WHAT IS IT?
Unless your prostate gives you trouble, you’re not likely to think much about it. This walnut-sized gland just above a man’s groin does a big job, though: It makes most of the fluid that carries and nourishes sperm.
As a man ages, his prostate is more likely to act up.In fact, you’re almost certain to have an enlarged prostate if you live long enough. This swelling can be a nuisance, but it is seldom a serious problem. Of far more concern is prostate cancer.
Protate cancer is the most common cancer, other than skin cancer, for men in the United States. But there’s also good news: Most prostate cancer grows slowly. If you detect and treat it early, you have a very good chance of leading a long, healthy life. Also, if you learn you have prostate cancer, you don’t necessarily need to take action right away. In some cases, prostate cancer grows so slowly that many older men who find out they have it choose not to treat it at all.
WHAT IS HAPPENING?
Most of the time, your cells grow, divide, and replace themselves in an orderly way. But sometimes a group of them will change-mutate-and grow out of control. Since your body has trillions of cells that are always growing and dividing, such changes are probably common. Your immune system usually destroys these changed cells before they cause problems. But when it is weakened by stress or illness, it may not get them all. Even a healthy immune system can miss a few.
When cells grow out of control in the prostate, they form a clump of tissue called a tumor. The tumor makes the prostate swell. Not all tumors are cancer: Some don’t spread, so they are called benign. A tumor is defined as cancer only when it can invade and damage nearby tissues. Then it’s called malignant.
If prostate cancer spreads, it may show up first in the seminal vesicles (two glands near the urinary bladder that add fluid to semen) or the urethra (the tube that passes through the prostate on its way from the bladder to the penis). It can also spread to the lymph nodes-which make cells that help fight infections-in your groin. If cancer cells get into lymph nodes, they can spread to your bones or other parts of your body, where they can start new tumors.
WHAT CAUSES IT?
No one knows why some men get prostate cancer and others don’t, but some factors increase the risk. A few, such as your age, race, and family history, are beyond your control. But you can do plenty about others, such as what you eat and whether you smoke.
THINGS YOU CAN’T CHANGE
Age
The older you are, the higher your risk. Your chances of developing prostate cancer increase rapidly after age 50. Eighty percent of prostate cancers occur in men over the age of 65.
Race
African American men get prostate cancer 60 percent more often than white men do. They are also more likely to die from it than men in other racial or ethnic groups.
Family history
If your father or brother had prostate cancer, you have a greater chance of getting the disease than if neither did.
THINGS YOU CAN CHANGE
Diet
Men who eat lots of fatty foods have a higher risk of prostate cancer than men who eat less fat and more fruits, grains, and vegetables do. If those fatty foods include a lot of red meat, that seems to push the risk even higher. In Japan, where most people eat much less fat and red meat than people do in the United States, men have a much lower rate of prostate cancer than men in the United States. But Japanese Americans who eat a typical American diet have about the same rate of prostate cancer as other American men.
Smoking
Smoking is one of the worst things you can do to your body. It raises your risk of heart disease and causes lung cancer. The link between cigarettes and prostate cancer is not as clear, though. Several studies do suggest that prostate cancer is harder to detect in men who smoke. That’s because the substances in tobacco smoke interfere with the PSA test, a test than can help detect prostate cancer early.
WHAT YOU CAN DO FOR YOURSELF
There are many steps you can take to cut your risk of prostate cancer. If you get prostate cancer, many of these same steps can help you get over it and keep it from coming back.
Start by staying healthy. Your own body is the first line of defense against prostate cancer. Healthy habits can keep your immune system strong enough to fight off this disease as well as others. If you have prostate cancer, being in otherwise good health makes you better able to handle the treatments; some of them can sap your strength. Then you’ll have a much better chance of beating the cancer.
Here are some tips that will help you live a long, healthy life:
Exercise
It’s clear that exercise can protect you from many kinds of illness. There is no doubt, for instance, that regular exercise helps keep your heart and bones healthy. And now it appears that in men it may also help prevent prostate cancer. One study found that men who were active most days had a 60 percent lower risk of prostate cancer than men who didn’t exercise.
How might exercise help? First, it lowers levels of the male hormone testosterone. This is a good hormone for a man to have, of course, but it also seems to speed the growth of prostate tumors. Exercise also reduces stress and tunes up your immune system, so your body has the best chance of getting rid of any cancer cells that develop.
