Prostate Cancer

Prostate Cancer: Overview

Prostate cancer is the second most common cancer in men, after lung cancer, and mainly affects older men.  Caught at an early stage, there is a good chance it can be cured, with treatments tailored to the individual patient and his particular cancer.

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Incidence; Contributing Risk Factors

Prostate cancer is rare in men under 50 years old.  However, the risk increases steadily with age and by the time they are 80, more than half of all men will have some cancerous growth, though in most cases it goes unnoticed.  Prostate cancer is usually slow-growing and, in men who have it, it is often not the cause of death.

The causes of prostate cancer are largely unknown.  It is clear that the chances of developing prostate cancer increase in men over 50.  Close relatives of men who have had prostate cancer are also more likely to be affected.  Ethnic origin appears to play a part: black men seem to be at highest risk, and men of Far Eastern descent the lowest.

Signs and Symptoms

The peripheral (outer) zone of the prostate is the area most susceptible to developing cancer.

Prostate cancer often has no symptoms.  The symptoms are similar to those produced by a common disease of the prostate, namely benign prostatic hypertrophy (BPH), and include:

  • a difficulty in starting to pass urine
  • a weak, sometimes intermittent flow of urine
  • dribbling of urine before and after urinating
  • a frequent or urgent need to pass urine
  • a need to get up several times in the night to urinate
  • a feeling that the bladder is not completely empty
  • (rarely) blood in the urine.

Diagnosis and Tests

There are several tests that may be undergone as part of the diagnostic process.  Some of these tests may also be performed as part of a routine health assessment.

  • Urine test. A simple urine test will be carried out to look for blood or infection.
  • PSA blood test. Testing a blood sample for the amount of prostate-specific antigen (PSA) plays an important part in the early detection of prostate cancer.  If an abnormally high level of PSA is detected in the blood, prostate cancer is a possibility.  However, a high PSA score does not always indicate cancer and can be caused by other prostate diseases such as benign prostatic hypertrophy or prostatitis (inflamed prostate).
  • Digital rectal examination. The urologist will carry out an examination of the prostate by inserting a finger into the rectum.  Although this can be uncomfortable, it is not painful, and tumors can often be felt by this method.  Many men find this embarrassing, but remember that urologists do this as an everyday procedure – and it may save your life.
  • Biopsy. The urologist may do a prostatic biopsy (removal of a small piece of tissue).  A biopsy involves passing an ultrasound probe into the rectum to give an accurate view of the prostate.  Samples of the prostate are collected using a needle.  Biopsies can be uncomfortable and you may be given a mild sedative or local anesthetic.

    A pathologist will examine the prostate sample under a microscope and check whether or not it is cancerous.  If cancer is found, the pathologist will "grade" it.  A scale known as the Gleason's score is used.  This gives you and your doctor an idea of how quickly your cancer is likely to progress.

  • Scans. To establish whether the cancer has spread (metastasized) to the bones, a bone scan may be performed.  Another technique is an MRI scan which can look at the body in sections using a strong magnetic field and radio signals.  CT scanning is similar to an MRI scan but uses X-rays to build up a picture.  These scans usually look for the spread of cancer to lymph nodes in the pelvis.  This helps the doctor to decide how far the cancer has spread (if at all), and therefore the best course of treatment.  This process is known as "staging" the cancer.

Treatment and Prevention

The most appropriate form of treatment will depend on several factors including:

  • the size and location of the tumor within the prostate
  • whether it is contained within the prostate, spread to the lymph nodes or spread to other more distant sites
  • the patient's age and general state of health.

Watchful waiting. Sometimes – particularly for slow-growing tumors – no treatment is the best course of action.  The patient's condition will be monitored closely with routine check-ups.  Some people, however, find this approach causes too much anxiety and will prefer to have some sort of treatment.

Hormone therapy successfully reduces the size of prostate tumors in 80% of men, but it does not kill cancer cells.  For many men, it will be recommended as well as surgery.  It is sometimes used prior to radiotherapy to reduce the size of the tumor.

