Prostate cancer is the most common cancer in American men. By age 50, up to one in four men have some cancerous cells in the prostate gland. By age 80, the ratio increases to one in two. As you age, your risk of prostate cancer increases. In the United States, the average age at diagnosis is 72.
Prostate cancer is also the second leading cause of cancer deaths in American men. Yet unlike other cancers, you're more likely to die with prostate cancer than you are of it. On average, an American man has about a 30 percent risk of having prostate cancer in his lifetime, but only about a 3 percent risk of dying of the disease.
The prostate gland surrounds the bottom portion ("neck") of a man's bladder and is located behind the pubic bone and in front of the rectum. The prostate's primary function is to produce most of the fluids in semen, including the fluid that nourishes and transports sperm. Tiny ducts within the prostate convey this fluid to the urethra, the channel that drains fluid from the bladder. This fluid is then released through the penis during ejaculation.
For many men a diagnosis of prostate cancer can be frightening not only because of the threat to their life but because of the threat to their sexuality. In fact, the possible consequences of treatment — which include bladder control problems and erectile dysfunction (impotence) — can be a greater worry for some men than the cancer itself.
The good news is that if prostate cancer is detected early — when it's still confined to the prostate gland — you have a better chance of successful treatment with minimal or short-term side effects. Successful treatment of cancer that has spread beyond the prostate gland is more difficult. But treatments exist that can help control the cancer.
The problem with detecting prostate cancer is that it often doesn't produce any symptoms in its early stages. That's why many cases of prostate cancer aren't diagnosed until they've spread beyond the prostate.
When symptoms do occur, they may include the following:
Dull pain in your lower pelvic area
Urgency of urination
Difficulty starting urination
Pain during urination
Weak urine flow and dribbling
Intermittent urine flow
A sensation that your bladder isn't empty
Frequent urination at night
Blood in your urine
Painful ejaculation
General pain in your lower back, hips or upper thighs
Loss of appetite and weight
Persistent bone pain
Cancer is a group of abnormal cells that grow more rapidly than normal cells and refuse to die. Cancer cells also have the ability to invade and destroy normal tissues, either where the tumor starts or after traveling to another part of your body. Microscopic cancer cells grow into small clusters that continue to grow, becoming more densely packed and hard.
Prostate cancer usually grows slowly and remains confined to the prostate gland, where it doesn't cause serious harm. But not all cancers act the same. Some forms of prostate cancer are aggressive and can spread quickly to other body parts.
What causes prostate cancer and why some types behave differently are unknown. Research suggests that a combination of factors may play a role, including family history, ethnicity, hormones, diet and the environment.
Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:
Age. As you get older, your risk of prostate cancer increases.
Race or ethnic group. For reasons that aren't well understood, black men are
more likely to have prostate cancer than are men of any other group in the United
States. Asian-American men, on the other hand, have the lowest rate of prostate
cancer. The rate of prostate cancer in Hispanic and American Indian men is lower
than in white men.
Family history. If a close family member — your father or brother —
has prostate cancer, your risk of the disease is greater than that of the average
American male.
Diet. A high-fat diet may increase the risk of prostate cancer. Researchers
theorize that fat increases production of the hormone testosterone, which in
turn speeds development of prostate cancer cells.
If you have difficulties with urination, see your doctor. Also see your doctor if you experience erectile dysfunction (impotence) that lasts longer than 2 months or is a recurring problem. These conditions don't always point to prostate cancer, but both can be signs of prostate-related problems.
If you're a man older than 50, you may want to see your doctor to discuss beginning prostate cancer screening. Mayo Clinic urologists, in accordance with the American Cancer Society and the American Urological Association (AUA), recommend having an annual blood test to check for prostate-specific antigen (PSA) beginning at age 50, unless you're at high risk of cancer. If you're black or have a family history of the disease, you may want to begin at age 40. Mayo Clinic urologists, along with the AUA, also recommend that men have a yearly digital rectal exam beginning at age 40.
Prostate cancer frequently doesn't produce symptoms. The first indication of a problem may come during a routine screening test. Screening tests include:
Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated
finger into your rectum to examine your prostate, which is adjacent to the rectum.
If your doctor finds any abnormalities in the texture, shape or size of your
gland, you may need more tests.
Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and
analyzed for PSA, a substance that's naturally produced by the prostate gland
to help liquefy semen. It's normal for a small amount of PSA to enter the bloodstream.
However, if higher than normal levels are found, it may be an indication of
prostate infection, inflammation, enlargement or cancer.
Urine test. A sample of your urine is analyzed for abnormalities that may indicate
a problem. This test doesn't detect prostate cancer, but it can help detect
or rule out other conditions that may cause similar signs and symptoms.
Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal
ultrasound to further evaluate your prostate. A small probe is inserted into
your rectum. The probe uses sound waves to get a picture of your prostate gland.
If initial test results suggest prostate cancer, you may undergo a prostate
biopsy. During a biopsy, small tissue samples are taken and analyzed to determine
if cancer cells are present.
To do a biopsy, your doctor inserts an ultrasound probe into your rectum. Guided by images from the probe, your doctor identifies any suspicious areas. Then a fine, hollow needle is aimed at the center of your prostate. A spring propels the needle into your prostate gland and retrieves a very thin section of tissue.
If an abnormal area is seen on the transrectal ultrasound, your doctor will biopsy that area. If no abnormality is seen, at least six sections of tissue are taken from different areas of your prostate gland. A pathologist who specializes in diagnosing cancer and other tissue abnormalities evaluates the samples. From those, the pathologist can tell if it's cancer and estimate how aggressive your cancer is.
Once a cancer diagnosis has been made, you may need further tests to help determine if or how far the cancer has spread, including:
Bone scan. A bone scan takes a picture of your skeleton in order to determine
whether cancer has spread to the bone. Prostate cancer tends to spread first
to areas near the prostate, such as the pelvis and lower spine.
Ultrasound. Ultrasound can not only help indicate if cancer is present but may
also reveal whether the disease has spread to nearby tissues.
Chest X-ray. X-ray films may show if the cancer has spread to your lungs, ribs
or backbone.
Computerized tomography (CT) scan. A CT scan produces cross-sectional images
of your body. CT scans can identify enlarged lymph nodes or abnormalities in
other organs but can't determine whether these problems are due to cancer. Therefore,
CT scans are most useful when combined with other tests.
Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional
images of your body using magnets and radio waves. An MRI can help detect evidence
of the possible spread of cancer to lymph nodes and bones.
Lymph node biopsy. A lymph node biopsy is the best way to determine whether
cancer has spread to nearby lymph nodes. During the procedure, some of the nodes
near your prostate are removed and examined under a microscope to determine
if cancerous cells are present.
Grading
When a biopsy confirms the presence of cancer, the next step, called grading,
is to determine if it's a slow- or fast-growing form. The tissue samples are
studied, at which time cancer cells are compared with healthy prostate cells.
The more different the cancer cells are from the healthy cells, the more aggressive
the cancer and the more likely it is to spread quickly.
Cancer cells may vary in shape and size. Some cells may be aggressive, while others aren't. The pathologist identifies the two most prominent types of cancer cells when assigning a grade.
The most common cancer grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer. Known as Gleason scores, named for the doctor who invented it, these numbers may be helpful in determining which treatment option is best for you.
Staging
After the level of aggressiveness of your prostate cancer is known, the next
step, called staging, determines if or how far the cancer has spread. Your cancer
is assigned four stages based on how far it has spread:
Stage I. Signifies very early cancer that's confined to a microscopic area
and which your doctor can't feel.
Stage II. Your cancer can be felt, but it remains confined to your prostate
gland.
Stage III. Your cancer has spread beyond the prostate to the seminal vesicles
or other nearby tissues.
Stage IV. Your cancer has spread to lymph nodes, bones, lungs or other organs.
Complications
Complications from prostate cancer are related to both the disease and its treatment. One of the biggest fears of many men who have prostate cancer is that their treatment may leave them incontinent or impotent. Fortunately, these side effects aren't permanent and therapies exist to help cope with or treat the conditions.
The typical complications of prostate cancer and its treatments include:
Spread of cancer. Prostate cancer can spread to nearby organs and bones and
can be life-threatening.
Pain. Although early-stage prostate cancer typically isn't painful, once it
has spread to nearby bones, it may produce pain, which can be intense. Treatment
can range from the use of over-the-counter pain relievers to prescription narcotics.
