July 31, 2010
 Soy-based foods mimic estrogen's effects and may lower women's risk of ovarian and endometrial cancers. More > 
Would you like to ask our staff a question?
>
Join the discussion and leave a comment on this article
>
|
Prostate Cancer
Dr. Haddad is Geriatric Fellow, Division of Geriatric Medicine, Saint Louis University, Health Sciences Center, Saint Louis, MO.
Cancer of the prostate is the most common cancer in men. It is estimated that this disease will be diagnosed in almost 200,000 U.S. men in the year 2001 and will lead to the death of nearly 32,000.(1) It is as controversial as it is widespread — there is no definite agreement among medical experts about screening, diagnosis or treatment for this disease. A man's risk of getting prostate cancer increases with age and begins to rise sharply after age 50. Race makes a difference, although we do not know why. In white men with a history of prostate cancer in their immediate family and in all African-Americans, this upturn in risk begins at age 40. For all men, the probability of developing prostate cancer between ages 40-59 is 2.06% (1/49) and climbs to 13.4% (1/7) between age 60-79.(2) African-Americans have a lifetime risk about 20% higher than the risk for white men and once they have the diagnosis they are, compared to whites, three times as likely to die from it. Risk Factors
Age and Race
Autopsy studies have shown that up to two-thirds of men develop prostate cancer, many without ever knowing it. Advanced age and African-American race are the strongest risk factors.
Family History
The risk doubles if there is an immediate family member with prostate cancer. As the number of family members affected increases, the risk increases exponentially. Hereditary prostate cancer, although rare, does exist and occurs at an earlier age. There is no definite proof of an association between prostate cancer and fatty diet, vasectomy or sexually transmitted diseases.
The Stages of Prostate Cancer
Early-stage disease
In this stage there are normally no symptoms, as the disease is confined to part of the prostate gland. In some rare cases, however, early-stage prostate cancer can cause bladder outlet obstruction (difficulty passing passing urine to empty the bladder).
Locally advanced disease
In this stage, the cancer has advanced, but has not spread beyond the prostate itself. Bladder outlet obstruction is usually present. Other symptoms include bloody urine and urinary tract infections.
Metastatic disease
In this stage, the cancer has spread beyond the prostate gland and into other areas of the body. Common symptoms include bone pain, weakness in the legs (caused by pressure on the spinal cord), swelling in the lower legs from accumulated lymphatic fluid, and bladder and bowel sphincter dysfunction. When these symptoms are present, doctors should have an MRI done as soon as possible, as well as begin chemotherapy. In some cases, surgical or radiation therapy may be considered.
Screening and Diagnosis
Prostate cancer screening is probably the most controversial issue in the field of preventive medicine. Those who advocate early detection efforts cite data that show that 75% of patients with localized prostate cancer will move on to the locally advanced stage within 10 years and of these individuals 65% will die from cancer. Among patients with metastatic disease, nearly 50% will die within three years. In theory, at least, early detection can mean earlier effective treatment that cures the disease and maintains normal life expectancy without a great impact on quality of life.
Those who are against screening have pointed out that early detection, based on the research data currently available, does not seem to improve life expectancy. They have also argued that the prostate tumors detected earlier tend to be those that are more slow-growing; with or without detection, these would have not otherwise changed the natural course of life for that individual. All early detection accomplishes, they say, is to increase the time that a person is known to have such prostate cancer. Data from some very recent studies, while not conclusive, do seem to support the concept that early detection can save lives.(3) Digital rectal examination (DRE)
This is the dreaded traditional rectal examination, in which a urologist or other physician uses his finger to test for the presence of swelling around the prostate gland. The National Comprehensive Cancer Control recommends an annual DRE for all men who are 50 or older, as well as higher-risk younger men. At the very least, DRE should be offered to men in these populations, along with an explanation of the how and why it is done. DRE can detect most, but by no means all, cases of prostate cancer.(4)
PSA Test
PSA is a substance naturally produced within the prostate and found in seminal fluid. Because PSA levels are increased by inflammation of the prostate, which can be caused by prostate cancer, testing for high PSA levels is a good way to detect at least the strong possibility of prostate cancer. While it is constantly being refined and improved, PSA testing has its limits, missing 18-25% of prostate cancer because of false negatives; it also produces false positive results approximately 60% of the time. It is inexpensive.(5)(6)(7)
No comments have been made |
| The Doctor Will See You Now | |
LEGAL RESTRICTIONS AND TERMS OF USE OF THIS SITE. USE OF THIS SITE IS YOUR AGREEMENT TO THESE TERMS. Copyright 2010 interMDnet Corporation. All rights reserved. About Us | Privacy Policy | Disclaimer | System Requirements |