Prostate cancer is a cancerous tumor in the prostate gland, a small walnut-sized gland in men that makes seminal fluid, which helps carry sperm out of the body. The prostate is located beneath the bladder and surrounds the urethra, the tube that carries urine out through the penis.
Prostate tumors can be benign or cancerous. With benign tumors, the prostate gets bigger and squeezes the urethra, interrupting the normal flow of urine. This condition, called benign prostate hyperplasia or BPH, is common and not usually life threatening. Prostate cancer -- one of the most common kinds of cancer in men -- can spread beyond the prostate gland and be life threatening.
Prostate cancer is the third most common cause of cancer deaths in men of all ages and the most common cause in men over 75 years old. Men younger than 40 don't usually get prostate cancer. Some are at higher risk, including African-American men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium.
Most cancerous tumors in the prostate grow slowly and either don't spread or don't cause harm for decades. When caught early, prostate cancer can be treated successfully in more than 90% of cases. Men 50 years old and older should talk to their doctors about being screened for prostate cancer.
Experts don't know what causes prostate cancer. Several things, including genes, diet, ethnicity, hormones, and your environment, may play a part.
Some studies have shown a link between a high-fat diet and higher testosterone levels. Testosterone stimulates growth of the prostate. Some doctors think that testosterone replacement therapy might make existing prostate cancer grow faster, and men who use testosterone therapy may be more likely to get prostate cancer than those with lower levels of the hormone.
Genes may come into play because prostate cancer tends to happen in men who are related to one another (see "Risk Factors" section). In addition, researchers have found a gene that is associated with 30% of family-related prostate cancers.
Asian men tend to have a lower rate of prostate cancer, while African-American men have one of the highest rates in the world.
There are several options, depending on how fast the cancer is growing, whether it has spread, how old you are, and the benefits and drawbacks to treatment.
If prostate cancer is found early, treatment usually involves either surgery to remove the prostate or radiation therapy. For more advanced cases, or if cancer spreads beyond the prostate, hormone medications may be used.
In some cases, if you have only a slow-growing tumor, the doctor may suggest "watchful waiting." Watchful waiting means closely monitoring the situation and giving treatment only if your condition worsens.
Making changes in your diet and considering certain herbs and supplements along with treatment may help either reduce risk of prostate cancer or make treatment work better. If you have prostate cancer, you should not use herbs or supplements by themselves to treat it. Prostate cancer should be treated with conventional medicine. Don't take any herbs or supplements without your doctor's supervision, because they can interfere with your treatment.
Acupuncture can relieve pain and the side effects of surgery. Meditation and massage may reduce stress and anxiety.
Hormone therapy or chemotherapy may be used to stop the growth of cancer cells in the prostate. Sometimes medications are used with or before surgery or radiation to shrink large tumors. Generally they are used when prostate cancer has spread.
Hormone therapy causes your body to not make as much testosterone or not be able to use it as well. Lowering testosterone levels shrink tumors or slow their growth. It is usually reserved for men whose prostate cancer has spread. These medications include:
- Luteinizing hormone-releasing hormone (LH-RH) agonists -- LH-RH is a natural hormone made by your body that lowers the production of testosterone. These drugs encourage your body to release this natural hormone. Side effects can include hot flashes, weight gain, development of male breast tissue, breast pain, and nausea.
- Leuprolide (Lupron, Viadur)
- Goserelin (Zoladex)
- Buserelin (Suprefact)
- Antiandrogens -- stop testosterone from reaching cancer cells by blocking the action of androgens, or male sex hormones. Side effects can include lower sex drive, fatigue, nausea, erectile dysfunction, diarrhea, and hot flashes.
- Flutamide (Eulexin)
- Bicalutamide (Casodex)
- Nilutamide (Nilandron)
- Chemotherapy -- may reduce symptoms in men whose cancer is advanced.
Surgery and Other Procedures
- Removal of the prostate (radical prostatectomy) -- used to treat prostate cancer that has not spread. There are two types of radical prostatectomy. In retropubic surgery, the prostate and surrounding lymph nodes are removed through an incision in the lower abdomen. In perineal surgery, the prostate is removed through an incision made between the anus and scrotum (the perineum). Side effects can include incontinence and erectile dysfunction. In some cases, a technique called nerve-sparing surgery can have fewer sexual side effects.
- Robot-assisted laparoscopic radical prostatectomy (RALRP) -- a newer procedure that uses a laparoscope, a long, thin tube with a camera, to magnify the area. Smaller incisions allow a quicker healing time.
- Resection of the prostate (called TURP or transurethral resection of the prostate) -- removal of prostate tissue to let urine flow freely. It is sometimes used to relieve symptoms of benign prostatic hyperplasia and may be used in men with prostate cancer who cannot have a radical prostatectomy.