Radiation is also commonly used to treat painful lesions. Often radiation and
prescription pain relievers are combined.
Urinary incontinence. Both prostate cancer and its treatment can cause incontinence.
Some men experience incontinence after prostate cancer treatments such as radiation
or surgery to remove the prostate. Treatment recommendations depend on the type
of incontinence you have, how severe it is and the chances that it will naturally
improve given time. Treatments include behavior modifications (such as going
to the bathroom at set times rather than according to urges), exercises to strengthen
pelvic muscles (commonly called Kegel exercises), medications and catheters.
If leakage problems have continued for at least a year without improvement,
your doctor may suggest a surgical procedure. These procedures may include the
implantation of an artificial sphincter, which can be placed around the urethra
or base of the bladder to control the flow of urine, or the injection of bulking
agents into the lining of the urethra at the base of the bladder to reduce leakage.
Erectile dysfunction (impotence). Like incontinence, erectile dysfunction can
be a result of prostate cancer or its treatment, including surgery and radiation.
Medication and vacuum devices that assist in achieving erection are available
to treat erectile dysfunction. Medications may include sildenafil (Viagra) and
alprostadil (Caverject, Edex). If other treatments fail, you may be able to
have penile implants inserted surgically to help create an erection.
Depression. Many men may develop feelings of depression after a diagnosis of
prostate cancer or after trying to cope with the side effects of treatment.
These feelings may last for only a short time, they may come and go, or they
may linger for weeks or months. Depression that lingers and interferes with
your ability to manage your life should be treated. Treatment may involve counseling
or antidepressant medication or a combination of the two.
Treatment
Often there's more than one way to treat prostate cancer. For some men a combination of treatments — such as surgery followed by radiation or radiation paired with hormone therapy — works best. The treatment you choose may depend on several factors. These include how fast your cancer is growing, how much it has spread, your age and your health, as well as the benefits and the potential side effects of the treatment.
The most common treatments for prostate cancer include the following:
External beam radiation. External beam radiation treatment uses high-powered
X-rays to kill cancer cells. A machine is used to deliver the radiation beam.
This type of radiation is effective at destroying cancerous cells, but it can
also damage adjacent healthy tissue.
Because of this the first step in radiation therapy is to map the precise area
of your body that needs to receive radiation. Three-dimensional scans are often
used to determine the exact location of your prostate and surrounding structures.
Computer-imaging software gives radiation therapists the ability to find the
best angles to fire the beams of radiation. By using new techniques — which
allow for more precise focusing of the radiation beams — greater doses
of radiation can be administered to your prostate without harming surrounding
tissue.
A body supporter holds you in the same position for each treatment. You'll also be asked to arrive with a full bladder for therapy. This will push most of your bladder out of the path of the radiation beam. Ink marks on your skin will help the radiation therapist hit the same targets each time. Custom-designed shields help protect nearby normal tissue — such as your intestines, anus and rectal wall — from the radiation.
Treatments are generally given 5 days a week for about 7 or 8 weeks. Each treatment appointment takes about 15 minutes. However, much of this is preparation time — radiation is only received for about 1 minute. You don't need anesthesia with external-beam radiation because the treatment isn't painful.
Most men have some side effects from this type of treatment, but the majority of the side effects disappear over time. Most men don't have problems with erections or intercourse immediately after radiation therapy. However, radiation can damage nerves that control erections and arteries that carry blood to your penis. So most men later sustain some erectile dysfunction. About half the men who had normal sexual function before radiation retain it after therapy. The younger you are, the better your chance of retaining normal sexual function.
During treatment most men experience urinary problems. The most common signs and symptoms are constantly feeling as if you have to urinate, burning or pain while urinating, frequent urination and urine leakage. Most of these problems are temporary and gradually diminish in a few months after completing treatment. About 5 percent of men experience severe symptoms.
Rectal problems — including diarrhea, rectal bleeding, discomfort during bowel movements and rectal urgency (a sense that you have to have a bowel movement) — may arise during treatment. Once the treatment course is complete, these symptoms generally subside. However, about 5 percent of men may continue to experience rectal problems. Most long-term rectal symptoms are controlled with medications. Rarely, you can develop severe bleeding or a rectal ulcer following radiation. Less than 1 percent of men who undergo radiation require surgery to correct complications of the rectum or bladder.
