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UNDERSTANDING PROSTATE PROBLEMS
CONTENTS
INTRODUCTION
WHAT IS THE PROSTATE?
SYMPTOMS OF PROSTATE PROBLEMS
DIAGNOSTIC TESTING
TREATMENT OPTIONS FOR CANCER
SURVIVING PROSTATE CANCER
NATURAL TREATMENT OPTIONS FOR BPH
SEX AFTER PROSTATE DIAGNOSIS
CONCLUSION
INTRODUCTION
Through the miracles of modern medicine,
today prostate disease is well defined and is no longer necessarily considered a
death sentence. The most effective methods for handling prostate disease are
knowledge and prevention.
In our guide we will help you understand
prostate disease, various diagnostic tools and provide recommendations for
treatment.
WHAT IS THE PROSTATE?
The first step toward understanding how the
prostate affects your health is to learn what the prostate is and how it
functions.
It is surprising how little many men know
about such an important part of their anatomy.
The prostate is an important segment of the
male reproductive system. It is a gland that is located in the lower abdominal
cavity, just below the bladder, in front of the rectum and behind the pubic
bone. It partially surrounds the urethra. The urethra is the channel that
carries urine to the penis from the bladder and it runs right through the
prostate.
A healthy prostate is about the size of a
walnut, weighs approximately 1 ounce and is shaped similar to a donut.
There are “seminal vesicles” that are
attached to the prostate. They produce a protein that mixes with prostatic
fluid which forms semen. How this works is that tubes from the testicles carry
sperm up to the prostate where sperm is mixed with the seminal vesicle and
prostatic fluids.
This fluid is ejaculated during orgasm
through ejaculatory ducts that connect to the urethra. In addition, the
prostate helps to control the flow of urine.
Nearly every man will experience some type of
prostate problem during his lifetime. Men who are over forty-five may
experience an enlargement of the prostate. While this is not a problem in
itself, it is uncomfortable and can be a forerunner to other more serious
maladies which we will discuss further.
The prostate actually continues to grow
throughout life, but grows very slowly after the age of twenty-five.
Enlargement of the prostate is part of the normal aging process due to hormonal
changes and usually does not become a serious problem until a man reaches sixty
years of age.
SYMPTOMS OF PROSTATE PROBLEMS
Enlargement of the prostate is called benign
prostate hypertrophy, or BPH. While this growth is usually considered a
nuisance, if a man experiences problems with burning, or difficult urination at
any time, the prudent course of action is consulting a urologist.
Other symptoms may be:
-
A feeling of having to push out urine
-
A sensation that the bladder is not emptying
-
Increased urinating, especially at night
-
Intermittent starting and stopping of the
urinary stream
After a diagnosis of BPH, many men will just
continue to live with the symptoms and subsequent discomfort. It is not a life
threatening condition, and there are treatments. In some cases surgery might be
considered if the enlargement is significant.
Ignoring BPH can be extremely dangerous and
lead to other disease such as kidney infections or damage as the urine can back
up into the kidneys because of the blockage of an enlarged prostate. There can
also be an occurrence of bladder infections.
There is a huge difference between BPH and
prostate cancer. BPH is a normal part of aging. Prostate cancer is a condition
where prostate cells grow exponentially and out of control. These cells create
tumors that may spread to any part of the body.
Numerous health organizations report that 1
in 6 men will experience prostate cancer. However, if the condition is
diagnosed early, approximately 99.3% of them will survive. The key is early
detection.
DIAGNOSTIC TESTING
Prostate cancer can occur in any man, but
there are certain “risk groups.” Younger African American men appear to have
twice the risk and fatalities of Caucasians. Sadly, many are diagnosed before
they reach the age of 50.
Another risk group is men who have a family
history of prostate cancer, placing them in the same group who may contract the
disease before the age of 50.
The only method to determine whether you are
at risk for prostate cancer is diagnostic testing. The earlier you are
screened the higher your chances of survival. Let’s explore some of the
diagnostic options.