If you haven’t been active for a long time, start by getting a little more exercise each day. Take the stairs instead of the elevator. Walk the dog after dinner. Once you’re used to being more active, add something such as brisk walking or even jogging. Experts suggest half an hour of activity at least three days a week. For flexibility and strength, many people like yoga. Lifting weights is a useful part of any exercise plan.
If you’re being treated for prostate cancer, talk with your doctor about the best kinds of activity for you.
Eat the right stuff
Eating well is important when you’re being treated for cancer-or even if you’re just trying to reduce your risk. If you have cancer, some foods may upset your stomach. Choose foods that appeal to you and don’t cause you upset. Also, eat smaller, more frequent meals so you’ll get a steady supply of energy.
Avoid fatty meats, whole dairy products, and other foods with a lot of fat. Eat a variety of foods, especially whole grains, fruits, and vegetables. These are high in fiber, loaded with vitamins, and low in fat. The fiber helps speed toxins out of the body. The vitamins and other active compounds called phytochemicals-phyto for plant-boost the body’s defenses. Some studies also suggest that eating lots of very well-done meat (hamburgers, steak, and bacon) can increase your risk for cancer, so you should try to avoid these foods.
Add vitamins and minerals
Vitamin and mineral supplements can help, though they won’t replace healthful eating. Choose a multivitamin that provides the recommended daily allowances of a broad range of vitamins. Vitamins C and E are especially important. These antioxidants may well help protect you against cancer (and heart disease). If you have cancer, talk to your doctor, nurse, or dietician before you take any supplements. Large amounts of some vitamins and minerals can work against your treatment.
Watch your weight
Too many extra pounds can raise your risk of cancer.
Limit alcohol
If you drink, do it moderately. A rule of thumb is to drink no more than one glass of wine (5 ounces), one can of beer (12 ounces), or one shot of liquor (1.5 ounces) a day.
Educate yourself
Learn as much as you can about prostate cancer, treatments, and side effects. How and when to treat prostate cancer is a hotly debated subject. If tests show that you have prostate cancer, make sure you know about all the treatment options. The more you know, the better you’ll be able to make choices that are right for you.
Get support
If you have prostate cancer, don’t try to bear it alone. When you feel able, share the news with your friends and family. This lifts a burden from you and gives them the chance to help.
Cancer support groups may also help. Some studies suggest that people who take part in such groups have less pain, are less depressed, and survive longer than patients who don’t. Whether this is true for men with prostate cancer remains to be seen-the studies were of women with breast cancer. In any case, in a support group you can talk with others who know what you’re going through and learn more about treatments.
WHAT YOUR DOCTOR CAN DO FOR YOU
There are several ways to treat prostate cancer: surgery, radiation therapy, hormone therapy, and biological therapy. Or your doctor may suggest “watchful waiting.” If you choose this route, you do nothing-no treatment at all. You simply watch closely to see how fast your tumor grows.
The first step is for you and your doctor to discuss your condition, weigh the pros and cons of each treatment option, and figure out a treatment plan.
Evaluation
Some tumors grow faster than others. To find out how advanced your cancer is, your doctor will first look at tissue taken from a biopsy under a microscope. Then he or she will rank the cancer in two ways-by how quickly the cancer cells are likely to grow, and by how far the cancer has spread.
Gleason scale: Your doctor will use a scale called the Gleason scale to estimate how fast the cancer cells will grow. Cancer cells that are clumped together, clearly set off from normal cells, get a low number on the scale, which goes from 2 to 10. Cells that look this way are likely to grow slowly and are not a big risk. Cells that are widely spread out and not well separated from normal cells get higher numbers. They are more likely to grow and spread quickly.
Staging: Another way of judging cancer is “staging.” Your doctor will rank your tumor with letters and numbers, based on the rectal exam, biopsy, and other tests. T1 and T2 cancers are confined to the prostate gland. T3 cancers have spread to the connective tissue near the prostate or to the seminal vesicles. T4 cancers have spread to tissues next to the prostate, such as the rectum or the pelvis wall. And N+ or M+ cancers have metastasized (spread) to other parts of your body.
