthy men, PSA levels tend to remain relatively stable, rising only gradually from year to year, while cancer causes the levels to rise more dramatically.

Ultrasound scanning of the prostate is often done to follow up on an abnormal rectal exam or PSA test. Other diagnostic tests, including computerized tomography (CT) scans, bone scans, and magnetic resonance imaging (MRI) may be necessary, but are costly. Ultimately, if test results point consistently to the presence of cancer, a tissue diagnosis must be done to confirm it. This can be done only by microscopic examination of a needle biopsy, preferably directed under ultrasound control. Repeated biopsies may be needed in some cases. This invasive procedure may itself cause complications. Bleeding, urinary retention, impotence and sepsis (blood poisoning) have been reported.

Prostate Cancer Treatment Options

Some of the treatment options for prostate cancer:

Prevention of prostate cancer

Since the prostate produces seminal fluid, there is a long-standing belief that regular ejaculations (two or three times per week) will help prevent an enlarged prostate. There is little scientific proof of this, but it is risk-free.

Diet is also a factor. Some recommend to maintain a whole-foods diet.:

Pain management

In most cases, pain is manageable. No one should have to suffer, especially terminally ill cancer patients. And, while many of the major pain killers like morphine are controlled by the federal government, and the DEA has been very active in prosecuting doctor’s for alleged "over prescription", many of these patients report that the pain in too great in lower dosages. (See the film " and see what you think.)

AIDS and cancer patients have long reported the positive affect of marijuana to reduce pain and improve the appetite, often an after effect of chemotherapy. California and Arizona have passed laws allowing doctors to prescribe marijuana for certain ailments. Even the New England Journal of Medicine has favored doctors who prescribe marijuana. However, the federal government, not really caring about people’s pain, has threatened to charge any doctor prescribing it with a felony. Similar drugs have not received the governments okay since they fear a person may become addicted, which is seldom the case. Regardless of research to the contrary, "Even if the person is dying, it seems that they (the government) would rather see him die in pain rather than become an addict for the short time he has to live," says Dr. Aubrey Pilgrim in his book A Revolutionary Approach to Prostate Cancer. X-rays can be used to reduce or eliminate pain for some time and Metastron (Stronitium 89) radiation works well on bone metastases. Quadremet, which is a radioactive dryg similar to Metasmon, has fewer side effects and Novantrone is the first chemotherapy drug approved for treatment of pain from advanced hormone refractory prostate cancer. For information, call 800.220.6302. Finally, there are a number of ways to deal with pain. If you aren’t successful with you current doctor, find one who will help. No one deseerves to have to live in pain.

Incontinence

The leakage of urine. Other happens after radical prostatectomy. It often requires the use of under garment pads like Attends or Depends. Some men are embarrassed about change these pads several times a day. Some alternatives are: Have a radical prostatectomy using the Gaker procedure which preserves the bladder sphincter. The procedure was published in The Journal of Urology, 8/96 or have your doctor call Dr. Douglas Gaker at 513.423.0739 for a video on the procedure. You can also do exercises to strengthen the lower sphincter, which might include the Kegel exercises, originally developed by Dr. Arnold Kegel for women. These exercises can be done in private or in public - no one will know. Other treatments that might help include penile clamps, condom catheters, biofeedback, artificial urinary sphinter, collagen and fat injections, and medication. There are other products yet to be approved by the FDA than are being used in Europe like poly-Teflon which is used instead of collagen as a bulking agent. (Resources.)

Erectile dysfunction/sex

The penis is a vascular organ which requires exercise. A healthy male will normally experience 3 to 4 erections during their sleep which may last a hour or more each. They are a normal body function whose purpose is to oxygenate the penile erectile tissue. Its inability to achieve and maintain an erection suitable for vaginal intercourse is called "male erectile dysfunction (ED) or impotency, for short. Impotency affects over 30 million men and their partners. So, having to face the possibility of impotency as an after-affect of prostate cancer treatment can be of major concern. To some men it is a symbol of the loss of their manhood, and can be critical to a man’s ego and self-image. And often, because of this, some men are afraid to seek help. And, often when he does, the physician feels uncomfortable or is unable to help because many aren’t aware of the options. If the truth were known, however, virtually 100% of impotency problems can be successfully diagnosed and treated, whether physical or emotional, unless there is permanent injury or severance of the nerves and or vascular supply necessary in the erectile process.