Hormone therapy is based on reducing the level of testosterone, which stimulates cancer growth.  This is done either by "switching off" the production of testosterone, or by damping down the levels that circulate in the bloodstream.  This can be achieved through medicines that block the conversion of a natural chemical into active testosterone.  Alternatively, orchidectomy – surgical removal of both testicles, stops the production of testosterone.

Radiotherapy is an alternative to radical prostatectomy.  At the time of writing there is no conclusive evidence to show that one method is more effective than the other.  The treatment involves radiation being applied to the affected areas to destroy the cancer cells.  This is usually done as an out-patient procedure.  The main side-effects are bladder irritation and diarrhea.  Some men also become impotent as a result.

Brachytherapy is a relatively new procedure which involves implanting radioactive pellets into the prostate, where they gradually lose their radioactivity over a period of months.  The pellets are inserted under general or spinal anesthetic.  Brachytherapy is not recommended for men whose cancer has spread to other parts of the body.

Signs, symptoms & indicators of Prostate Cancer:

Symptoms - Urinary

Conditions that suggest Prostate Cancer:

Reproductive

Erectile Dysfunction (ED, Impotence)

A cancerous prostate gland may interfere with blood flow and nerve impulses to the penis.  That can cause ED; impotence can be one of the signs of prostate cancer.

Symptoms - Reproductive - General

Uro-Genital

Risk factors for Prostate Cancer:

Habits

Problems Associated With Lack Of Exercise

Physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight.  [JAMA.  2001;286: pp.921-929]

Medical Procedures

Counter-indicators

Nutrients

Vitamin A Requirement

Carotene compounds called lycopenes, which are found in high amounts in tomatoes, have been shown to protect against prostate cancer.  Several studies have shown that males consuming tomato sauce receive some protection against cancer.

Personal Background

African ethnicity

African-Americans have higher rates of diabetes, prostate cancer, hypertension and coronary heart disease than whites.

Supplements and Medications

Counter-indicators

Symptoms - Food - Beverages

High sugared soft drink/sugary soft drinks consumption

A study published in the American Journal of Clinical Nutrition in November, 2012 found that those who drank at least one can of sugar-containing soft drink per day were 40% more likely to develop prostate cancer than those who never consumed these drinks.  Even worse, this increased risk applies to the more aggressive (faster-growing) forms of prostate cancer that are more likely to be fatal.  The study followed the dietary habits of more than 8,000 men for an average of 15 years and found a clear (but as yet unproven) link between sugary drinks and prostate cancer.  One theory is that sugar triggers the release of insulin, which feeds tumors.

Symptoms - Reproductive - General

History of prostate cancer

Although there are cases of post-prostatectomy prostate cancer after apparent complete remission (from reawakened metastases), this is rare.

Counter-indicators
High/moderate frequency of sex

May 15, 2015: Results from a study of 32,000 men over 18 years were reported by the American Urological Association.  The conclusion of this study was that "the risk for prostate cancer was 20% lower in men who ejaculated at least 21 times a month than in men who ejaculated 4 to 7 times a month."

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Prostate Cancer suggests the following may be present:

Tumors, Malignant

Prostate Cancer can lead to:

Reproductive

Erectile Dysfunction (ED, Impotence)

A cancerous prostate gland may interfere with blood flow and nerve impulses to the penis.  That can cause ED; impotence can be one of the signs of prostate cancer.

Uro-Genital

Recommendations for Prostate Cancer:

Botanical

Not recommended
Maca

Men with a high PSA level or a history of prostate cancer should not be using maca.

Diet

Soy Isoflavones

Soy protein is one of the dietary elements that has been talked about for a long time as having a potentially beneficial effect for preventing prostate cancer.  Soybeans are full of chemicals called isoflavones which closely resemble the structure of estrogen-like hormones once widely used to treat prostate cancer.

Phytochemicals in soy protect against cancer via several different mechanisms, including interacting with intracellular enzymes, regulating protein synthesis, controlling growth factor actions, inhibiting malignant cell proliferation, inducing differentiation, deterring cancer cell adhesion, and inhibiting angiogenesis.