Hormone therapy. When you have prostate cancer, male sex hormones (androgens)
can stimulate the growth of cancer cells. The main type of androgen is testosterone.
Hormone therapy uses drugs to try to stop your body from producing male sex
hormones. It can also block hormones from getting into cancer cells. Sometimes
doctors use a combination of drugs to achieve both.
About 75 percent of men with advanced prostate cancer choose this form of treatment
to help slow the growth of prostate cancer. Because it's effective at shrinking
tumors, doctors use hormone therapy in some early-stage cancers — often
in combination with surgery and radiation. Hormones shrink large tumors so that
surgery or radiation can remove or destroy them more easily. After these treatments,
the drugs can inhibit the growth of stray cells left behind at the tumor site.
Some drugs used in hormone therapy decrease your body's production of testosterone. The hormones — known as luteinizing hormone-releasing hormone (LHRH) agonists — can set up a chemical blockade. That blockade prevents the testicles (where 90 percent of testosterone is produced) from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Viadur) and goserelin (Zoladex). They're injected into your buttocks once every 3 or 4 months for the rest of your life.
Other drugs used in hormone therapy block your body's ability to use testosterone. Five percent to 10 percent of testosterone comes from the adrenal glands and won't be suppressed by leuprolide or goserelin. Certain medications — known as antiandrogens — can prevent testosterone from reaching your cancer cells. Drugs typically used for this type of therapy include flutamide (Eulexin), bicalutamide (Casodex) and nilutamide (Nilandron). They come in tablet form and, depending on the brand of drug you're prescribed, are taken orally one to three times a day.
Simply depriving prostate cancer of testosterone usually doesn't kill your cancer. Within 1 to 3 years, the cancer often learns to thrive without testosterone. Once this happens, options to stop the cancer are limited.
In an effort to avoid such resistance, you may receive intermittent hormone therapy. During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady. The drugs are resumed if your PSA level rises again, generally above 10.
Because most testosterone is produced in the testicles, surgical removal of the testicles (castration) also can be an effective form of therapy — especially for advanced prostate cancer. The procedure is often performed on an outpatient basis using a local anesthetic.
Side effects of hormone therapy may include breast enlargement, reduced sex drive, impotence, hot flashes, weight gain and reduction in muscle and bone mass. Some of these drugs can also cause nausea, diarrhea, fatigue and liver damage.
Radical prostatectomy. Surgical removal of your prostate gland, known as a
radical prostatectomy, is another option to treat cancer that's confined to
your prostate gland. During a radical prostatectomy, surgeons use special techniques
to completely remove your prostate and local lymph nodes, while trying to spare
your muscles and nerves that control urination and sexual function.
Two surgical approaches are available for a prostatectomy: retropubic and perineal.
In retropubic surgery, the gland is taken out through an incision in your lower
abdomen that typically runs from just below the navel to an inch above the base
of your penis. It's the most commonly used form of prostate removal for two
reasons: Your surgeon can use the same incision to remove pelvic lymph nodes,
which are tested to determine if the cancer has spread. In addition, the procedure
gives your surgeon good access to your prostate, making it easier to save the
nerves that help control bladder function and erections.
With the perineal approach, which doctors use less commonly, an incision is made between your anus and scrotum. There's generally less bleeding with perineal surgery, and recovery time may be shorter if you are heavier. This approach makes it more difficult for your surgeon to locate and save the adjacent nerve bundles. In addition, your surgeon isn't able to remove nearby lymph nodes.
During your operation a catheter is inserted through your penis and into your bladder to drain urine from the bladder during your recovery. The catheter will likely remain in place for 1 to 2 weeks following the operation while the urinary tract heals.
After the catheter is removed, you'll likely experience some bladder control problems (urinary incontinence) that may last for weeks or even months. About 95 percent of men eventually regain complete control. Most of the remaining 5 percent experience stress incontinence, meaning they're unable to hold urine flow when their bladder is under increased pressure, as happens when they sneeze, cough, laugh or lift. In some men, major urinary leakage persists and secondary surgical procedures may be needed in an attempt to correct the problem.
