Dr. Anil Shah

What is Prostate Cancer?
The prostate is a small, rubbery gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum. It is important for reproduction because it supplies part of the seminal fluid (semen), which mixes with sperm from the testes. Seminal fluid helps the sperm to travel and survive. It is important to understand how prostate cancer develops and impacts a man's life over time due either to cancer growth or as a result of treatments.

1 in 9 men will be diagnosed with prostate cancer, but did you know that prostate cancer is 99% treatable if detected early? September is the perfect month to share critical information on screening and prevention.
Whether you are trying to protect your health or take care of the men in your life, early detection and screening is the key. Prostate cancer is the 2nd most common cancer among men, yet it's also one of the most treatable. Nearly 32,000 men die from prostate cancer yearly, but early detection can be a game-changer. Risk factors for prostate cancer include family history, genetic factors, race, lifestyle and dietary habits.
Prostate uses male hormones called androgens, such as testosterone and dihydrotestosterone (DHT), to trigger and maintain male sex characteristics and reproduction. Normally, the process of producing male hormones and using them to guide and maintain male gender characteristics and sexual function happens smoothly.

How Prostate Cancer Develops
Prostate cancer occurs when a normal prostate cell begins to grow out of control. In many cases, prostate cancer is slow-growing cancer that does not spread beyond the prostate gland before the time of diagnosis. Once prostate cancer forms, it feeds on androgen and uses it as fuel for growth. This is why one of the backbones of treatment for men, especially with advanced prostate cancer, is to lower a man's androgen levels with drugs collectively termed "hormone therapy.”

Not all prostate cancer cells are alike. Prostate cancers that are composed of very abnormal cells are much more likely to divide quickly and spread, or metastasize, from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including seminal vesicles and nearby lymph nodes.
In many cases, prostate cancer is relatively slow-growing, which means that it can take years to become large enough to be detectable, and even longer metastasize outside the prostate. However, some cases are more aggressive and need more urgent treatment.

When a man is diagnosed with prostate cancer, his treatment team will evaluate his cancer and his overall health to custom-design a treatment path that will give him the greatest chance of beating cancer. Treatment can range from a wait-and-watch approach to a very aggressive medical and surgical plan.

Risk Factors of Prostate Cancer:
As indicated by the rates of diagnosis, age is the biggest—but not the only—risk factor for prostate cancer. Other important factors include Family history, Genetic factors, Race, Lifestyle, Dietary habits.
Prostate Cancer Symptoms and Signs:
If you’ve recently been diagnosed with prostate cancer, you may be asking yourself if there were warning signs or symptoms you should have noticed earlier.

So what are the warning signs of prostate cancer?
Unfortunately, there usually aren't any early warning signs for prostate cancer. The growing tumour does not push against anything that causes pain, so for many years, the disease may be silent. That's why screening for prostate cancer is such an important topic for all men and their families. In rare cases, prostate cancer can cause symptoms. Contact your doctor for an evaluation if you develop lower urinary tract symptoms. Remember: Urinary symptoms don't necessarily mean you have cancer.

Prostatitis and BPH (Benign Prostatic Hypertrophy, also known as enlargement of the prostate) are benign diseases but can cause similar symptoms and are very common.
What about the difficulty in having an erection? Again, this is most likely not caused by cancer but by other factors such as diabetes, smoking, cardiovascular disease, or just plain getting older.
That said: Symptoms are symptoms, and no matter what’s most likely to be causing them, you should get them checked out by a doctor.

Prevention of Prostate Cancer
The ultimate goal is to prevent men from developing prostate cancer. Although significant progress has been made and genetic and environmental risk factors for prostate cancer have been identified, the evidence is not strong enough for conclusive recommendations on prostate cancer prevention.
Given that prostate cancer feeds on testosterone and DHT (dihydrotestosterone), there have been multiple large studies trying to lower DHT in men to prevent prostate cancer. These studies have investigated finasteride and dutasteride, which lower DHT levels and are often used to treat men with the noncancerous condition BPH, have shown that these drugs may reduce the chances that a man will be diagnosed with prostate cancer. The Prostate Cancer Prevention Trial was one of the largest prostate cancer trials ever and involved more than 18,000 men followed for over a decade. This study showed that finasteride therapy reduced the risk that a man would be diagnosed with prostate cancer by 25%. The study did find a slightly higher rate of aggressive prostate cancers in men who took finasteride, which other studies have suggested may be due to artefact or greater ability to find more aggressive cancers due to a smaller prostate size (ie if you put 12 biopsy needs into a small prostate it is more likely to find cancer than if you put 12 biopsies in a large prostate). Diet and lifestyle modifications have also been shown to reduce the risk of prostate cancer development and progression and can help men with prostate cancer live longer and better lives.

Top 10 Considerations for Preventing Prostate Cancer
To understand how to prevent prostate cancer, one must first understand what causes it. Four major factors influence one's risk for developing prostate cancer.
Age: The average age at the diagnosis of prostate cancer in the United States is 69 years and after that age, the chance of developing prostate cancer becomes more common than any other cancer in men or women.
Race: African-Americans are more likely to develop prostate cancer and have more than twice the risk of dying from it. Conversely, Asian men who live in Asia have the lowest risk; however, when they migrate to the west, their risk increases.
Family history: A man with a father or brother who developed prostate cancer has a twofold-increased risk for developing it. This risk is further increased if the cancer is diagnosed at a younger age (less than 55 years of age) or affected by three or more family members. You should discuss with your doctor if you have a family history of not only prostate cancer, but also breast cancer, colon cancer, or pancreatic cancer.
Where you live: The risk of developing prostate cancer for men who live in rural China is 2% and for men in the United States is 17%. When Chinese men move to the western culture, their risk increases substantially; men who live north of 40 degrees latitude (north of Philadelphia, Columbus, Ohio, and Provo, Utah) have the highest risk for dying from prostate cancer of any men in the United States – this effect appears to be mediated by inadequate sunlight during three months of the year which reduces vitamin D levels.
Unfortunately, the factors above are difficult or impossible to change, however, there are many things that men can do to reduce or delay their risk of developing prostate cancer. Why is prostate cancer so common in Western culture and much less so in Asia, and why does when Asian men migrate to western countries the risk of prostate cancer increases over time? We believe the major risk factor is diet – foods that produce oxidative damage to DNA.
What can you do about it to prevent or delay the onset of the disease?
1. Eat fewer calories and exercise more so that you maintain a healthy weight.
2. Try to keep the amount of fat you get from red meat and dairy products to a minimum.
3. Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,200 mg per day.
4. Eating more fish – evidence from several studies suggesting that fish can help protect against prostate cancer because they have "good fat," particularly omega-3 fatty acids. Avoid trans-fatty acids (for example, in margarine).
5. Incorporate cooked tomatoes (prepared with olive oil), which may be beneficial, and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy-based foods and green tea are also potential dietary components that may be helpful.
6. Avoid smoking for many reasons. Drink alcohol in moderation, if at all.
7. Seeking medical treatment for stress, high blood pressure, diabetes, high cholesterol, and depression. Treating these conditions may save your life and will improve your survival of prostate cancer.
8. Avoid over-supplementation with megavitamins. While a multivitamin is not harmful, you probably don't need it if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils. Ask your doctor about herbal supplements as some may harm you or interfere with treatment.
9. Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
10. For men 45 or older (40 or older for African American men or those with a family history of prostate cancer), discuss the risks and benefits of screening with a PSA test and, if indicated, a rectal examination, with your doctor.

(Dr.Shah is Resident Urologist Surgeon,
Nepal Mediciti Hospital)