Digital Rectal Exam (DRE)
Testing begins with a digital rectal exam
(DRE). This examination has been the benchmark for discovering cancer as well
as BPH. Your doctor can determine the condition and size of the prostate by
inserting a gloved finger into the rectum.
Prostate Specific Antigen (PSA)
In the mid-1980s’ the FDA approved the use of
monitoring blood levels for prostate specific antigen (PSA). At that time, this
was considered a major breakthrough in the diagnosis and treatment for prostate
cancer.
Here’s why. PSA readings specifically target
prostate cells. A healthy prostate gland produces a constant level, usually 4
nanograms per milliliter which is considered as a PSA reading of “4” or less.
Cancer cells produce growing amounts that
escalate. They correlate with the severity of cancer. A PSA level greater
than 4 will give the doctor some cause for investigation. If the level reaches
10 he will have cause to consider the presence of prostate cancer. An amount
over 50 may indicate that the cancer has spread to other parts of the body.
A PSA test usually measures the total amount
that is attached to blood proteins. However, later research gained an FDA
approval for a test called the Tandem R test. This test also gives a measure of
the total PSA and reads another component called free PSA. Free PSA floats
unbound in blood.
Have these two tests to compare helps to rule
out prostate cancer in men whose PSA is just mildly elevated due to other
causes. A 1995 study in the Journal of the American Medical Association shows
that a free PSA test reduces unnecessary prostate biopsies by 20% in certain
patients whose PSA is between 4 and 10.
As newer sophisticated methods are made
available, it is creating a controversy among the healthcare community regarding
“when” men should be screened, how often and whether to screen men under 50 with
no symptoms.
Some are saying that mass screening is
expensive while others point out reductions in mortality rates when early
screening diagnoses prostate cancer. The jury is still somewhat “out” on that
debate, but it never hurts to err on the side of caution. It is your body,
after all!
It should be noted that both The American
Urological Association and The American Cancer Society recommend annual PSA test
for all men over 50 and for those at high risk over 40.
Take the case of Joe. A healthy, 36 year
old, robust father of two was required to take a routine physical exam for his
work-related insurance. During this exam, his doctor noted that his prostate
was enlarged. Unfortunately, the resulting tests proved that he did indeed have
prostate cancer. Further investigation revealed that he was “at risk” based on
family history.
Why take chances? Get yourself screened so
you have a benchmark, then having annual screening. Remember, prostate cancer
is slow growing so the odds are in your favor when detected early.
Urine Test
A standard urine test can also help to
diagnose prostate problems by screening for blood or infection. The chemical
tests will also check for liver, diabetes or kidney disease.
Hyperplasia INTRAVENOUSPYELOGRAM (IVP)
This test is actually an X-ray. Dye is
injected into one of the major veins. While the dye is circulating, pictures of
vital organs are taken. This test will record the progress of the dye through
the kidneys, bladder and ureter tubes (the tubes that drain the kidneys). This
test is more or less optional since most men who have enlargement of the
prostate usually have no abnormalities of the ureter tubes or kidneys in a
normal urinalysis.
Bladder Ultrasound
This is a simple procedure that can be
conducted right in the doctors’ office. It is non-invasive and determines if
there is urine left in the bladder after urination. If a large amount of urine
remains, it could be an indicator of enlarged prostate that is not allowing the
bladder to be completely emptied.
Prostate Ultrasound
This is a test to estimate the size of the
prostate by using state of the art software that helps guide the physician. The
prostate ultrasound is also important if a biopsy is called for which we will
discuss later.
Uroflow
This is a simple test that entails the
patient urinating into a container and measuring how strong the stream of urine
is.
Radionuclide Bone Scan
A test that can be used if staging (see
below) indicates that cancer has spread into the lymph nodes. If the tumor has
spread to the lymph nodes, bone commonly follows. However, if PSA levels are
under 10ng and there is no indication of bone pain, physicians find that the
presence is so unlikely that this procedure is skipped.
