Prostate Cancer Symptoms
Even aggressive prostate cancer tends to grow more slowly than other cancers in solid organs, such as stomach or pancreatic cancer. This slow growth creates a large window of opportunity (typically lasting several years) during which the cancer can be detected and cured before it spreads outside the prostate to other areas of the pelvis or to distant sites either in the bloodstream to the bones or through lymphatic channels to lymph nodes. This process of distant spread (‘metastasis’) is already present in 30% of men diagnosed with prostate cancer in the UK and whilst treatable cannot be cured.
Symptoms of prostate cancer
Early prostate cancer has no symptoms. Later stages can produce urinary symptoms, lethargy, nausea, leg swelling and bone pain.
PSA - Prostate specific antigen
This simple blood test is capable of indicating the degree of risk of prostate cancer in most men. If, at the age of 45 years a man's PSA is 2-3 ng/ml, he has a 10x risk of dying of prostate cancer. PSA testing should be combined with a digital rectal examination (DRE) of the prostate, as this doubles the likelihood of detecting prostate cancer (the PSA is normal in 20% of men with prostate cancer). PSA is neither completely sensitive (it has a false-negative rate) nor completely specific (it also has a false-positive rate) for prostate cancer but it remains an extremely useful tool. The normal range for PSA is 0-4 ng/ml. The PSA level in any man fluctuates from day to day, so although absolute PSA levels are important, so too is the trend of PSA results. This is especially so in patients who have the SNP-1 gene variant, which is associated with an elevated PSA and decreased risk of prostate cancer. PSA is increased by age, prostate size, poor bladder emptying, infection, ejaculation, prostate injury (such as biopsy) and cancer. In a proportion of men, none of these can be found. Although it is true that the likelihood of prostate cancer increases with age (75% of men aged over 80 years dying of any cause have evidence of prostate cancer present at post mortem) the evidence suggests that prostate cancer associated with an elevated PSA tends to be 50x greater in size than if the PSA is normal, and therefore poses a threat.
Screening for Prostate Cancer
A number of screening studies from Europe and the USA have previously suggested an improvement in cancer-specific survival because of screeing but now the largest study ever to have been undertaken, the European Randomized Study of Screening for Prostate Cancer (ERSPC), has reported a 31% reduction in deaths from prostate cancer in screened patients. Unfortunately, the studies results were published at the same time as those of the smaller America PLCO screening study, which showed no such advantage but which was methodologically flawed, rendering its results unreliable and diverting attention away from the importance of the results in the ERSPC trial.
Screening is especially important for men with a family history of prostate cancer (see below), as the risk is at least 2-3x higher if a first degree relative is affected.
Compelling evidence of the effectiveness of screeing for prostate is also provided by the reduction of prostate cancer-specific deaths in the USA, which coincided with widespread screening for prostate cancer with PSA, seen below.
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Reduced mortality after screening |
Men most at risk of prostate cancer
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family history of prostate cancer (the risk increases with the number of relatives affected and the younger the age at which they were affected). An individual's risk can be calculated more accurately by testing his DNA from a simple mouth swab for 8 genetic variants, which appear to account for about half of the cases of prostate cancer (www.decodediagnostics.com/PC.php). |
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age (55+ years). |
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diet high in animal fat & dairy products. |
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race (black). |
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obesity. |
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smoking. |
How often should my PSA be checked?
Between the ages of 40-70 men should have their PSA checked regularly. This should be once a year if the PSA is 2-4 ng/ml and once every 2 years if the PSA is 0-2 ng/ml.
What happens if my PSA is elevated?
Two tests are essential:-
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repeat PSA to exclude lab error or an unrepresentative result. |
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urine sample to exclude infection. |
What tests will the urologist do?
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Ask you questions about any urinary symptoms you might have and about your general health. |
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Perform a physical examination, including a rectal examination to assess the size and consistency of the prostate. Prostate cancers generally feel hard. |
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If the rectal examination is normal he/she may check your free PSA level (a different form of PSA in the blood, which is not bound to proteins and provides additional information regarding the likelihood of you having prostate cancer). The PCA3 test is a new prostate cancer gene test, which has 95% accuracy for detecting prostate cancer if present and may replace free PSA tests (http://www.bostwicklaboratories.com/patientservices/PCA3.html). Following a DRE, during which both lobes of the prostate are massaged 3 times, a urine sample is sent to look for over-expression of the PCA3 gene. The results is usually available in about a week. |
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transrectal ultrasound-guided (TRUS) prostate biopsy is performed if the DRE, free PSA or PCA3 test is suspicious for prostate cancer. After the prostate has been anaesthetised with local anaesthetic 12 or more tiny cores of prostate tissue are removed under ultrasound guidance to sample the prostate. Blood in the urine and semen for up to 2 weeks is normal following this procedure but infection is rare if antibiotics are prescribed before and after the biopsy. |
What if the biopsy shows no prostate cancer?
Unfortunately, a negative biopsy does not give a guarantee that no cancer is present due to sampling error (like looking for a needle in a haystack). Your urologist will want to follow you up with a repeat PSA and perhaps PCA3 test after 6-12 months. Further prostate biopsy might be necessary.
It is important to reduce your risk of prostate cancer by making any necessary lifestyle and dietary changes
Diet and supplements to reduce the risk of Prostate Cancer
You are what you eat’ (Ayurveda, 700 B.C.)
During the past 10 years there has been an increasing realisation that what we put into our bodies has the potential to significantly affect its metabolism and the way the body reacts to environmental influences such as carcinogens, for example. Twin and migration studies have demonstrated that 20% of cases prostate cancer are genetic, which means that 80% are environmental, the strongest influence suspected being diet.
The following have been shown in medical studies to:-
Reduce the risk of prostate cancer
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Vitamins A, D & E |
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Selenium – found in Brazil nuts |
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Carotenoids – especially lycopene, found in (particularly cooked) tomatoes |
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Phytoestrogens – especially soy products, as well as cereals, fruit and vegetables |
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Chinese green tea |
Increase the risk of prostate cancer
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A diet which is heavy in animal fat (red meat & dairy products) |
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Obesity |
Supplements
Although a balanced diet is part of healthy living, our lifestyle often makes this goal difficult to achieve. A number of plant extracts and minerals have historically been used over the centuries for specific medical conditions, some of which have now been used to make drugs (e.g. aspirin and digoxin) and have a scientific basis for their use (e.g. selenium, zinc, saw palmetto). The use of supplements and herbs is not guaranteed to cure any condition but offers an alternative and natural pathway to explore which is at very worst unlikely to do harm and at best might make a positive and significant difference to symptoms and the condition causing it. As always, do not exceed the specified dosage as this might be harmful.
What if the biopsy shows prostate cancer? »
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