PROSTATE CANCER: What every man should know

Prostate cancer is the most common cancer in men and the second most common tumor diagnosed worldwide.

The prostate is a walnut sized gland that is part of the male reproductive system. It is located beneath the urinary bladder and in front of the rectum.

The prostate makes some of the fluid that nourishes and protects sperm cells in the semen. Just behind the prostate are the seminal vesicles, which make most of the fluid for the semen.

Prostate cancer is to men what breast cancer or cervical cancer is to women. It has the potential to grow and spread quickly, but for most men, it is a relatively slow growing disease.

About 20,000 men die of prostate cancer every year in Nigeria. One new case occurs every 3.3 minutes and a man dies from prostate cancer every 20 minutes.

On daily basis, at least 14 men die in the country and 1 in 5 men will be diagnosed with prostate cancer in their lifetime.

A black man is 70 percent more likely to develop prostate cancer than a Caucasian man, and is nearly 2.3 times more likely to die from the disease.

Even if you don’t smoke you are more likely to develop prostate cancer than to develop colon, bladder, melanoma, lymphoma and kidney cancers combined.

As men increase in age, the risk of developing prostate cancer increases exponentially. About 6 in 10 cases are found in men over the age of 65.

If you have relatives—father, brother, son—with a history of prostate cancer, then you are twice as likely to develop the disease.

Men with prostate cancer do not always experience symptoms, however, if the cancer is caught at its earliest stages, most men will not experience any symptoms. Prostate cancer is 100 percent treatable if detected early.

Most of the time, men don’t have symptoms. Some men, however, do experience changes in urinary or sexual function, including frequent nighttime urination, painful or burning urination, difficulty getting or maintain an erection or a dull pain in the lower pelvic area.

Men of average risk are often advised to consider screening earlier at age 40 to establish a baseline. Every man needs to  learn what makes the most sense for their personal health risks and lifestyle.

Screening is to detect prostate cancer at its earliest stages, before any symptoms have developed. That’s when the cancer can be treated most effectively. Screening may include a Prostate-Specific Antigen, PSA, blood test, with or without a Digital Rectal Examination, DRE.

Elevated PSA levels do not always mean cancer. Only about 30 percent of the time does an elevated PSA indicate cancer. Other conditions that can raise PSA include an enlarged prostate due to benign prostatic hyperplasia (which can affect  ability to pass urine), prostatitis (an infection or inflammation of the prostate gland), or even injury or recent ejaculation (which can raise PSA)

If caught early, prostate cancer has  95 percent survival rate. Purpose of screening is to detect prostate cancer at its earliest stages, before any symptoms have developed.

Old age particularly 65 and over is the main risk factor for prostate cancer. The older a man gets, the more likely he will develop prostate cancer. The disease is rare in men under 45 years of age.

Diagnosis of prostate cancer should be part of a routine annual examination by a primary care doctor. The prostate cancer tests for early detection and screening are the Digital Rectal Exam, DRE, combined with a blood test to measure the Prostate Specific Antigen, PSA level, in the bloodstream. Abnormal DRE, elevated PSA or confirmation of more advanced Prostate Cancer will require additional testing.

This is an enzyme found in the blood produced exclusively by prostate cells. Normal levels of PSA in the blood are small amounts between 0-2.5 ng/ml. Higher than normal levels,  greater than 2.5 ng/ml, can be caused by cancer or benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma.  All elevated readings of PSA should be checked.

Occasionally, a Digital Rectal Exam, DRE, does not reveal any abnormalities, but the PSA is elevated. Sometimes the opposite is true, and PSA is normal, but the DRE is abnormal. For this reason,  the Prostate Specific Antigen PSA blood test together with the DRE is best for early detection.

Normal prostate cells and prostate cancer cells make PSA even if they are outside the prostate. That is why PSA monitoring after treatment is so important. Returning prostate cancer cells, confined to the prostate or that have spread to the bone or lymph nodes, will cause the PSA to rise. PSA is important for diagnosis, treatment and follow-up as well as useful for comparing treatment results.

Research has investigated what PSA levels within age ranges should raise concern about the likelihood of significant prostate cancer. PSA is measured by a simple blood test. The typical test for diagnosis and risk group determination is the “total PSA” which is simply a measure of all the PSA. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive technology (monoclonal antibody technique).

Diagnosis is confirmed with a biopsy. The biopsy can give important indications as to how extensive the cancer is within the prostate by the number of cores that are positive for cancer. The pathologist will also look for perineural invasion, (cancer invading small nerves within the prostate), which can be an indication of how likely the cancer is to spread outside of the gland. Prostate Cancer Gleason Score is set by inspection of prostate cancer cells how quickly it grows and how likely it is to spread outside of the gland.

The Prostate Cancer Gleason Score  ranges from 2 to 10. To determine the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue.

A high Gleason score (such as 10) means a high-grade prostate tumour. High-grade tumours are more likely than low-grade tumours to grow quickly and spread.

When facing a diagnosis, there are a lot of things for you to consider. Is prostate cancer or a benign condition? How bad is this prostate cancer ? Which treatment is right for you ? What are the side-effects of treatment? How long is the recovery time and which doctor is best ?

The good news is that the probability of survival for most prostate cancer patients is very good. However, you need to complete treatment. Some treatments increase the likelihood that your prostate cancer will not return.

It is extremely unusual that there is any need for you to rush to a decision. Most cancers have been quietly sitting in the prostate, slowly growing for 10-15 years. You haven’t just gotten cancer, you have just been diagnosed with cancer that you have been living with for a long time. No need to become an instant expert. Take your time, become informed. Learn about available treatment options. Select several specialists who can describe the different treatments. Arrange consultations and   discuss the options.