Cystoscopy
This test allows the physician to visually
examine the bladder and prostate. This is done by inserting an instrument
through the urethra.
Computed Axial Tomography (CAT)
This is another test that could identify
cancer in remote areas of the body. Without probable cause, like the
Radionuclide Bone Scan above, it is probably unnecessary just as the
Magnetic Resonance Imaging (MRI)
This test may be unnecessary, especially if
the prostate cancer is localized.
Pelvic Lymph Node Dissection
Considered to be the “final check” to
determine if cancer has spread, this procedure can be completed through normal
open surgery but more often is conducted using a fiber optic probe that is
inserted through a small incision in your abdomen.
All of these diagnostic tests are tools to
determine whether there is a possibility of cancer present in the prostate and
if so, just how invasive it may be.
However, there is only one way certain method
to determine the presence of cancer cells and that is by examining the tissue
itself.
Based on the findings of the tests we have
discussed, if a physician determines that there may be cancer cells he will
recommend a biopsy.
A biopsy is conducted by a urologist and the
procedure is normally done right in his office. Here is where the ultrasound we
discussed previously comes into play. Using a transrectal ultrasound (TRUS),
the doctor will image the prostate by using sound waves by inserting an
instrument into your rectum. This allows the doctor to “image” the prostate.
He will use biopsy needles that are hollow into any area of the prostate that
looks or feels suspicious. Small bits of tissue are extracted through the
needle. You may feel a stinging sensation.
Depending on the reasons for the biopsy, the
doctor may take samples randomly. For instance, if the biopsy is conducted due
to elevated PSA instead of a suspected abnormality in the prostate gland, as
many as a half dozen or more samples may be taken. This is considered a
“pattern biopsy” and is done to help determine the size and invasiveness of any
cancer. Even though you may have multiple samples, a biopsy can still miss some
cancers.
Once the biopsy is complete, the tissue
samples are taken to a pathologist to determine the presence of cancer cells.
Normal prostate cells are usually uniform in
size and are neatly patterned when viewed under a microscope. They appear
similar to one another in an orderly manner.
Abnormal cells change their appearance and
are not well defined. They will usually appear as misshapen and irregular.
As they deteriorate, a tumor can appear.
Tumors can be benign (non-cancerous) or malignant (cancerous).
If the pathologist determines the presence of
prostate cancer, he will “grade” each of the tissue samples. This will
determine how advanced beyond normal the cancerous tissue has developed. This
grading system gives the physician a good idea as to how the tumor is behaving.
Tumors with a low grade are most likely to be slow-growing. Tumors with a high
grade are more apt to spread aggressively or may have already spread outside of
the prostate. If the latter is true, it is said to be “metastasized.”
The actual grading system most widely used by
pathologists is the Gleason Grading System, developed in 1977 by Pathologist
Donald Gleason. You will find the Gleason Scores in numerous places on and off
the internet as it is a standard method, but we have provided them for you here.
Gleason Scores
The Gleason grading system
assigns a grade to each of the two largest areas of cancer in the tissue
samples. Grades range from 1 to 5, with 1 being the least aggressive and 5 the
most aggressive. Grade 3 tumors, for example, seldom have metastases, but
metastases are common with grade 4 or grade 5.
The two grades are then added
together to produce a
Gleason score. A score of 2 to 4 is
considered low grade; 5 through 7, intermediate grade; and 8 through 10, high
grade. A tumor with a low Gleason score typically grows slowly enough that it
may not pose a significant threat to the patient in his lifetime.
Once the grade is established, your physician
will need to have additional information before determining a course of
treatment. He will need to “stage” your tumor which is dependent upon the size
and how far it has spread.
There are two systems used for “staging” the
tumor. One of them is TNM and the other is ABCD Rating. They both evaluate the
size of the tumor and the spread in reference to nearby lymph nodes and if the
cancer has spread beyond those parameters.
The staging system determines whether the
tumor is “Localized,” “Regional” or Metastatic. Within each of these categories
are divided into categories that are more precise.
