Prostate Cancer

Prostate is a walnut-sized gland in the male reproduction system, located between the bladder neck and the urinary passage (urethra). Prostate secretes whitish fluid that nourishes and transports sperm; when mixed with sperm, the fluid becomes semen. Male hormone secreted by testicles directly affects the growth and functions of prostate.

Swollen prostates are common among middle aged and elderly males but most of the cases are benign hyperplasia (abnormal increase in number of cells). When there is abnormal genetic mutations, malignant tumors may develop in the prostate, causing prostate cancer. Prostate cancer may spread to other parts of the body, particularly the bones and lymph nodes in the pelvis.

Prostate cancer is one of the most common male cancers, with an increasing number of reported cases in recent years. New cases in Hong Kong increased from 683 in 2000 to 1655 in 2013 and most patients are above the age of 60.

Some people have higher risks of prostate cancer than others. You have to pay special attention if you fall within the following categories:

• Age: over 50

• Hereditary: males with family history of prostate cancer carry higher risks

• Diet: prolonged intake of food with high calorie and high fat

• Others: smoking, over-weighted and prostate diseases, etc.

To prevent prostate cancer, we should have healthy life styles and eating habits. For example, food with high fiber and low fat can help to prevent or delay the occurrence of prostate cancer:

• Limit the intake of animal fat and meat (especially red meat)
  
• Eat more bean and related products
  
• Eat more fresh vegetables and fruits
  

    Prostate cancer is a slow growing disease, which may exist in patients’ bodies for years without being detected. Often there is no obvious symptom at the early stages and the most common symptoms of prostate cancer and an enlarged non-cancerous prostate are similar.

• Passing urine more often than usual, especially at night
   
• Difficulty in passing urine
   
• Pain on passing urine
   
• Blood in the urine or semen

As symptoms above are very similar to those of prostate enlargement, you should consult your doctor as soon as possible for diagnosis. Pain in your pelvis, back or hips  suggest advanced disease with tumuor spreading to other sites.

For proper diagnosis of prostate cancer, doctors may need to perform one or more of the following examinations:

• Digital rectal examination – the doctor will insert his gloved finger into the patient’s rectum to check for any abnormal enlargement or hardening.

• Blood test – patients suffering from prostate cancer, inflammation of prostate or benign prostate enlargement may have raised level of prostate-specific antigen (PSA).

• Ultrasound scan and biopsy–a small ultrasound probe will be inserted into the rectum to measure the size and detect abnormality of the prostate. Tissue samples can also be obtained through needle biopsies for further microscopic examination.

• Endoscope examination of the bladder etc

Once the diagnosis of prostate cancer is confirmed, the following additional tests may be needed in some patients:

• Bone X-ray and/or bone scan

• Pelvic computer tomography (CT) scan or magnetic resonance imaging scan (MRI)

• Chest X-ray

    If a patient is diagnosed with localized prostate cancer, choices for treatments will depend on the estimated tumour growth rate, extent of disease, age and medical conditions of the patient:

(I) Early stage of prostate cancer – small localized tumors without invading  surrounding tissues

The prostate and surrounding lymph nodes will be removed in surgery (prostectomy). The resection can be done through conventional incisions or newer laparoscopic approach. After surgery, the patient may have some risk of urinary incontinence and impotence. External radiotherapy and internal radiotherapy (brachytherapy) are viable alternatives with similar treatment outcomes.

For elderly patients or those with chronic ill health, especially those with early slow-growing tumours with no significant discomfort, doctors may recommend only regular monitoring (i.e. “wait and see”) and no specific treatment. It is because some prostate cancer cells can grow very slowly and will not threaten the patient’s life in the near term.

(II) Intermediate stage of prostate cancer – more extensive disease with invasion of surrounding tissues

The usual treatment is external radiotherapy, often used together with hormonal therapy to improve the treatment outcome.

(III) Advanced stage of prostate cancer – cancer cells have spread to bones or other distant organs

The main treatment is hormonal therapy (androgen deprivation treatment) by either surgical removal of testicles or medication. The rationale is to control the growth of prostate cancer by suppressing the male hormone levels. This treatment may control the growth of cancer cells for a few years and relieve the discomfort and pain. For tumors no longer responding to hormonal therapy, palliative chemotherapy may also be considered.

If prostate cancer is not properly controlled, the condition may worsen and result in the followings:

• Spread to other organs: prostate cancer may spread along lymphatic vessels to the surrounding lymph nodes and then bones or other distant organs.
  
• Pain: if cancer cells invade the bones, patients may suffer from severe pain.

Patients of prostate cancer may also suffer from the following complications caused by treatments:

• Incontinence of urine
   
• Impotence (inability to get and maintain an erection sufficient for a satisfactory sexual intercourse): cancer itself, surgery, radiotherapy or hormonal therapy can all cause impotence in some patients

• Rectum bleeding or ulcer: usually caused by radiotherapy
  

Patients need to be attentive to various aspects before and after treatment and during recovery. Knowing more about prostate cancer and being considerate will help them deal with the disease in a positive way.

• Diet: reduce intake of fat; avoid to eat raw or undercooked meat, poultry, eggs, seafood, raw or unpasteurized dairy products, and ready-to-eat raw vegetables.
• Moderate exercise: moderate exercise daily is helpful to maintain a healthy body Body weight control: patients receiving hormonal therapy have tendency to gain weight and impaired control of blood sugar and lipids
• Maintain sexual contacts with partner: patients with impotence may express themselves by embracing and touching their partners. Medications may also improve the erectile functions in some patients.