Medications taken for hypertension and depression usually inhibit normal erectile function and can be changed to an alternative which may allow the return to normal sexual function. In addition, three drugs may offer hope. Viagra has achieved very good results in men with psychogenic impotence and also in men with organic impotence. The intensity of the erection is enhanced as well as overall performance and there may be major side effects, and a risk of death for some patients. A doctor will be able to determine if Viagra is right for you. (This too will be reviewed November 1. For books on the subject, check "Books" "Issues" "Health-General".) Vasomax has been used for years as an injectable medication and is now being tested in pill form. It is another medication which works to dilate penile blood flow in men with mild vascular problems. Apo-Morphine is being evaluated for treatment of only psychogenic impotence.

Vacuum erection devices work to create an erection mechanically by drawing the blood into the penis. While this eliminates the need for medication, it does require some preparation time which decreases spontaneity. However, they work for many men and are covered by Medicare and many insurance companies.

Medical Urethral System for Erection (MUSE) is a cream which is absorbed through the urethra and dilates the cavernosal spongy tissue of the erectile chambers. It has about a 66% success rate and anxiously awaits approval to replace injectable forms of therapy.

Injection Therapies - Papaverine was the first effective medical treatment for ED. To date, there are two currently approved by the FDA. Caverject and Edex which are effective in about 85% of patients. Occasionally, Papaverine by itself or with Regitine and Prostaglandin E will be used, which is much better than any on eof them used alone. Some men will have erections lasting a few minutes to 45 minutes. Dosage determines this. Used immediately after radical prostatectomy or radiation therapy may prevent atrophy of the smooth muscle necessary for erection which is associated with non-use of the penis.

Penile Prosthesis, rigid, semi-rigid or inflatable implants, can very a scary thing for many men. Getting your questions answered is most important because it is a serious decision. They are only necessary in about 10% of patients. For men who have become impotent following radical surgery, radiation or cryosurgery, or have arthritis and decreased manual dexterity, this procedure may be the last hope. The success rate is very high and they remain effective at a 90-95% rate 5 years after implantation.

Watch out

I’m usually more skeptical of Western medicine and chemical solutions than natural or Eastern methods. With anything, you should get as much information as possible and know what you’re doing. One place to turn is the Cedars of Sinai Comprehensive Cancer Center, which publishes a monthly newsletter dealing with cancer advances, therapies, prevention and support concerns. The February, 1997 issue included an article titled "Unproven Methods of Cancer Management" which discussed the potential dangers of various claimed cures such as macrobiotic diets, psychic surgery, quack drugs such as Prostada, shark cartilage and biological products, electronic gadgets, and devices, herbal and fold remedies, dietary approaches, bogus diagnostic tests, metabolic therapies, mental imagery, faith healing, homeopathic and many other unproven treatments and modalities. It can be found at www.csccc.com There is also a newsletter, published by the National Council Against Health Fraud with short articles about many of the current health frauds. Write PO Box 1276, Loma Linda, CA 92354. If you encounter a scam, contact the National Fraud Information Center, 1.800.876.7060 or you may write the Federal Trade Commission, Room 1105, Washington, D.C. 20580. Do as much checking as possible before you spend good money, and possibly risk your life, using up-proven methods to cure prostate cancer or anything else for that matter.

Recommendations

Some recommendations:

Considerations

Some considerations:

Summary

This will give you some background on the subject. The important thing to remember is "Don’t wait." The longer you wait, the greater the worry, the more difficult the treatment and recovery, and you’ll miss out on a lot of great evenings in bed, too. So, find a qualified doctor who is knowledgeable of the latest medical therapies. If you need help in locating someone, one of the following organizations can help: Impotence Institute of America & Impotence Anonymous - 1.800.669.1603 or Male Potency Centers of America - 1.800.438.7683. The Institute also offers anonymous groups where men can hear the experiences of other men which usually relates to what they are going through. And, there is an excellent tape discussing all of the causes of impotence, diagnostic treatment options and therapies by Dr. Aubrey Pilgrim for $15 + shipping by calling 1.714.644.7200.

The appropriate treatment for impotence depends upon whether the cause is physical or psychological. A man whose impotence is psychologically based generally still has erections during sleep, whereas an individual whose impotence is physical in origin usually does to. One easy, inexpensive way to test for nocturnal erections is with postage stamps. Glue a strip of stamps around the shaft of the penis before going to bed. If the ring of stamps is broken in the morning, the cause of the impotence is likely psychological. If the strip is unbroken, the impotence is likely physiological. You can also purchase a kit called Snap Gauge from UroHealth Corporation. This test is designed to detect the measure the rigidity of erections experienced during sleep. Call 800.328.1103 for more information.

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