Soy extracts also provide doses of soy isoflavones such as genistein.  Cancer cells use the enzyme protein kinase as a growth factor and genistein is a potent inhibitor of its activity.  Genistein may reduce the metastatic capacity of hormone-dependent cancers.  Studies have shown that genistein inhibits proliferation of prostatic cancer cells.

Laboratory studies are backed up by observations in Asian countries, particularly Japan, where men may develop small prostate tumors but rarely the kind of large, aggressive tumors seen in American men.  However, the aggressive form of the cancer becomes more prevalent when Asian immigrants come to the US and are likely to substitute their soy-rich diet with one based mainly on animal protein.

Since prostate cancer cells usually multiply slowly, the development of prostate cancer can take many years before symptoms appear.  During this time period, the benefits of natural therapies like soy consumption are more effective at dealing with the problem while it is still small.

Note: Do not take any soy genistein products 10 days prior to, during, or 3 weeks after any form of radiation therapy.  Genistein may protect cancer cells against radiation-induced death.

Drug

LDN - Low Dose Naltrexone

Dr. Bihari, MD has found that the treatment does not seem to work for prostate cancer patients who have received or are receiving some form of hormone manipulation treatment prior to starting the low dose naltrexone.  This includes patients who have received Lupron, Casodex, Eulexin, DES, or other drugs designed to reduce testosterone.  In addition, patients who have been treated with PC-SPES, the herbal preparation with estrogenic effects, also do not seem to respond.

Hydrazine Sulfate

See the link between Cancer (General) and Hydrazine Sulfate.

Extract

DIM / I3C

DIM may reduce prostate cancer incidence as it has been shown to stop human cancer cells from growing (by 54-61%) and provokes the cells to self-destruct (apoptosis).  DIM also improves prostate function.

In two papers published in the Journal of Biological Chemistry (Mar 27, 2003) researchers reported that DIM significantly halted proliferation of androgen-dependent human prostate cancer cells.  In one of the studies, androgen-dependent prostate cancer cells treated with DIM grew 70% less than androgen-dependent untreated cells.  DIM also inhibited dihydrotestosterone (DHT) stimulation of DNA synthesis in the androgen-dependent cancer cells.  These effects were not seen in androgen-independent prostate cancer cells.

To determine whether men are at risk for prostate cancer, they are usually tested for levels of prostate-specific antigen (PSA), a growth factor for prostate cancer.  In prostate cancer cells, DIM reduced intracellular and secreted PSA protein levels caused by DHT.  The researchers determined that DIM's molecular structure is similar to Casodex, a synthetic anti-androgen drug.

"As far as we know, this is the first plant-derived chemical discovered that acts as an anti-androgen," said Leonard Bjeldanes, professor and chair of nutritional sciences and toxicology at UC Berkeley's College of Natural Resources and principal investigator of the study.  "This is of considerable interest in the development of therapeutics and preventive agents for prostate cancer."

Habits

Aerobic Exercise

A 14-year study by a team from the Harvard School of Public Health found that men over 65 who worked out vigorously for at least three hours a week had an almost 70% lower risk of advanced and fatal cases of prostate cancer.  The 47,620 men involved in the study were followed from 1986 to 2000.

Hormone

Natural Progesterone

Dr. John Lee, M.D., the author of several books including What Your Doctor May Not Tell You About Menopause, has found that progesterone for men is one of the most effective treatments for prostate cancer.  He has a series of patients who had metastatic prostate cancer who went into complete remission with natural progesterone.  5-6mg twice per day is applied to the back of the hands in cream form.  Progesterone appears to turn on the anti-cancer gene p53.

Melatonin

Melatonin has been shown to inhibit several types of cancers, especially hormone-related cancers like breast cancer and prostate cancer.  [Bartsch and Bartsch] This may be due to its ability to reduce the number of cellular estrogen receptors, which reduces the production of cell-multiplication factors.  The immune-modulating properties of melatonin seem to convey additional anti-cancer properties.  It has been shown to support the use of interleukin-2 in anti-cancer therapy, especially under conditions of controlled lighting.  Many animal studies have demonstrated an increase in tumor growth rates in animals whose pineal glands have been removed.