Localized
Using the TNM method, you have Stage I (could
also be referred to as T1.) These are tumors that cannot be felt. Using the
ABCD method the staging is considered “A.”
TNM Stage II or B or T2 are tumors that you
can feel but are still confined to the prostate gland.
Regional
In Stage III or C or T3 tumors have broken
through the prostate capsule. They may have invaded the seminal vesicles.
T4 indicates that tumors are growing into
muscles and organs that are nearby.
Metastatic
Stage IV, D or N+ or M+. This staging refers
to tumors that have invaded either the pelvic lymph nodes (N+) or into other
distant areas of the body (M+).
If you receive a diagnosis of cancer and
different treatment options from your doctor, it would be prudent to get a
second opinion. This is a normal practice and one which can help you make
intelligent decisions about the most important step you may take in your life.
Getting that second opinion may confirm the
diagnosis but help you to adjust the staging and your treatment options. A
second opinion may also lead you to a special clinical trial of new cancer
treatments that your current physician is not aware of.
Try and locate a prostate cancer support
group in your area. Speaking to other men who have experienced prostate disease
can do wonders in learning how to deal with your diagnosis and treatment
options.
TREATMENT OPTIONS
Again, it can’t be stressed enough, early
detection is imperative in combating prostate cancer. The challenge is that in
the early stages there are no symptoms of prostate cancer. By the time symptoms
appear in the form of urinary complications, the cancer has spread beyond the
prostate.
Treatment options vary depending upon several
factors such as age, overall health of the patient and whether there is evidence
of bladder infection or kidney damage resulting from an enlarged prostate.
Faced with the enormity if your disease, when
you add treatment options into the mix it can be overwhelming to say the least.
This is why we recommend that second opinion. We will take a look at some of
those options here. Just remember, that the best option for you will be the one
that you and your doctor determine is the best route for your situation. When
it comes to treating prostate cancer there’s no such thing as “one size fits
all.”
There are some questions that you will need
to address before selecting any of the options your physician may recommend.
Let’s take a look at some of those now. These shouldn’t be taken lightly, as
you will be making decisions that will absolutely affect the rest of your life.
-
Other than the prostate cancer, are you in
good overall health?
- Is the cancer confined to the prostate?
- How fast is it growing?
- How old are you?
- Is it important for you to be able to
maintain control of your bladder or bowel?
- Would you find it unsettling to live with
cancer that is untreated and have to look at strict monitoring of the disease?
- Are you healthy enough for surgery?
Treatment Options for Localized Cancer
In this situation you are looking at Stage I
or II based on the Gleason Score. In this particular scenario, you are looking
at three different choices of treatment for treatment that can result in long
term survival.
One is called Watchful Waiting; one is
Surgery; and finally Radiation. Let’s explore each of these options further.
Watchful Waiting
Watchful Waiting is the term coined by the
medical community to describe an approach for managing cancer that has not yet
moved beyond the prostate gland. This approach is also known as “observation”
or “surveillance.”
Because cancer in this stage advances very
slowly there is the possibility that it will not cause any lifetime problems.
This is especially true of older men. Men who opt for this approach do not
participate in any active treatment without cause. They visit their physicians
for monitoring but unless a problem arises they have no other treatment.
If there are no indications of infection,
kidney or bladder damage this can be a reasonable approach. Other obvious
advantages to this approach are sparing the man pain and potential side effects
related to surgery or radiation.
The down side of this approach is the risk of
decreasing control of the disease before it spreads. Another minus factor is
postponing treatment until a man is more at risk from the side effects and the
difficulty of dealing with the treatment itself. Some men also find that
dealing with the stress of having cancer and doing “nothing” about it can cause
panic and anxiety.
Watchful Waiting is more viable for older men
who have tumors that are very small and growing very slowly as mentioned above
in the low-grade Gleason Score.
Some men who opt for this approach have been
known to live for years with no outward signs of disease and in several studies
for as long as 10 or 15 years, there is no significant difference in life
expectancy than those men who were treated with surgery or radiation.
