Download PROSTATE CANCER The prostate is a walnut sized gland located

By Dr. Karl P. Exell BSc (Hons.) MBBS (UWI) General Practitioner, Guardsman Group Medical Services Ltd.
PROSTATE CANCER
The prostate is a walnut sized gland located beneath the bladder, and surrounding the upper part
of the urethra. It helps produce semen, the thick fluid that carries sperm cells.
Prostate cancer grows very slowly and in its early stages often causes no symptoms. If detected
early it can be cured. If the cancer has spread beyond the prostate to liver, lungs or bone it is
usually not curable but can be controlled.
RISK FACTORS
Several factors increase the risk of prostate cancer. These include age, race, family history, diet
and hormonal levels.
Age
Primarily, prostate cancer affects older men. It is said that no other cancer is as age dependent.
Four out of five cases are diagnosed in men over 65, but less than 1% in men under 50. In one
study, microscopic quantities of low-grade cancer have been found at autopsy in 20% of men
younger than 40. Clinically detected prostate cancers are found in the 7th and 8th decades of life.
Race
Jamaicans and African-Americans have the highest incidence of prostate cancer in the world. A
study (done by Glover, Coffey, Lawson-Douglas, Cadogan, Russell, Tulloch, Baker, Wan and
Walsh in 1998) entitled “The Epidemiology of Prostate Cancer in Jamaica” found the average age
adjusted incidence of prostate cancer in Kingston to be 304/100,000. This compares with rates of
224/100,000 for African Americans, 150/100,000 for white Americans, Western Europeans
39.6/100,000, Japanese 8.5/100,000, Chinese 1.1/100,000 (Kantoff).
When members of a racial group move from a region of low to high incidence of prostate cancer
the incidence of that group increases, indicating the importance of environmental factors.
Family History
The incidence is higher in men who have or have had relatives with prostate cancer.
Diet
There is a direct relationship between diet and prostate cancer. However this is difficult to prove
beyond doubt.
The disease is much more common in countries where meat and dairy products are dietary
staples than in countries where the basic diet consists of rice, soy bean products and vegetables.
Data from various studies support the contention that red meat, animal fat, and a higher total fat
consumption increase risk. Higher consumption of lycopene (found in tomatoes) decreases risk.
Selenium, Vitamin E, soy and Vitamin D consumption are thought to lower risk.
Hormones
This is another controversial area. Some studies have shown that individuals with low androgen
levels (eunuchs) rarely develop prostate cancer, and individuals with high androgen levels are at
a higher risk of developing cancer. Still another study showed that some men with low androgen
levels developed more malignant type cancers.
It is reassuring that currently no link exists between prostate cancer and an active sex life,
vasectomy, masturbation, use of alcohol or tobacco, circumcision, infertility, infection of the
prostate or benign enlargement of the prostate.
SYMPTOMS
Early prostate cancer rarely causes symptoms. If a tumour causes the gland to swell or the
cancer spreads beyond the prostate, the following symptoms may occur:
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Frequency of urination, especially at night
Straining
Burning during urination
Blood in the urine or semen
In advanced prostate cancer, there may be:
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Dull ache or pain in the lower back/ pelvis
Loss of weight/appetite
Nausea/vomiting
DIAGNOSIS
There is currently no “best way” to detect prostate cancer in its early stages. Suspicion should be
aroused by a strong family history of the cancer.
The American Cancer Society currently recommends an annual digital rectal examination, a
blood test- the PSA (prostatic specific antigen) for men older than 50 years. High-risk individuals
(e.g. Jamaicans) should be screened at ages 40 to 45 and then every 2 years from age 50.
The interpretations of PSA results remain somewhat controversial, but if there are doubts an
experienced urologist must be consulted.
An additional diagnostic tool is the transrectal ultrasound (TRUS). In this test an ultrasonic probe
is inserted into the rectum to visualize the prostate and suspicious areas are sampled in a very
specific way. The samples are sent to the pathologist to see if cancer cells are present and how
malignant they are. To find out if the cancer has spread outside the prostate, other tests are
employed – CT scan, bone scan, x-ray, MRI.
TREATMENT
The decision to treat is based on the age of the patient, the location if the cancer and how
aggressive it is. The decision will involve the patient, the family doctor and the specialists
(urologist, pathologist and radiologist).