Knowing the Gleason rating and the stage of your cancer will help you and your doctor decide which treatment makes the most sense.
Radical prostatectomy
Many men with prostate cancer choose to have a radical prostatectomy, surgery to remove the prostate. It’s the most common treatment for men whose cancer has not spread outside the prostate.
Pro
If done early, removing the prostate gives you an excellent chance of getting over your cancer. Men with early-stage cancer who have the prostate removed live just as long as men who never had the cancer.
Con
For slightly more than 1 in 10 men, some cancer is left behind after the surgery. About 10 percent of men who have the surgery become seriously incontinent-they can’t keep their urine from leaking. And between 65 and 90 percent can’t get erections after surgery. (The risk of this depends on the man’s age and the stage of his cancer-older men with more advanced cancer have a higher risk of erection problems after surgery.) A surgical technique that helps spare the nerves that control erection can reduce the chance of impotence. Men who become impotent as a result of prostate cancer surgery may also be able to achieve erections with medication.
Cryosurgery
If your cancer hasn’t spread, your doctor may advise another form of surgery known as cryosurgery. In this procedure the surgeon freezes the cancer cells with a metal probe. Short-term results of this surgery look encouraging. However, long-term survival rates are not yet known.
Pro
Cryosurgery is less painful than radical surgery and the recovery time is shorter
Con
Freezing can damage nerves near the prostate, which can lead to incontinence or impotence. Cryosurgery may also damage the intestines and bladder, causing pain, a burning feeling, and the need to empty the bladder and bowels often.
External beam radiation/brachytherapy
This treatment uses high-energy rays to kill cancer cells and stop them from growing. It’s used on early-stage tumors that are still confined to the prostate or have only spread to nearby tissue. Your doctor may also recommend external beam radiation if the cancer is more advanced and surgery isn’t an option. Sometimes men who have had prostate surgery will also get radiation to kill any cancer cells that have spread just outside the prostate.
Pro
It’s not painful, and you don’t lose your hair or have nausea. You don’t need to stay in the hospital.
For the earliest stage prostate cancers, radiation seems to be about as effective as surgery. One study compared men who had their prostates removed with men who were treated with radiation. After five years, three out of four men in each group were still alive.
Con
The treatment is long: You have to go to the hospital five days a week for six or seven weeks. In some men, it can cause stomach and digestive problems such as diarrhea or urinary problems such as burning during urination, blood in the urine, or the frequent need to urinate. These symptoms most often clear up when treatment is over, but not always. Some men bleed slightly from the rectum, because it, too, gets dosed with radiation. The bleeding can last for several months after treatment. During the treatment, many men feel tired.
Several years after the radiation, men can experience severe bleeding from the bladder and urethral scarring (stricture). Long term, about 7 percent of men who have had radiation will have at least some incontinence and 30 to 40 percent will have trouble getting erections.
Brachytherapy
In another kind of radiation therapy, known as brachytherapy, a surgeon inserts tiny radioactive pellets into your prostate. They emit low-level doses of radiation that kill cancer cells.
Pro
It’s quick: It takes only an hour or two, and many men return home the same day. The pellets don’t usually cause incontinence, and impotence may be less likely than after surgery or external beam radiation.
Con
Long-term bowel problems, such as burning and pain in the rectum, may occur in less than 5 percent of men who get this procedure. About one third of patients have frequent urination. Impotence occurs in about 20 to 40 percent of cases.
Hormone therapy
The male hormone testosterone spurs the growth of cells in the prostate, including cancer cells. Hormone therapy blocks the production of testosterone in an effort to slow the cancer’s growth. This can be done by removing the testicles, which make most of a man’s testosterone. Or it can be done with female hormones or drugs called LHRH analogs that reduce the amount of testosterone the testicles can make to almost zero. The two LHRH analogs currently available in the United States are leuprolide (Lupron) and goserelin (Zoladex). Hormone treatments will not cure cancer, but they may slow the growth of a tumor and relieve some of the symptoms.
Pro
This is the most effective treatment when cancer has spread to other parts of the body. Studies suggest it can add about two years to a man’s life.
Con
You may lose interest in sex and be unable to get an erection. Depending on which drug you take, it may cause your breasts to grow, give you hot flashes, or cause osteoporosis (weakening of the bones).