Impotence is another common side effect of radical prostatectomy because nerves on both sides of your prostate that help control erections may be damaged or removed during surgery. Between 60 percent and 80 percent of men younger than age 50 who have nerve-sparing surgery are able to achieve normal erections afterward. Twenty percent to 40 percent of men are unable to do so. For men in their 70s, about 15 percent to 25 percent maintain normal sexual functioning. Men who had trouble achieving or maintaining an erection before surgery have a higher risk of being impotent after the surgery. Several options are available to help restore potency after surgery.
Radioactive seed implants. Radioactive seed implants are injected into the
prostate and have gained popularity in recent years as a treatment for prostate
cancer. The seeds, also known as radiation brachytherapy, deliver a higher dose
of radiation than do external beams.
During the implant procedure — which typically lasts about 1 to 2 hours
and is done on an outpatient basis — between 100 and 200 rice-sized radioactive
seeds are injected into your prostate through ultrasound-guided needles. The
exact number of seeds inserted depends on the size of your prostate. The therapy
generally works better on smaller or moderate-sized prostates.
The seeds may contain one of several radioactive isotopes — including iodine and palladium — depending on the grade of your cancer. These seeds don't have to be removed after they stop emitting radiation.
Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location. This type of radiation isn't likely to escape your prostate area. However, doctors recommend that for the first few months you stay at least 6 feet away from children and pregnant women, who are especially sensitive to radiation. All radiation inside the pellets is generally exhausted within a year.
Side effects of seed implants are somewhat different than with external-beam radiation. Seed implants deliver a higher dose of radiation to your urethra, causing urinary symptoms to occur in nearly all men. You may require medication to treat these symptoms, and some men require the use of intermittent self-catheterization to help them urinate.
Urinary symptoms tend to be more severe and longer lasting with seed implants than with external-beam radiation. Rectal symptoms, however, quite often are less frequent and less severe. Additionally, between 30 percent and 50 percent of men experience impotence.
Chemotherapy. This type of treatment uses chemicals that destroy rapidly growing
cells. Although it's often effective in treating cancers elsewhere in the body,
chemotherapy has not shown to be successful in the treatment of prostate cancer.
As new chemotherapy drugs are developed, trials continue using single-drug chemotherapy,
multiple combinations of chemotherapy, and combinations of chemotherapy and
hormone therapy. Early results are positive, but extensive experience with newer
drug agents is still unavailable. In the future, gene therapy or immune therapy
may be more successful in treating metastasized tumors of the prostate. Current
technology limits the use of these treatments to a small number of centers around
the country due to patient safety.
Cryotherapy. This treatment is used to destroy cells by freezing tissue. Original
attempts to treat prostate cancer with cryotherapy involved inserting a probe
into the prostate through the skin between the rectum and the scrotum (perineum).
Using a rectal microwave probe to monitor the procedure, the prostate was frozen
in an attempt to destroy cancer cells. Poor precision in monitoring the extent
of the freezing process often resulted in damage to tissue around the bladder
and long-term complications such as injury to the rectum or the muscles that
control urination.
More recently, smaller probes and more precise methods of monitoring the temperature
in and around the prostate have been developed. These advances may decrease
the complications associated with cryotherapy, making it a more effective treatment
for prostate cancer. Although progress continues, more time is needed to determine
how successful cryotherapy may be as a treatment for prostate cancer.
Watchful waiting. The prostate-specific antigen (PSA) blood test can help detect
prostate cancer at a very early stage. This allows many men to choose watchful
waiting as a treatment option. In watchful waiting (also known as observation,
expectant therapy or deferred therapy), regular follow-up blood tests, rectal
exams and biopsies may be performed to monitor for evidence of progression of
your cancer.
During watchful waiting no medical treatment is provided — meaning, medications,
radiation and surgery aren't used. Watchful waiting may be recommended if your
cancer isn't causing symptoms, is expected to grow very slowly, and is small
and confined to one area of your prostate.
Watchful waiting may be particularly appropriate if you're older, in poor health or both. Many such men will live out their normal life span without treatment and without the cancer spreading or causing other problems. But watchful waiting can also be a rational option for a younger man as long as you know the facts and are willing to be vigilant.
Prevention
Although there isn't any formula that can guarantee you won't get prostate cancer, you can take measures to reduce your risk or possibly slow the disease's progression. The three most important steps you can take to maintain prostate health — and health in general — are to eat well, keep physically active and see your doctor regularly.
