Prostate cancer is the most common male cancer and the second cause of cancer deaths behind lung cancer. Prostate cancer can be a slow growing cancer, and many elderly men die with their cancer, rather than because of it. In younger men, biopsies give an indication of staging and allow the range of treatments to be discussed.
Besides prostate cancer, other more common (and less serious) prostate issues include Benign Prostate Hyperplasia or BPH (an enlarged prostate) and Prostatitis (infection in the prostate).
The prostate is a small donut-shaped gland, about the size of a walnut, situated at the base of the bladder. The prostate gland surrounds the urethra (the tube which carries urine from the bladder). Its function is to provide essential fluid to transport, protect and nourish sperm.
Symptoms of prostate problems
Urinary problems in middle-aged and older men often signify the presence of benign prostatic hypertrophy (BPH), as the enlarged prostate obstructs the normal flow of urine. This is one of the most common of all male health conditions, affecting up to 50% of all men during their lifetime, with over 90% of men aged 85 and older affected. BPH is caused by hormonal changes associated with aging, especially a reduction of testosterone and an increase in oestrogen. Signs include both obstructive and irritative symptoms. Obstructive symptoms include increased urinary frequency day and night, trouble starting, poor flow and dribbling off. Irritative symptoms are urgency, frequency and dribbling. Untreated BPH can eventually lead to significant urinary obstruction with eventual kidney damage.
Understanding the PSA test
The Prostate Specific Antigen (PSA) test is a blood test which measures the levels of a protein produced by the prostate. The test is used to look for possible prostate cancer. A normal PSA test is usually less than 4 nanograms per millilitre. The PSA rises with age, urinary or prostate infections and with BPH. An elevated PSA should be repeated and accompanied by a digital (finger) examination. A raised PSA and an abnormally hard feel to the gland, or a segment of it, is highly indicative of cancer. If the test is positive, referral for prostatic biopsies under ultrasound guidance is necessary. Despite its wide use, the test remains controversial as a tool for population screening. Elevated PSA levels can indicate conditions other than cancer; and sometimes prostate cancer can be present without causing an elevation in PSA levels.
Prevention and treatment
1. If it’s prostate cancer
Treatment for prostate cancer may include the surgical removal of the prostate and lymph nodes if needed – this is radical surgery undertaken to achieve a cure; there’s also radiotherapy with either rays or radioactive seeds implanted into the prostate gland; hormonal therapy to suppress testosterone production and block its stimulation of cancer growth; or cryotherapy in which the prostate gland is frozen to destroy cancer cells. Removal of the testes is sometimes done to reduce testosterone levels which drive the cancer.
2. If it’s prostatitis
Prostatitis tends to occur in younger men and is an inflammation of the prostate caused by bacteria (acute prostatitis) or by unresolved infection or toxins in the urine (chronic prostatitis). Antibiotic treatment is used for bacterial-related prostatitis. Chronic prostatitis is recurring and is treated with anti-inflammatory drugs. Longer-term, there may be problems with low sperm count, frequent urination and sexual difficulties.
3. If it’s BPH
BPH treatment may involve drug therapy, surgery or non-surgical heat therapy to reduce the size of the prostate and improve urine flow. Alpha blockers are a type of drug which relax the muscles around the prostate reducing the pressure on the urethra. Heat therapy may include microwave, radiotherapy, electrovaporisation or laser treatment. Laser surgery is frequently used and is very successful in alleviating symptoms although there can be some ongoing side effects such as erectile dysfunction and incontinence.
4. Talk to your doctor about check-ups
If you’re aged over 40, you can request a check-up, including a PSA test and a digital rectal examination. However, the diagnostic value of these tests are limited, and routine screening for prostate cancer is not recommended for men not showing any symptoms of disease. According to the National Health Committee, the majority of men with a positive PSA test who proceed with further investigation and treatment will end up with a poorer quality of life than if they hadn’t had any treatment at all. The best thing to do is to speak to your doctor about the risks and benefits of screening.
5. Lifestyle and diet
Lifestyle and diet factors can reduce your risk of prostate cancer. Eat a high-fibre diet with at least 5 servings of fruits and vegetables daily; Include lentils, legumes and beans to boost fibre, along with wholegrains. Limit red meat intake and reduce total dietary fat levels. Avoid saturated fats (animal fats from meat and dairy, and palm oil), and trans-fats from processed foods such as snack foods, some margarines, French fries etc. Increase healthy fats such as olive, flax, and avocado oils, and omega-3 fats from fish, nuts and seeds and avocado. Eat plenty of soy products such as soy milk and tofu; limit dairy products and boost your intake of the antioxidant lycopene from cooked tomatoes and tomato pastes and sauces.
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