- Removal of the testes (orchiectomy) -- lowers testosterone levels, but side effects can include erectile dysfunction and hot flashes. Most men choose hormone therapy instead.
- Radiation -- uses radiation to kill cancer cells. There are two types of radiation therapy:
- External beam radiation therapy (EBRT or ERT) -- uses a machine to send a high-energy beam to the tumor.
- Radioactive seed implants (brachytherapy) -- places tiny radioactive seeds in the prostate to deliver radiation over a longer time period. Using irradiated seeds can lower the risk of radiation damage to organs around the prostate.
Nutrition and Dietary Supplements
Some early studies suggest that some nutritional supplements may reduce the symptoms of some prostate cancers or lower your risk of developing it. Ask your team of health care providers about the best ways to use these therapies in your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using. Do not try to treat prostate cancer with supplements on your own.
Follow these tips to reduce your risk of developing prostate cancer:
- Eat antioxidant foods, including fruits (such as berries, watermelon, and tomatoes) and vegetables (such as squash and bell peppers).
- Include more cruciferous vegetables (such as broccoli, cauliflower, cabbage, and Brussels sprouts) in your diet. One preliminary study found men who eat three or more servings a week reduced their chance of getting prostate cancer. Another study found that men who ate 28 or more servings of all kinds of vegetables per week were 35% less likely to develop prostate cancer than men who had fewer than 14 servings per week. These foods also seem to kill cancer cells in test tube studies.
- Eat more fish. Some studies show men who regularly eat fish have a lower risk of prostate cancer than those who don't eat as much fish.
- Don't eat foods high in saturated fat. High-fat diets may raise your risk of prostate cancer.
- Stay at a healthy weight, and exercise regularly.
These nutrients may have cancer-fighting properties:
- Lycopene, 15 mg two times per day, is an antioxidant found in tomatoes and watermelon. Researchers think it may help prevent prostate cancer, although the studies have been preliminary and at least one study suggested it might not be good for advanced prostate cancer. In one preliminary study, men with prostate cancer got either a lycopene supplement or placebo for 3 weeks before having prostate surgery. Cancer cells didn't grow as much in the men who took the supplement, compared to those who took placebo. Lab studies have also found that lycopene stops the growth of prostate cancer cells in test tubes. However, one study on a specific line of advanced prostate cancer cells found that lycopene might make cancer grow faster. Lycopene seems to reduce the risk of developing prostate cancer.
- Vitamin E -- in one lab test, a specific kind of vitamin E blocked the growth of prostate cancer cells. In men who smoke, vitamin E may also lower the risk of getting prostate cancer. Overall, studies on vitamin E and prostate cancer have been mixed. One study found that men who took a multivitamin more than 7 times in a week and also took a vitamin E supplement had a higher risk of prostate cancer. More research is needed to know how vitamin E affects prostate cancer.
Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. Don't use herbs by themselves to treat prostate cancer, and don't take any herbs without your doctor's supervision. Some herbs can interfere with cancer treatment.
- Green tea (Camellia sinensis) is an antioxidant that may lower risk of cancer and heart disease. In one study, green tea extract seemed to help slightly in treating some forms of prostate cancer, but more research needs to be done. Use caffeine-free products. You may also make teas from the leaf of this herb.
- Pomegranate (Punica granatum) -- In one study, men who had surgery or radiation to treat prostate cancer that had not spread and who drank 8 oz. of pomegranate juice every day slowed down the time it took their PSA levels to double. Researchers think that means their tumors may have not grown as fast, either. More research needs to be done. Ask your doctor before drinking pomegranate juice daily because it can interact with some medications.
Acupuncture may provide relief from side effects of orchiectomy, removal of the testes. Studies also support using acupuncture to relieve pain that often happens when cancer has spread, particularly to the bones. A National Institutes of Health statement released in 1997 also supports acupuncture to reduce nausea from chemotherapy.
Evidence suggests acupuncture can be valuable for cancer-related symptoms, particularly nausea and vomiting that often goes with chemotherapy treatment. Studies have also found that acupuncture may help reduce pain and shortness of breath. Acupressure, or pressing on rather than needling acupuncture points, may also help control breathlessness and is something people can learn and then use to treat themselves.
Massage and Physical Therapy
Studies suggest that massage reduces stress and boosts immune function, so it may help relieve anxiety for men being treated for prostate cancer.
Pelvic floor exercises -- tightening and releasing muscles that start and stop the flow of urine -- may help with incontinence caused by prostatectomy (removal of the prostate).
Meditation may reduce stress, ease anxiety, and allow men with prostate cancer to regain a sense of self-control.
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