Surgery
There is no doubt about it. Surgery is an
invasive procedure. There is evidence that surgery for prostate cancer is
rampant in the United States with an increase of 60% between 1984 and 1990.
Contrast this with the Watchful Waiting approach used in Europe for the same
stage prostate cancer. Recent studies, however, do show a decrease in the
number of men having radical prostatectomy procedures.
While the medical community would like to see
more incidence of the Watchful Waiting approach, patients find the approach too
stressful.
Let’s discuss the actual surgical procedure.
It is called a radical prostatectomy and is the complete removal of the prostate
as well as tissue nearby. The procedure can be further described by the
incision used to accomplish the procedure. These incisions are:
·
Retropubic prostatectomy. The prostate is
reached via an incision in the lower abdomen;
·
Perineal prostatectomy. The prostate is
reached via an incision in the perineum which is the space between the scrotum
and the anus.
Radical prostatectomy consists of removing
the entire prostate gland, the seminal vesicles, both of the ampullae (the
enlarged lower sections of the two vas deferens which are the tubes that carry
sperm from the testicles to the actual prostate gland) and the other surrounding
tissue. The portion of the urethra that travels through the prostate is cut
away as well as the bladder neck and some of the sphincter muscle that controls
urine flow.
Dissection of the pelvic lymph node is
routine with a retropubic prostatectomy but with a perineal prostatectomy the
dissection requires a separate incision.
A radical prostatectomy is a serious,
complicated, demanding procedure. The surgery itself will take anywhere from 2
to 4 hours. The patient will remain in the hospital for approximately 3 days.
He will require a catheter (tube to drain urine) for about 10 days to 2 weeks.
There is a small percentage (5 to 10%) of surgical related problems like
bleeding or infection. The risk of death from the surgery is very minimal and
much less for younger men as opposed to older men who may be frail.
Post surgical, long term problems associated
with prostatectomy range from sexual impotence, stool incontinence and urinary
incontinence. It is highly unlikely that a man will father children after the
procedure. The reason is that without the prostate, very little ejaculate is
produced.
It is common for the majority of men to
experience incontinence after surgery and have occasional dribbling when
coughing or exerting themselves. A few will lose all urinary permanently.
Some men are candidates for an artificial urinary sphincter which is implanted
surgically or narrowing the bladder opening with injections of collagen.
Stool or fecal incontinence (loss of normal
muscle control of the bowels) may affect some men after their prostatectomy.
This is caused by muscle damage during rectal surgery and stool incontinence is
also caused because of a reduction of the elasticity of the rectum. What this
does is shorten the time period between the sensation of the stool and the need
to have a bowel movement. The rectum can be scarred and stiffened by surgery
or radiation.
Historically, a prostatectomy always resulted
in sexual impotence. Advances in surgical procedures called “nerve-sparing
surgery” may reduce the risk of impotence. The nerve sparing technique avoids
cutting the two bundles of nerves and vessels that run along the surface of the
prostate gland that are needed for an erection.
Unfortunately, this procedure is not viable
for everyone, if the cancer is too large or if it is located too close to the
nerves. Under these circumstances, even with this technique many men
(especially older men) will become impotent.
The fact is that most men will lose a degree
of sexual function and if a man has a problem with erections before treatment,
the nerve-sparing surgery is not indicated.
The chances of impotence run the gamut from
20 to 90% depending on age, stage of the disease and the type of surgery.
Radiation Therapy
Radiation therapy consists of using very high
energy x-rays. They are delivered by an external beam from a machine or
actually implanted in the prostate to kill cancer cells.
External Beam Radiation Therapy
This treatment can also be used to treat men
whose cancer tumors have advanced into the pelvis and can’t be removed with
surgery if they have no indication of lymph node invasion. Radiation therapy
can also reduce tumors and relieve pain for men who have advanced disease.
External beam radiation therapy treatments
are usually conducted 5 days a week for up to 6 or 7 weeks. The treatments are
painless with each session lasting just a few minutes. Sometimes, if the tumor
is extremely large, hormonal therapy may begin during the radiation therapy and
can continue for several years.
