Information all men “” and the women who love them “” should know.
By Arthur A. Stamler, M.D., F8100
Prostate cancer is a common problem. It is the second most frequent cause of cancer deaths in men, after lung cancer. Most men find it difficult to discuss prostate cancer, probably because it is so inextricably tied up with their sexuality. In this sense, it becomes a spouse’s disease as well.
This article is based on the seminars I have presented on prostate cancer at FMCA international conventions and area rallies during recent years. The seminar has been so well-received that I was asked to share some of the content with readers of Family Motor Coaching magazine. Most motorhomers are past age 60, and most prostate cancers occur beyond age 60.
In the United States, about 1 person in every 200 will be diagnosed with some form of cancer this year; it’s the second-leading cause of all deaths, at 25 percent, surpassed only by cardiovascular diseases. The American Cancer Society predicts 1.3 million new cases of all forms of cancer in 2004 in the United States. An estimated 563,700 people will succumb “” that’s nearly half. But more than half will survive!
For prostate cancer, the incidence is expected to be 230,110 in 2004, with a fatality rate of 29,900 “” approximately 13 percent. Every three minutes another man is newly diagnosed with prostate cancer. It’s the most common internal cancer among men. But most men who have this disease will die of something else “” usually one of the cardiovascular diseases, such as heart attack, stroke, or the effects of high blood pressure. Breast cancer in women and prostate cancer have a similar rate of occurrence, although nearly 19 percent of women with breast cancer will succumb to the disease.
From ages 60 to 79, one man in seven is going to be diagnosed with prostate cancer. There are no specific warning signs of its presence. Pain is seldom encountered early. The African-American male is 1.5 times as likely to develop prostate cancer and two times as likely to die from it than his white counterpart. The reasons are incompletely understood. Hispanics fall somewhere between the two groups.
Most men aren’t even aware of their prostate until something goes wrong. The normal gland is about the size of a walnut and lies just beneath the urinary bladder. The urethra, the tube through which urine passes to the outside of the body, is surrounded by the prostate.
The prostate’s function is to secrete a thick fluid that forms part of the semen. Nerves that control erection are located on the lateral surfaces of the prostate, and it’s these nerves that may be damaged in the course of treatment for prostate cancer; the result may be erectile dysfunction.
The three most common disorders of the prostate are as follows:
- Prostatitis, an inflammation of the prostate that can have several causes.
- Benign prostatic hyperplasia, abbreviated as BPH, which is a thickening and enlargement of the gland. This is very common past the age of 50. It isn’t cancer, and won’t develop into cancer, but tends to obstruct urine flow. Several treatments are available, including medication and surgery.
- Prostate cancer.
Each of these disorders can elevate the body’s prostate specific antigen, called PSA. PSA is measured by a blood test that has been in common use since about 1990. If the PSA is elevated, doctors’ suspicion is aroused and further testing is done, which may include a tissue biopsy.
Current recommendations call for beginning PSA testing in all men by age 45, and even earlier for those considered at risk “” those with a father or brother who have had prostate cancer, and all African-American men. The test is usually done during the annual physical examination along with other blood tests.
Prostate cancer may be confined to the capsule that surrounds the gland, or it may spread locally or even distantly to other parts of the body. The severity is classified into grades and stages depending on evidence of spread; this information is important in deciding management. The grade of the cancer is called the Gleason Score, after the doctor who devised it. It is measured in numbers from 2 to 10 and is a description of any aggressive appearance of the cancer cells under the microscope. Lower numbers are better.
Other factors involved in planning treatment include the patient’s age, his basic state of health, and even his personal preferences.
A treatment plan is individualized for each man in consultation with his physician, which absolutely requires that the patient become educated about his disorder. The physician usually will suggest appropriate educational resources, and there is usually ample time to learn, since prostate cancer is generally slow-growing.
Let’s take a look at available treatments.
The first is watchful waiting, because sometimes not taking any immediate action is the safest course. Cancer growth is usually slow in this instance and isn’t expected to cause a significant problem for the balance of a man’s life. Matters are followed closely, and treatment can be initiated later if desirable. Poor general health, advanced age, and personal preferences also may dictate this decision.
Second is surgery, also called radical prostatectomy. This involves removal of the prostate. It’s major surgery and may have long-term side effects, including incontinence and erectile dysfunction.
Radiation is a treatment that uses ionizing radiation of the prostate bed to kill the cancer. In the case of prostate cancer, radiation can take two major forms “” external beam radiation and brachytherapy, the latter involving the use of internal radiation seed implants. The possible complications of both of these methods are similar to those seen with surgery. Radiation may also induce bowel dysfunction.
Cryotherapy involves freezing the prostate, with the patient under anesthesia, so that the cancer cells are effectively killed. This newer method should be performed only by an experienced physician who has done it successfully many times before. Complications are similar to the previously mentioned methods.
Hormone therapy involves taking medication that suppresses the male hormone testosterone. The method is usually reserved for those in whom the cancer has spread, or metastasized, or whose health won’t allow the previous types of treatments. It is also occasionally employed to shrink the size of the prostate prior to utilizing the above discussed methods. It can slow the spread of cancer for many years.
Chemotherapy is usually reserved for those in whom hormone therapy has failed. Some newer drugs are particularly useful. Treatments are often given in clinical trials (research studies conducted to answer specific health questions).
Immunotherapy is a developing, newer treatment in which laboratory-created antibodies are targeted to antigens on the tumor surface. It treats many cancers that already have metastasized, and is also available in clinical trials.
