Tuesday, April 4, 2023

What is prostate cancer?

When I got my diagnosis of prostate cancer, I didn’t know much about the disease. To be totally honest, I didn’t even know much about the prostate or what it did. If you’re new to the subject, you may not know much either, so let’s start at the beginning.

The prostate is a small gland that is part of the male reproductive system. The walnut-shaped gland is located in the pelvis underneath the bladder and its job is to produce seminal fluid.

Photo by Patty Brito on Unsplash

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Since the prostate is closely associated with the penis and sexual function, that’s where you find the symptoms of prostate cancer. These symptoms can include:

  • Pain during urination

  • Difficulty urinating

  • More frequent urination at night

  • Loss of bladder control

  • Decreased strength of the urine stream

  • Blood in the urine

  • Blood in semen

  • Erectile dysfunction

  • Painful ejaculation

  • Unexplained weight loss

  • Bone pain

If you have any of these symptoms, especially symptoms that persist, go to the doctor and get yourself checked out. It may not be prostate cancer, but if it is, it’s better to find out early.

It’s also important to note that early-stage prostate cancer may not produce any noticeable symptoms. That was the case with me. This is why it’s important to get regular checkups that include a prostate exam and a PSA test.

PSA is something that I had to learn about as well. PSA is the “prostate-specific antigen.” PSA is a substance manufactured by the prostate and elevated levels can be an early sign of prostate cancer.

The rub is that high PSA levels can also be caused by other conditions. A high PSA reading may be caused by an enlarged prostate, an infection, or be the result of certain medical procedures or medications. Don’t assume that a high PSA level means that you definitely have prostate cancer, but don’t ignore it either.

Back in January 2023, the American Cancer Society reported that prostate cancer deaths rose three percent while overall cancer deaths declined 33 percent. The reason for this seems to be a failure at early detection in many cases. Diagnosis of advanced prostate cancer increased by five percent. The problem is worst for black men who have a 70 percent higher chance of contracting prostate cancer compared to whites and a chance of death that is two-to-four times higher.

The American Cancer Society recommends starting screening for prostate cancer at age 40 for men with more than one close relative who had prostate cancer earlier than age 65. Other high-risk men, such as blacks and those with a father or brother who had prostate cancer at an early age, should be screened starting at age 45. Men who don’t fall into either of those categories should be screened starting at age 50.

Prostate cancer seems to be largely genetic with family history being one of the largest indicators. There have been studies that suggest some lifestyle risks, but most of these findings have not been confirmed. Some of the factors that may be linked to prostate cancer include dairy intake, vasectomies, testosterone supplements, and exposure to certain chemicals.

Prostate cancer is very common as men age. Per the American Cancer Society, about one in eight men will be diagnosed with prostate cancer at some point. About 60 percent of diagnosed cases are in men older than 65.

The good news is that prostate cancer is very survivable, especially with early detection. While prostate cancer is the second leading cause of cancer death in American men (behind lung cancer), only about one in 41 men will die from it.

After a tumor is discovered and your prostate is biopsied, the cancer is graded with a Gleason score. The Gleason score is made up of two numbers with a range of one through five, with one being the lowest grade of cancer and five being the highest. The first number is the most common grade of cancer in the tumor while the second number reflects the highest grade of cancer in the tumor. For example, my Gleason score was 3+4=7. Most of my tumor was grade three but one area was a four.

The highest Gleason score is 10 with lower numbers being better. My 3+4 meant that I was high-risk, but I was also in a significantly better position than eight or above.

Once you have a diagnosis and biopsy, you will talk with your doctor about treatment options. There are a number of options available, and surprisingly, one possible course of treatment is to simply watch and wait. Because prostate cancer is often a very slow-moving cancer, active surveillance is sometimes preferable to treatment. This is especially true in older men.

In early-stage prostate cancer, there are two common treatment options. The first is surgery, called a radical prostatectomy. This procedure removes the cancer along with your entire prostate and a few lymph nodes. Surgery works best if the cancer has not spread beyond the prostate.

The second option is radiation. There are two different options for radiation therapy. One is the traditional external radiation given over a period of weeks and the other is brachytherapy. In brachytherapy, a small radioactive grain is inserted surgically into the prostate. In both cases, radiation therapy is often used in combination with hormone therapy.

In hormone therapy, also called androgen deprivation therapy, drugs such as Lupron are used to reduce the male hormones in the body. This can slow or reverse the cancer.

Other treatments are available for more advanced cases. These include chemotherapy an immunotherapy, which teaches the immune system to attack the cancer cells. One new form of immunotherapy is a vaccine that can slow cancer growth and spread but which has not been shown to reverse the growth of tumors.

But in the case of early stage prostate cancer, your doctor will probably offer the choice of radiation or surgery. Often, the decision comes down to a combination of personal preference and status of your cancer. There are pros and cons to both strategies, and even the side effects seem to be similar. In my case, I found that for the most part, surgeons leaned toward the prostatectomy and radiation oncologists leaned toward radiation treatments.

My recommendation would be to look closely at your options and get a second opinion before you commit to a course of treatment. In the end, the choice will be yours, but you don’t have to make it blindly.

Talk to your doctors, others who have been each course of treatment, and spend time in prayer seeking spiritual guidance. Consider what you know about your individual case to determine what is best for you.

From My Prostate Cancer Journey

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