Prostate Cancer

Epidemiology:

The second most deadly male cancer with a very variable worldwide distribution: in the US , the Afro-American affliction rate reaches 25%, while in Asia the rate lies between 3-5%. The incidence varies from 1 to 100: there are 100 times more prostate cancers among Californians than among Shangai Chinese (but the Los Angeles Chinese demonstrate a much higher rate). Thus there are genetic factors and environment factors that remain to be discovered. This cancer is nevertheless decreasing, 180 000 cases per year, they were double 10 years ago, with a mortality of 40 000.Prostate cancer has also a very long latency: after autopsy, cancer damage is discovered in 45% of men.The "true" cancer, with clinical signs, is found at about age 70: this is a disease of the elderly. The evolution is slow, the tumor volume doubles every 4 years.

The cancer growth

this is a cancer from a gland. Born in one or several points of this gland, it develops in the fat surrounding the prostate: capsular invasion, then the bladder, seminal passages, and bordering nodes. The metastases are bone in 90% cases.

The symptoms

• hesitancy in urinating, urgency, especially during night, incomplete voiding, stream weakness; sometimes blood in urine or sperm.
• bone pains; signalling extension to skeleton; pains in legs, hips, backbone.

The diagnosis

• clinical examination: digital palpation of rectum by trained professional;
• the tumor markers: the PSA assay: the cut-off is 4.0 ng/ml. When level is between 4 and 10 ng/ml, there is doubt: there can be a benign prostatic hyperplasia (adenoma). The difference between cancer or benign condition can be greatly helped by measuring the FPSA (free PSA ) and ratio FPSA/ PSA : normally, it is higher than 0,25: the lower the ratio, the higher the risk for cancer.]
• transrectal ultrasound.
• instrument biopsies, for evaluation of the location and size of the tumor. Since they are not without risk, these biopsies often can be avoided with the FPSA assay.

The treatment
it depends on the tumor stage when discovered: whether localised (limited to capsular invasion), or enlarged. Some medical teams advise just a simple surveillance for limited forms; this does not mean exemption from treatment, and in particular, hormone therapy.

• surgery: radical prostatectomy, or partial prostatectomy;
• radiation: huge advances in machines and protocols;
• hormone therapy: aimed at lowering the testosterone level: this is hormonal ablation. Meaning impotence and hot flashes;
• chemotherapy: rarely used.

The post-treatment follow-up

• clinical exams;
• ultrasound;
• PSA and FPSA assays. After prostatectomy, the PSA level comes to 0. Any PSA increase signals recurrence.

Prevention
much controversial, this is a choice for each individual and his Doctor: this is your concern.
It means regular rectal exams, and PSA /FPSA dosages.

WARNING : should you have any ANTI-AGING treatment, using in particular the DHEA, you should MAKE SURE there is no underlying prostate cancer. "No one should take DHEA except under the supervision of a physician, who should routinely check steroid and cholesterol levels, glucose tolerance, and prostate health in men," says John Nestle, MD, professor of endocrinology and metabolism at Virginia Commonwealth University , who studies DHEA's effects on diabetes and blood clotting.