Positive results have been shown with melatonin on its own and in combination with interferon, tumor necrosis factor, and tamoxifen.  These preliminary results are quite encouraging because approximately 30% of the patients taking anywhere from 10 to 50mg daily (at 8pm) experienced improvements in survival time and quality-of-life assessments.  (Lissoni et al, Brit J Cancer 7l(4): pp.854-6, 1995)

Not recommended
Testosterone

Testosterone supplementation causes the acceleration of pre-existing prostate cancer growth.  It is recommended that physicians screen for prostate cancer with a digital rectal exam and PSA (prostate specific antigen) level prior to initiating therapy, and monitor hematocrit and PSA levels closely during therapy.

Mineral

Calcium

See the link between Prostate Cancer and Vitamin D.

Oxygen / Oxidative Therapies

Surgery/Invasive

Surgery

Surgery is the main treatment for most prostate cancer.  The most common technique is a "radical prostatectomy", which involves removing the prostate gland, seminal vesicles and nearby lymph nodes.  It is a major operation, so it is most suitable for otherwise healthy men (usually, those under 70) whose cancer appears not to have spread.  About 80% of men who have this operation are still alive after 10 years.  Possible side-effects of the procedure include some urinary incontinence, sterility and erectile dysfunction (impotence), although modern surgical techniques can minimize the risks of this to some extent.  It is important to remember that it is very hard through surgery alone to remove every single cancer cell: a radical prostatectomy is no guarantee that one will remain free from cancer.

Vitamins

Vitamin D

In patients with advanced hormone refractory prostate cancer with bone metastases, 2000 IU of vitamin D with 500mg of calcium per day for three months was found to reduce bone pain, increase muscle strength, and improve the quality of life.  [J.  Urology 2000; 163: pp.187-190]

Preventive measures against Prostate Cancer:

Animal-based

Fish Oils

Several studies have shown an inverse relationship between blood levels of fish oils (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) and the risk of prostate cancer.  A study by medical researchers at the Karolinska Institute confirms this association.  [The Lancet, Vol. 357, June 2, 2001, pp. 1764-66 (research letter), British Journal of Cancer, Vol. 81, No. 7, December 1999, pp. 1238-42]

Diet

Low/Decreased Fat Diet

It may be possible to reduce the risk by avoiding a high fat diet through, for example, cutting down on dairy foods and red meat.

Mineral

Selenium

In one study, the risk of prostate cancer for men receiving a daily supplement of 200mcg per day of selenium was found to be one-third that of those receiving a placebo.

Nutrient

Lycopene

A study conducted by Harvard researchers examined the relationship between carotenoids and the risk of prostate cancer.  [J Natl Cancer Inst 1995;87: pp.1767-76] Of the carotenoids studied, only lycopene was clearly linked to protection.  The men who had the greatest amounts of lycopene in their diet (6.5mg per day or more) showed a 21% decreased risk of prostate cancer compared with those eating the least.  This report suggests that lycopene may be an important tool in the prevention of prostate cancer.  This study also reported that those who ate more than ten servings per week of tomato-based foods had a 35% decreased risk of prostate cancer compared with those eating less than 1.5 weekly servings.  When the researchers looked at only advanced prostate cancer, the high lycopene eaters had an 86% decreased risk (although this did not reach statistical significance due to the small number of cases).

Contrary to popular opinion, research suggests that there is no preferential concentration of lycopene in prostate tissue.  [Am J Epidemiol 2000;151: pp.124-7 (review, discussion 128-30)] Although prostate cancer patients have been reported to have low levels of lycopene in the blood [Nutr Cancer 1999;33: pp.159-64], and lycopene appears to be a potent inhibitor of human cancer cells in test-tubes [Nutr Cancer 1995;24: pp.257-66], evidence is conflicting concerning whether an increased intake of tomato products is protective against prostate cancer.  Some studies, like the one discussed above, have reported that high consumption of tomatoes and tomato products reduces risk of prostate cancer.  Other studies, however, are inconclusive [Am J Epidemiol 2000;151: pp.119-23], and some have found no protective association.

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