I've been going to the gym for years now, and I've developed a neighborly rapport with the man who uses the locker next to mine. One day we got to talking about different types of cancer, and he mentioned that he actually has late stage prostate cancer - though it's in remission. Turns out, to cut down the testosterone that fuels the growth of this type of cancer, he chose castration, and had fake testicles implanted. No, I didn't ask to inspect his balls! But I will say, in all the time we've spent as neighbors, I never noticed anything strange or different about him - his balls looked the same as everyone else's.
Intro
Prostate cancer is serious -- and common. It affects 1 in 5 men, and rates are even higher for African Americans. Don't panic. There are ways to screen for prostate cancer, and better yet, if you catch it early, treatments are extremely effective. Mortality rates from prostate cancer are declining, probably the result of improved screening and treatment.
What is it?
Prostate cancer is the second most common cancer in men - 1 in 5 of you guys will have it at some point in your lives. And if you're African-American, you're more than twice as likely as Caucasian men to get it. One glimmer of good news is that it's a slow-growing cancer; it can take fifteen years for the earliest tumor to grow and spread throughout your body. For this reason, many men who develop prostate cancer usually die from something else.
Symptoms
Symptoms of prostate cancer include bone pain and blood in your urine, but by the time these symptoms surface, chances are your cancer has already grown and spread. There are no reliable symptoms to look for in the early stages. Regular screenings by your doctor are crucial to spotting this disease early on, when it's most treatable.
Diagnosis
There are two ways your doctor can diagnose prostate cancer. The first is a rectal exam; your doctor will feel your prostate for any small, hard nodules or lumps, which are often malignant. The second is a blood test that measures your level of prostate-specific antigens (PSA). Cancer cells produce a lot more PSA than is normally found in your blood, so this test is a great way to alert your doctor to a potential problem. Unfortunately, neither the exam nor the blood test is foolproof, and your cancer can be missed.
If your doctor finds something unusual, he or she is likely to recommend a transrectal ultrasound and needle biopsy. Don't worry, both are generally painless. The ultrasound bounces sound waves into your rectum. These waves cause a lump or nodule to stand out. The biopsy is the insertion of a small needle into the lump in order to take some cell samples, which are examined under a microscope to see if they are cancerous. Fifteen percent of the time, your first biopsy is negative even if you have cancer, so your doctor may recommend doing a second procedure, just to be on the safe side.
How is it acquired?
The causes of prostate cancer are not yet clear, though doctors know for sure that it's not contagious (spread from person to person). Studies have shown that your risk for this disease increases if your father or brother had it. Other evidence shows that high-fat diets increase your risk, while low-fat diets may keep the disease at bay, but this has not been proven. Finally, some studies suggest that workers exposed to metal cadmium (welders, for example) or rubber production have higher rates of cancer, though again, this is unproven.
How to treat it?
There are three treatment options your doctor may recommend to you: Surgery, radiation or doing nothing. Doing nothing? That's right. Because prostate cancer grows so slowly, your doctor may determine -- based upon your age and health, and how much the cancer has grown - that you're better off to ignore it. Don't make this judgment call on your own, though. Always consult your doctor.
A radical prostatectomy is surgery that removes the entire prostate gland and nearby lymph nodes. If your cancer has not spread to other parts of your body, your chances of living for fifteen years after this procedure is about 90 percent. Side effects may include impotence (which can be cured with penile implants or medications), retrograde ejaculation (orgasm without ejaculation) and urinary incontinence (you're unable to control your urine flow). Complete incontinence happens to less than five percent of men after surgery -- you're more likely to just have some dribbling when you sneeze, cough or give your abdominal muscles a workout. Years after surgery, you may develop a blockage in your bladder which impedes urine flow. In this case, your surgeon may dilate the blocked area or suggest more surgery to fix it.
Radiation is another highly effective way of treating prostate cancer that has not spread, and your chances of living fifteen years after this procedure are approximately 85 percent. Radiation targets your prostate, killing the cancerous cells. This painless treatment, which is spaced over seven weeks, often affects your surrounding organs - like your bladder, intestines and rectum. Side effects can be impotence (again, treatable with medications or penile implants, but less common than after surgery), indigestion, cramps, irregular bowels, rectal bleeding and painful, bloody urination. The good news is that medications can help to control these side effects, and once your radiation treatment ends, they usually become less severe or go away.
Although radiation and surgery offer approximately the same cure rates, most surgeons feel that surgery will give younger men slightly better odds for surviving 20 years or more.
If your prostate cancer has spread to other parts of your body, there's still hope. Though chemotherapy at this stage isn't that effective, hormone therapy is. Prostate cancer cells need testosterone (the hormone that gives you your deep voice, facial hair and libido) to grow. The best way to lower your testosterone level is castration - either by physically having your testicles removed or by medications, such as Lupron or Zoladex, that achieve the same effect. If you do choose physical castration, fake testicles (that look and feel real) can be inserted into your scrotum. If getting implants interests you, talk with your doctor about it before surgery. Though the side effects of castration are impotence and loss of your sex drive, many men can look forward to many good years of living while their cancer either regresses or, at least, its growth slows.
Myths dispelled
Here are some facts to clear up some common misconceptions.
The fact is, prostate cancer is not contagious and not caused by anal sex -- it develops on its own. There may be dietetic or genetic causes.
Prevention
For the time being, there's not much you can do to prevent prostate cancer. Some studies advocate taking vitamin E supplements, and doctors are looking into hormone therapies as a possible preventative tool. The next best thing to prevention -- and this can't be stressed enough -- is early detection. True, this not a preventative measure per se, but when you catch this disease early you can greatly increase your chances of survival and prevent a lot of the complications and procedures that usually accompany prostate cancer at its later stages. All men 50 or over should get a yearly rectal exam and prostate-specific antigen (PSA) blood test, as recommended by The American Cancer Society. All African-American men and any man with a father or brother who's had prostate cancer should begin yearly screenings at age 40. All screenings generally stop at age 70.
Of particular concern to Ethnic, Older Men
Twenty percent of men will get prostate cancer - a disconcerting number. African-American men, however, are twice as likely as Caucasian men to develop this disease. If you're 50 or older, The American Cancer Society recommends that you get a yearly rectal exam and PSA blood test. African-American men and all men with a father or brother who's had prostate cancer should begin yearly screenings at age 40.
Special notes Ethnic Men
African-American men are more than twice as likely as Caucasian men to develop prostate cancer.