High-fat diets have been linked to prostate cancer. Therefore, limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods rich in lycopenes, an antioxidant, also may help lower your prostate cancer risk. These foods include raw or cooked tomatoes, tomato products, grapefruit and watermelon. Garlic and cruciferous vegetables such as arugula, bok choy, broccoli, brussels sprouts, cabbage and cauliflower also appear to help fight cancer.
Soy products contain isoflavones that seem to keep testosterone in check. Because prostate cancer feeds off testosterone, isoflavones may reduce the risk and progression of the disease.
Vitamin E has shown promise in reducing the risk of prostate cancer among smokers. More research is needed, however, to fully determine the extent of these benefits of vitamin E.
It's well known that regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren't as clear-cut, but studies do indicate that regular exercise may reduce your cancer risk, including prostate cancer.
Exercise has been shown to strengthen your immune system, improve circulation
and speed digestion — all of which may play a role in cancer prevention.
Exercise also helps to prevent obesity, another potential risk factor for some
cancers.
Regular exercise may also reduce your risk of benign prostatic hyperplasia (BPH) or minimize your symptoms. Men who are physically active usually have less severe symptoms than men who get little exercise.
A Mayo Clinic study released in March 2002 suggests that regular use of aspirin, ibuprofen (Advil, Motrin, others) and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help protect against prostate cancer. The study found that men age 60 and older who used NSAIDs daily may reduce their risk of prostate cancer by up to 60 percent, and that the beneficial effect may increase with age.
Coping skills
Once you receive a diagnosis of prostate cancer or are treated for the disease, you may experience a range of feelings — including disbelief, fear, anger, anxiety, emptiness and depression. You may not be able to get rid of these distressing feelings. But you can find positive ways to deal with them so that they don't dominate your life. The following strategies can help you cope with some of the difficulties of prostate cancer:
Be prepared. Ask your doctor questions and read about prostate cancer and its
potential side effects. The fewer the surprises, the more quickly you'll adapt.
Maintain as normal a routine as you can. Don't let the cancer or side effects
from treatment dominate your day. Try to follow the routine and lifestyle you
had before learning of your cancer. Go back to work, take a trip, join your
children or grandchildren on an outing. You need activities that give you a
sense of purpose, fulfillment and meaning. But realize that to begin with, you
may have some limitations. Start slowly and gradually build your level of endurance.
Try not to wallow in sad feelings. Seek diversions and plan at least one enjoyable
experience every day. This might include a pursuing a hobby, playing golf or
going to a movie. Make it something you enjoy and look forward to.
Get plenty of exercise. Exercise helps fight depression and is a good way to
relieve tension and aggression.
Look for ways to compensate. If you have problems with incontinence, sit in
the back of the movie theater or meeting room instead of the front. That way
you're less conspicuous if you need to leave for the bathroom. Sit in an aisle
seat on an airplane or train. Wear absorbent undergarments if you're not sure
whether you'll be near a bathroom. Avoid caffeinated products, which tend to
increase your need to urinate.
Open up to a friend, a family member or a counselor. Cancer is too heavy a load
to carry all by yourself. Sometimes it helps to talk with someone about your
deepest feelings and fears. Your mind and body aren't separate. The better you
feel emotionally, the better you'll be able to physically cope with your illness.
Some men find joining a support group helpful because it can provide you with
a sense of belonging, give you an opportunity to talk with people who understand
your situation and provide you with advice. Your doctor or someone you know
who has experienced prostate cancer may be able to help you locate a support
group. Or you can contact a national cancer organization such as the American
Cancer Society, 800-ACS-2345 (800-227-2345), or Cancer Care, 800-813-HOPE (800-813-4673).
Seek sexual contact. Your natural reaction to impotence may be to avoid all
sexual contact. Don't fall for this feeling. Touching, holding, hugging and
caressing may become far more important to you and your partner. In fact, the
closeness you develop in these actions can produce greater sexual intimacy than
you've ever had before. There are many ways to express your sexuality.
Look for the positive. Cancer doesn't have to be all negative. Good can come
out of it. Confrontation with cancer may lead you to grow emotionally and spiritually,
to identify what really matters to you, to settle long-standing disputes and
to spend more time with people important to you.