Hormonal therapy prevents cancer cells from
receiving the hormones that feed their growth. In prostate cancer, male
hormones are blocked with hormonal drugs or by surgically removing the
testicles.
The prime target of the external beam
radiation is the prostate gland itself as well as irradiating the seminal
vesicles as they are a common area of cancer spread. It was once believed that
irradiating the lymph nodes in the pelvis was necessary, but the long term
benefits have proven that this only applies to certain situations.
Since a radiation beam is passed through
normal tissue to reach the prostate, there is the risk of killing healthy
cells. Diarrhea is a side affect when radiation is applied to the rectum but
diarrhea, in addition to fatigue caused by the radiation, will usually disappear
when treatment is completed.
One of the long term affects of radiation is
proctitus. This presents as inflammation of the rectum, bleeding, bowel
problems such as diarrhea and cystitis which is an inflammation of the bladder.
This usually leads to problems with urination. Radiation therapy also results
in impotency for 40 to 50% of men treated.
Some of these side effects may be minimized
by using higher energy radiation beams that can be more precise in targeting the
affected area. Coupled with computer technology, treatments are tailored to
exactly match the anatomy of the man being treated. This type of state of the
art equipment is not always readily available.
Internal Radiation Therapy
Internal Radiation Therapy is a procedure
that delivers a very high dose of radiation to tissue in the immediately
affected area and minimizes the damage to healthy tissue like the rectum and the
bladder.
This is accomplished by inserting dozens of
tiny seeds that are radioactive directly into the prostate gland. The therapy
depends on ultrasound or CT that guides placement of very thin needles through
the skin of the perineum. The needles deliver the tiny seeds (made up of
radioactive palladium or iodine) directly into the prostate using a
pre-determined, customized pattern created by extremely sophisticated computer
programming. This high tech process allows the needles and seeds to directly
conform to the size and shape of each prostate.
This procedure is normally completed in just
an hour or two. It is done under a local anesthesia and the patient goes home
the same day.
Radiation is emitted from the seeds for up to
several weeks. Once insertion is complete, the seeds remain in place causing no
harm whatsoever.
Some physicians use a different approach.
They will use a more powerful radioactive seed and implement over several days.
These are temporary implants. This procedure requires hospitalization and may
be combined with low doses of external beam radiation.
Long term results are not yet in on this
procedure primarily due to the fact that internal radiation therapy is still a
recent process and is limited to just a few patients. However, after 5 years
more than 90% of patients treated still remain cancer free.
The procedure is not recommended for large,
advanced tumors or for men who were previously treated with transurethral
resection of the prostate (TURP) or Benign Prostatic Hyperplasia (BPH). These
men are at a higher risk for urinary problems. When a man has small,
well-differentiated tumors it is an option that has fewer side effects as well
as being less invasive. It is less costly than external radiation or surgery
and requires a shorter hospital stay.
Discomfort experienced post-implant is
usually controlled by oral painkillers and a man can expect a few weeks of
incontinence. Long term problems like prostatitis (inflammation of the prostate
gland) are infrequent and usually not severe in nature. Only 15% of men under
the age of 70 experience sexual impotence and 30 to 35% of men over the age of
70.
Treatment options for cancer spread beyond
the prostate.
In this situation the localized therapies
just won’t be enough to stop the growth. This is Stage III and radiation
therapy will most likely help by keeping the tumor in check. Radiation
combined with hormonal therapy will help to slow the growth.
Hormonal therapy
We briefly touched on this subject in the
previous chapter, but now let us explore this therapy.
With hormonal therapy, the goal is to cut off
all production of male hormones, such as testosterone, resulting in castration.
Castration can be surgical or medical but the end result is the same and for
good reason.
Prostate cancer cells can actually “feed” on
male hormones causing them to grow. Blocking the hormones with an antiandrogen
(drugs that block male hormones from circulating in the blood) will slow the
growth of the cancer cells. This process is the equivalent of a medical
castration.