Treatment of Localized Cancer
If the cancer is confined to the organ, surgery, radiation therapy or cryosurgery (freezing the
malignant cells with liquid nitrogen) may be employed successfully.
Surgery
Radical prostatectomy involves the removal of the prostate and nearby lymph nodes. After
surgery, most men experience some degree of bladder incontinence but in the main this can be
controlled. Impotence is another side effect but usually can be treated with drugs (Viagra);
however, frequency and severity of the aforementioned side effects are subject to debate.
RADIATION THERAPY
With the aid of computers, radiation therapy can be administered with fewer side effects and at
higher doses than traditional radiation therapy. Implantation of radioactive iodine 125 or
palladium 103 seeds directly into the tumour (brachytherapy) is an alternative treatment, which
allows for delivery of high doses to the prostate with limited damage to surrounding tissues.
TREATMENT OF ADVANCED CANCER
1. Lowering the production of testosterone (high levels of testosterone causes the cancer
to grow). This is achieved by castration (surgical or by use of chemicals); the side
effects are hot flashes, impotence and loss of libido. Lowering of testosterone slows
disease progression and prolongs survival of patients.
2. Chemotherapy – mitoxantrone plus a steroid, or docetaxel plus a steroid have been
demonstrated to prolong survival.
PREVENTION
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Reduce intake of dietary fats
Eat less red meat
Eat more foods containing lycopene (e.g. tomatoes)
Eat more fresh vegetables
Eat more fish (especially salmon)
Selenium and vitamin E lower risk of prostate cancer
REFERENCES
1. Glover FE Jr., Coffey DS, Douglas LL, Cadogan M, Russell H, Tulloch T et al. The
epidemiology of prostate cancer in Jamaica. J Urol 1998; 159: 1984 – 7
2. Understanding prostate cancer from WebMD.
September 2003.
Reviewed by Michael W Smith, MD
3. Prostate Cancer – Phillip W Kantoff, MD ACP Medicine. 2005; ©2005 WebMD Inc.
NEUROSURGERY
Neurosurgery is much more than brain surgery. It is the surgical specialty concerned with the
diagnosis and treatment of disorders of the nervous system including the brain, skull, spinal cord,
spinal column, and peripheral nerves.
Neurosurgeons may treat:
Hydrocephalus (water in the brain)
Head injuries
Brain tumours
Spinal cord tumours or malformations
Back pains
Neck pains
Strokes
Peripheral nerve compression e.g. carpel tunnel syndrome
Technological advances have made it possible to treat neurosurgical problems that were thought
to be impossible a few years ago.
Depending on the nature of an injury or illness, neurosurgeons may provide surgical or nonsurgical treatment.
Some of the conditions diagnosed and treated by neurosurgeons include strokes, slipped disks,
and brain tumours.
Strokes
A stroke occurs when the normal blood supply to the brain is interrupted. A blood clot (thrombus),
fatty deposit, air bubble or other substances may become lodged in a blood vessel blocking the
circulation. This sudden blockage can result in a type of stroke called an ischemic (lack of blood)
stroke.
A haemorrhage from a blood vessel that allows blood to float to the brain can cause tremendous
injury and often irreversible damage to the brain’s delicate structure. This type of stroke is a
haemorrhagic stroke and can result from hypertension, ruptured cerebral aneurysm,
arteriovenous malformation (AVM) or other vascular (blood vessel) abnormalities.
Prolapsed (Slipped) Disks
The vertebral column is like stacks of cotton reels. A disk is a small mass of elastic gristle-like
tissue located between each of these cotton reels (the vertebra) in the spinal column. These disks
act as shock absorbers for the spinal bones (vertebrae). Thick ligaments attached to the
vertebrae hold the pulpy disk material in place. A slipped disk occurs when some of the disk
material slips out of place and bulges into the spinal canal.
Brain Tumours
Brain Tumours can occur at any age but the tumours that occur in children are generally different
from those occurring in adults. A brain tumour is a cluster of abnormal cells growing in the brain.
Tumours that begin in the brain are called primary tumours. These tumours grow from the cells of
the brain, the blood vessels in the brain, nerves that emerge from the brain or the membranes
covering the brain. Approximately half of all primary brain tumours are benign (non-cancerous).