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Monday, 03 August 2015 14:47

Prostate cancer: The truth, the myths and the hope Featured

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By Dr. Anesa W. Ahamad, MD, MSC, FACR, DABR

Did you know that a blood test at age 45–50 can predict a man’s lifetime risk of dying of prostate cancer more so than his family history or ethnicity? Did you know that a man can increase his risk of prostate cancer by taking certain vitamins and supplements?

Prostate cancer is still the number one cancer in the US and the Caribbean among men. It is a major cause of death and disability. It is much commoner in African Caribbean men than any other races.  It makes sense to pay attention to reducing the risk of prostate cancer and to detecting it early enough to get high cure rates.  

Lowering the risk of prostate cancer: The truth, the myths and the hope

The truth:  Some things that increase the risk cannot be changed such as: increasing age above 50, prostate cancer in a father, brother, or son, and being African- Caribbean.  However the risk of cancer is also increased by taking vitamin E, folic acid and calcium supplements. The risk can be reduced by a diet high in folate:  green vegetables, beans and orange juice. Folic acid is a man-made form of folate. A 10-year study showed that the risk of prostate cancer was lower in men who had enough folate in their diets. However, the risk of prostate cancer was increased in men who took 1 milligram (mg) supplements of folic acid.

Drugs used to lower the amount of male sex hormones made by the body: finasteride and dutasteride has been shown to lower the risk for prostate cancer, but it is not known if these drugs lower the risk of death from prostate cancer. Side effects include erectile dysfunction, loss of desire for sex, and enlarged breasts.

The myths: It is not true that regular use of multivitamins reduces the risk of prostate cancer; in fact, a large study showed an increased risk of advanced prostate cancer among men who took multivitamins more than seven times a week. Selenium and vitamin E are also ineffective.  It is also a myth that taking lycopene supplements decreases the risk of prostate cancer. Common myths in the Caribbean are that the high rate of prostate cancer is related to sexual activity or foods such as ackee, or nuts. This is incorrect. Is commonly thought that saw palmetto supplements reduce the risk of prostate cancer; however this is incorrect.

The hope:  research. Cancer prevention trials are ongoing to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

Finding prostate cancer before a person has any symptoms: The truth, the myths and the hope  

The truth:  Prostate cancer can be diagnosed early using a blood test and an examination. The blood test measures the level of prostate-specific antigen (PSA) which is a substance made mostly by the prostate. PSA may be found in an increased amount in the blood of men who have prostate cancer. The examination is done by a doctor or nurse who inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for unusual lumps.

A man’s PSA level at age 45–50 is a strong predictor of his lifetime risk of dying of prostate cancer more so than his family history or ethnicity. PSA levels at this age can be used to decide how often to do more testing. For example men with a PSA level below average for this age range can be screened every 5 years, those with intermediate PSA levels (1–3 ng/mL) may be screened less frequently (2 to 4 years) and men with PSA level greater than 3 ng/mL may be considered for biopsy. This is removal of a small piece of the prostate to look at the cells under a microscope to see if there are cancer cells.

If PSA is high and biopsy does not show cancer, a urine test for a gene called prostate cancer gene 3 (PCA3) may be done. If urine PCA3 level is high, another biopsy may be necessary as the initial biopsy may not have taken cells from the area that contains cancer.

The myths: It is often thought thatmen can avoid the clinical examinationby the doctorand that this can be substituted by the blood test or an ultrasound. An ultrasound is not needed to screen for prostate cancer but is used when a biopsy is being done.

The hope:research. Scientists are developing new such as phi (Prostate Health Index, Beckman Coulter) and 4K (four-kallikrein, OPKO Diagnostics), both of which have been shown to markedly increase the specificity of PSA testing and reduce the need for biopsies without the risk of missing high-grade cancers.

Prostate cancer treatment: The truth, the myths and the hope.

The truth: Some patientswithvery low grade low risk prostate cancer may not need immediate treatment. For those who need or choose to get treated, surgery and radiotherapy are two options for treating prostate cancer.  The surgeon removes the prostate, surrounding tissue, and structures connected to the prostate called seminal vesicles and nearby lymph nodes and then reconnects the tube that carries urine to the bladder.

Radiation to kill prostate cancer cells is either given as painless beams from a machine or radioactive substances that are placed directly into the cancer. A lot of advancements were made over the past decade to create radiation volumes that are shaped to fit each patient’s tumor.  Currently a very highly skilled team of board certified physicists and scientific staff work with physicians using complex computers  to create highly targeted radiation treatments that focus with great precision on the prostate itself and a slim margin of surrounding. This enables a very high cure rate with very little side effects or complications.

The myths: Proton beam therapy is also a new technology used for prostate cancer. However this has not been proven as better than X-rays (also called photons). One study also showed that there were more complications in patients who had protons than photons from commonly used linear accelerator equipment.

The hope:

The ability to treat small volumes with high precision has led to the development of a technique called stereotactic body radiotherapy (SBRT) which allows cancer to be treated in just 5 X-ray sessions. This is much more convenient that the classical way of giving daily treatments over six to nine weeks. This is being done on research protocols and will likely lead to more patients being treated at much lower cost with same effectiveness.

Anesa Ahamad MD FRCR;  Oncologist 21st Century Oncology. This email address is being protected from spambots. You need JavaScript enabled to view it.

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