Prostate Cancer

We all change as we get older, and some changes are gender-specific (that is, affect men or women, but not both). One of the most common serious issues affecting men, especially older ones, is cancer of the prostate. Recently, ex-President Biden has been diagnosed with the tumor.

The prostate gland is part of the male genital tract and surrounds part of the urethra, the tube through which urine and sexual fluid exits the body. The prostate is responsible for producing some of that fluid.

The prostate gets larger as men age. Normally the size of a walnut, it gets bigger as time goes on. An enlarged prostate is not necessarily an indication, however, that a cancer exists. 50 percent of men aged 51-60  have an enlarged but benign prostatic condition called “benign prostatic hyperplasia” on BPH. That percentage increases to over 80 percent in those over the age of 70. For my article on BPH, click here.

According to the American Cancer Society, approximately 60 percent of prostate cancer cases are diagnosed in men aged 65 or older. Among men over 70, the prevalence of prostate cancer is estimated to be around 70 percent. As the average age of the general population gets older with modern medical advances, more and more men will reach the age when prostate cancer is common. Only skin cancer is more common in elderly males.

RISK FACTORS RELATED TO PROSTATE CANCER

Besides gender and age, several other risk factors exist for prostate cancer:

Ethnicity: Prostate cancer is more common in black men than other ethnicities.

Family History: Having a first-order relative (father or brother) with prostate cancer significantly increases risk.

Genetics: Some inherited genetic mutations are linked to a higher risk of prostate cancer.

Diet: While the data is not concrete-hard, studies suggest that high-fat diets and diets high in dairy products may increase the risk.

Obesity: Obesity may be linked to certain aggressive forms of prostate cancer.

Chemical Exposure: Certain chemicals found in pesticides, herbicides, and some industrial products may increase cancer risk .

Evidence for both smoking and alcohol as risk factors has been presented, but the evidence is not as strong as the above factors.

WHAT ARE THE SYMPTOMS OF PROSTATE DISEASE?

As the mass of the prostate gland increases from either cancer or benign conditions, it applies pressure to the urethra. It may not be noticeable in early stages, or it might cause a number of changes that can affect quality of life, including:

-A weaker stream of urine
-Difficulty beginning the process of urination (also called “hesitancy”)
-A sudden urge to go (also called “urgency”)
-Waking up frequently with an urge to urinate
-Obstruction of urine flow
-Bladder and kidney infections (otherwise rare in males)

Besides the list of symptoms just mentioned, actual cancers of the prostate may manifest as blood in the urine or semen. If the cancer has spread, it usually invades bone, causing significant pain.

DIAGNOSIS OF PROSTATE CANCER

Abnormalities in the prostate may sometimes be felt during a rectal exam. This is performed by a medical provider’s gloved index finger. A normal prostate will feel rubbery and smooth. Pain during the exam or an irregular lump is a concern.

In addition to performing a rectal exam, tests to identify one from the other include the blood exam PSA (prostate specific antigen), which is elevated in prostate cancer) and various other diagnostic studies. Normally, a result that is above 4.0 or is trending upward suggests further evaluation is needed.

Official proof of prostate cancer is obtained by performing a biopsy (taking a small sample of tissue and sending it for analysis).

STAGES OF PROSTATE CANCER

Prostate cancer was typically classified into four stages based on the size, location, and aggressiveness of the tumor. A number of complicated alternative categorization systems, however, have emerged in recent times. The CDC uses a system called Summary Staging. These stages are broken down as follows:

Localized: The cancer is limited to the prostate gland and has not spread beyond it. 70 percent of prostate cancers are diagnosed as localized.

Regional: The cancer has spread to nearby structures or regional (nearby) lymph nodes, but not distant parts of the body. 12 percent are found at this stage.

Distant: The cancer has spread to other parts of the body, such as the bones, lymph nodes, or other organs. 8 percent of prostate cancers have spread to distant sites when diagnosed.

Unknown: The stage of the cancer is not clearly defined or cannot be determined.

The news of the ex-president Biden’s prostate cancer mentions something called the “Gleason Score.” This system assigns numbers to grade the level of abnormality of the cancer cells and, thus, its aggressiveness. Higher Gleason scores indicate more aggressive cancer. Mr. Biden’s cancer is level 9, a very invasive grade. Using the classical level of numbered stages, his cancer would be considered Stage 4.

TREATMENT OF PROSTATE CANCER

Prostate cancer treatment options are many, especially in localized and regional cases.  Surgery for prostate removal, radiation therapy, hormone therapy, chemotherapy, targeted therapy, and immunotherapy have been used successfully, and new options such as high-intensity focused ultrasound (HIFU) have emerged. The best treatment approach depends on:

• Cancer Stage: The stage of the cancer (localized, regional, or metastatic) is a primary factor.
• Gleason Score: This score, based on a biopsy, helps determine the aggressiveness of the cancer.
• PSA Level: Prostate-specific antigen (PSA) levels..
• Overall Health: The patient’s overall health and age are important considerations.
• Personal Preferences: The patient’s preferences and wishes regarding treatment must always be taken into account.

PREVENTION OF PROSTATE CANCER

image: Pixabay

While there’s no guaranteed way to completely prevent prostate cancer, adopting a healthy lifestyle can reduce the risk. This includes maintaining a healthy weight, engaging in regular physical activity, and following a balanced diet.

Diet: Limit high-fat foods. Some studies suggest a high-fat diet, especially from animal sources like red meat, may increase risk. Instead, choose a plant-based diet: A diet rich in fruits, vegetables, and whole grains can provide essential nutrients and antioxidants.

Consider including lycopene-rich foods: Lycopene, found in tomatoes and other red fruits, has shown potential in reducing prostate cancer cell growth.

Include healthy fats: Fish and nuts are good sources of healthy fats.

Limit processed foods: Some evidence suggests that processed foods can increase risk.

Maintain a normal weight: Obesity is linked to an increased risk of prostate cancer. Work in some moderate exercise most days of the week: Regular physical activity can help maintain a healthy weight and offer other protective effects. Some studies suggest that more vigorous exercise may be particularly beneficial.

Other lifestyle factors may play a role, such as limiting smoking and alcohol consumption.

Consider regular PSA testing starting at age 50 (earlier if African-American or high-risk for other reasons). Some physicians stop testing around age 70. I would suggest continuing yearly testing even after that age.

From a pharmaceutical standpoint, those at risk might consider a family of drugs known as 5-alpha reductase inhibitors. These medications, like finasteride and dutasteride, are sometimes used to reduce the risk of prostate cancer in high-risk individuals. Be aware that they are not without possible side-effects.

It should be noted that, if you follow all of the above, you will likely reach an advanced age, which….increases your risk of prostate cancer!

Ex-President Biden’s advanced stage of prostate cancer may not be curable. There are many options, however, than can give relief from pain and improve quality of life. Hopefully, his advanced age and infirmities will allow him to access all the available therapies.

Joe Alton MD