Anti-angiogenesis is another new technique in which medication is used to attack the blood vessels that supply a cancer, effectively killing it. It is also available in clinical trials.
Still other methods are currently under clinical trial; most of them are directed at cancers that already have spread and are, therefore, not manageable by surgery or radiation or freezing methods. Therapy is individualized and may take many forms. It’s absolutely essential that each patient learn about his disease and participate with his physician in treatment decisions. Rarely will a patient have an opportunity like this to decide his own destiny.
What about prevention? Can a man alter his lifestyle and thereby reduce the likelihood of developing prostate cancer? The answer is possibly yes. Dietary modification is probably the greatest change one can make. This involves choosing a diet low in fats and red meats, and low in grilled meats of any kind. Increasing seafood consumption, especially fish high in omega-3 fatty acids, is believed to be useful. The diet also should be high in fruits and vegetables, especially those containing lycopene, which is found in tomato products and other foods. Supplements of selenium and vitamin E are generally regarded as helpful. The use of soy, green tea, gingko, saw palmetto, and ginseng is debatable. Discontinuation of tobacco in any form is highly recommended.
Treatments for prostate cancer may create a number of problems. They include incontinence (loss of urinary control to varying degrees), infection, bowel difficulties, and erectile dysfunction (also called impotence), among others. With the exception of erectile dysfunction, most men recover from their treatments with only temporary and manageable difficulties; problems that linger are usually controllable by appropriate specialists.
Recovery of erectile ability tends to be related to the degree of function prior to treatment. Those who were competent before have a greater likelihood of capability following recovery from treatment. There is often a latent period following healing that can last for a year or more before full function is achieved. During this latent period, various artifices can be employed temporarily, including drugs such as Viagra; vacuum pumps; and a great deal of understanding between conjugal partners. If difficulties persist, and appear to be permanent, the above-mentioned techniques remain useful, plus surgical implants and injections.
Impotence has many causes other than treatment for prostate cancer. Tobacco usage in any form promotes arterial insufficiency. Diabetes; obesity; medications (particularly those used to treat elevated blood pressure and depression); urinary tract disease; alcohol use and abuse; disorders that cause pain; spinal cord disease; stress; fatigue; mental illness, including depression; and many circulatory diseases are a short list of some of the causes of impotence, and each requires its own management, with the assistance of a competent specialist.
When planning treatment for prostate cancer, a man must establish his personal priorities. Staying alive is usually first on the list, but age, sexuality, state of health, agility, and personal preferences regarding the various treatments usually enter the decision. It’s extremely important to seek the advice of the best physicians you can locate, and get a second opinion. You may find expert doctors in your own area. Often they are located in major university medical centers where the volume of cancers seen gives them a greater degree of expertise.
A man’s partner needs to be involved at all levels of discovery and decision-making. Remember, it’s her problem, also. The patient needs to seek the advice, the support, and the experience of men who already have dealt with prostate cancer. Support groups are everywhere, and members are dedicated to sharing their knowledge, empathy, and understanding.
Even if a man’s body is altered by medical or surgical difficulties, or old age, a couple can discover new ways of loving one another. Both partners are responsible for their physical and emotional intimacy, and together they can develop their own level of normalcy “” whatever is required of them together as partners in life.
About the author: Dr. Arthur Stamler is a retired physician and a prostate cancer survivor. He has indicated that he will respond to inquiries sent to him at the following address: 105 Altamont Terrace, Travelers Rest, SC 29690.
The American Cancer Society
1599 Clifton Road N.E.
Atlanta, GA 30329
The toll-free number is useful for free publications about prostate cancer. Your own hometown probably has a local chapter of the ACS, which also can assist you.
National Cancer Institute
Public Inquiries Office
6116 Executive Blvd., MSC8322
Bethesda, MD 20892-8322
This is a federally funded information source of excellent quality. They can discuss your concerns with you by telephone and send printed material at no cost.
US TOO Prostate Cancer Education & Support
5003 Fairview Ave.
Downers Grove, IL 60515
This nonprofit prostate cancer support group has more than 300 chapters in the United States, and more in other countries. It provides education and is run by volunteer survivors.
A Note From Former FMCA President Jeff Jefcoat
Dr. Art Stamler and I, like many of you, are survivors of prostate cancer. As you read Dr. Stamler’s article, you will find statistics indicating that many men die of prostate cancer each year.
I would like to emphasize three main points:
1. Early detection is extremely vital, and it must start with you, the individual, by way of regular checkups with your physician.
2. If you are diagnosed with prostate cancer, prepare yourself through research and counseling with your doctors. That way, you and your doctor can decide on the best method of treatment for your particular situation. Get at least two opinions and more if it’s possible and practical. Be aware that most doctors will suggest the procedure that fits their specialty. Surgeons will suggest surgery, radiologists will suggest radiation, etc.
3. Make your diagnosis known to your friends. You will be surprised that so many of them are survivors, and most are very willing to share with you the nitty-gritty details of the treatments and the aftermath.
Dr. Stamler offers seminars on prostate cancer at FMCA conventions and some area rallies. I urge you and your spouse to attend one of his programs. There is no charge and you will be better informed and prepared to help yourself and others.
Dr. Stamler is a retired pediatrician. He has become not only a survivor of prostate cancer but also has developed an expertise on the symptoms, treatments, and management of the subject. We thank him for sharing his expertise with fellow FMCA members.