Complementary and alternative medicine
As people take a more active role in their health care, many are exploring other options of care that fall outside the realm of traditional medicine. In fact, a range of dietary supplements and herbal medicines offer new ways to prevent or treat prostate disease, and cancer in general. The question is, do these therapies work? Some do show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproven by scientific methods.
Herbal products marketed to relieve common prostate problems, such as frequent urination or a weak urine flow, include:
African plum tree (Pygeum)
South African star grass (Hypoxis rooperi)
Pumpkin (Cucurbita pepo)
Rye grass (Secale cereale)
Stinging nettle (Urtica dioica and Urtica urens)
Taken in small to moderate amounts, these products appear safe. But they haven't
been studied in large, long-term trials to confirm their safety or to prove
they work.
An exception is the herb saw palmetto (Serenoa repens). Unlike other herbal supplements, it has been widely tested, and the results show promise.
Saw palmetto is thought to work by preventing testosterone from breaking down into another form of the hormone associated with prostate tissue growth. In 1998 researchers with the Department of Veterans Affairs reviewed more than a dozen studies involving saw palmetto and concluded that the herb appears to be as effective as the medication finasteride (Proscar) in reducing the size of an enlarged prostate. It also appears to produce fewer side effects. The researchers recommended additional studies to determine the appropriate daily dosage of the supplement and its long-term effectiveness.
Saw palmetto works slowly. Most men begin to see an improvement in their urinary symptoms within 1 to 3 months. If after 3 months you haven’t noticed any benefit from the product, then it may not work for you. It appears safe to take saw palmetto indefinitely, but possible effects from long-term use are unknown.
One drawback of this herb, and many other such herbal products, is that it may suppress PSA levels in your blood. This action can interfere with the effectiveness of the PSA test. That's why if you take saw palmetto or other herbal medicines, it's important to tell your doctor before having a PSA test.
A few herbal and dietary products claim to help cure or prevent cancer. There's no scientific evidence that these products work, and some may be dangerous. Three popular "cancer-fighting" supplements are:
Chaparral. Also known as creosote bush or greasewood, chaparral (Larrea tridentata)
comes from a desert shrub found in the southwestern United States and Mexico.
Research of chaparral hasn't shown that the herb effectively treats cancer,
and it can lead to irreversible liver failure.
PC-SPES. This is an herbal mixture that has been marketed for treatment of prostate
cancer. It contains eight herbs: Da Qing Ye (Isatis indigotica), licorice (Glycyrrhiza
glabra, Glycyrrhiza uralensis), San Qi (Panax pseudoginseng), Reishi mushroom
(Ganoderma lucidum), Baikal skullcap Scutellaria baicalensis), chrysanthemum
(Dendranathema morifolium), Rabdosia rubescens and saw palmetto (Serenoa repens).
A study of PC-SPES published in the New England Journal of Medicine in 1998
found that the product works like estrogen supplements. It reduces concentrations
of testosterone that help fuel prostate cancer growth, and in some instances
may suppress the cancer, at least temporarily. However, the product commonly
produces impotence and breast tenderness. It can also cause blood clots in deep
leg veins and, if taken in large amounts, can be toxic. Another concern with
this product is that it can mask progression of your cancer. It reduces PSA
levels, even when the cancer is advancing. If your doctor is unaware you're
taking PC-SPES, PSA test results may lead him or her to think that your cancer
is under control, when it really is not. The product's manufacturer, BotanicLab,
recalled the supplement temporarily beginning in March 2002 after questions
were raised by the California Department of Health Services. The California
agency said its testing had revealed the presence of undeclared prescription
drug ingredients in samples of PC-SPES. BotanicLab then took steps it said would
ensure the product's purity.
Shark cartilage. Shark cartilage contains a protein that has some ability to
inhibit the formation of new blood vessels within tumors in sharks. Shark cartilage
therapy is based on the theory that capsules containing shark cartilage will
do the same in humans — stop and shrink cancerous tumors. However, these
benefits haven't been shown in humans, although some clinical trials are under
way.
Because it's not always easy to tell which products may be unsafe, interact
negatively with other medications or affect your overall cancer treatment, it's
best to talk with your doctor before taking any dietary or herbal product.