There are numerous approaches to the use of
hormonal therapy. Different drugs have been combined to test the results. An
example of one such combination is known as maximum androgen blockade. This is
a total hormonal therapy usually combined with either surgical or medical
castration. An antiandrogen pill is ingested each day for months or years.
Evidence as to the efficacy of this approach
has proven that there is no significant difference in the effectiveness of this
process as opposed to standard hormonal therapy. However, surgical and hormonal
therapies in combination do seem to relieve symptoms.
When considering surgical castration versus
medical castration, it’s important to keep one fact in mind. Medical castration
can be reversed simply by ending use of the drug. Oddly enough, in some cases
ceasing the hormonal treatment has temporarily interrupted the growth of the
cancer.
While hormonal therapy in the case of
metastatic cancer seems to work, sadly, the reprise is only temporary.
Remission will normally last for 2 or three years. At some point, those cancer
cells that do not need testosterone to grow will begin the growth cycle again.
If this takes place a second array of hormonal drugs (progesterone or
hydrocortisone to name two) may be considered.
Clinical Trials
Investigating the possibility of
participating in clinical trials is always an option for treatment. Clinical
trials are usually new drugs, combination of drugs or mechanical in nature.
Cryosurgery
This process is used to kill prostate cancer
cells by freezing them. Similar to the tiny radioactive seeds delivered through
thin needles that we discussed previously, rather than seeds liquid nitrogen is
passed through thin probes that are passed through needles that have been passed
through the perineum directly into the prostate. The liquid nitrogen will form
a ball of ice from the cancer cells and as the frozen cells thaw out they break
up. This procedure will take a couple of hours under anesthesia which can be
either local or a spinal and a 1 or 2 day hospital stay.
There is a downside to this treatment. Even
though a “warming catheter” is inserted into the penis to protect the urethra,
the overlying nerve bundles usually freeze as well rendering the man impotent.
Chemotherapy
While chemotherapy is an aggressive approach,
according to the medical community it is not necessarily effective as a choice
to fight the slow growing prostate cancer cells.
This does not mean that it should be ruled
out entirely. New anti-cancer drugs are always being studied and released.
There are a few currently under study that are being included surgical or
radiation therapy in men at Stage III prostate cancer.
Another study includes them in the regimen
along with hormonal therapy. This is specifically being used for men with
advanced cancer that is not responsive to hormonal therapy by itself.
Early Hormonal Therapy
Just as the name signifies, this is the
practice of starting hormonal therapy immediately upon the diagnosis of prostate
cancer. The goal is to slow the growth of cancer cells that have grown beyond
the prostate and into surrounding tissue and even the lymph nodes. Sometimes
early hormonal therapy helps in shrinking the tumor.
Conformal Radiation Therapy
Conformal radiation therapy (3D-CRT) is a
three dimensional computer software program. It allows radiation beams to
conform and shape to fit the prostate thereby accurately targeting only the
prostate gland thereby minimizing damage to the surrounding healthy tissue.
No matter what avenue of treatment you select
for managing prostate cancer, do your very best to maintain a positive
attitude. Yes, the horizon may look a bit gloomy, but with modern medicine
advancements are being made every day.
Your best defence is a strong offence. Get
screened as soon as possible for early detection then have regular follow-ups
especially if you are in an at risk group.
SURVIVING PROSTATE CANCER
Chances for survival from prostate cancer are
dependent on many different factors. Obviously, early diagnosis is the best
case scenario. Nip it when it is still in State I or Stage II with a Gleason
Score of less than seven and you are looking at optimum results using any of the
three treatment options we’ve discussed: Watchful Waiting, Surgery or Radiation
Therapy.
For a man who is over 70 there is a strong
possibility that he might die of other natural causes rather than prostate
cancer. The fact is that many men with localized Stage I or II prostate cancer
ARE much more likely to die of something other than the cancer itself.
If a man with localized prostate cancer
decides to take the Watchful Waiting treatment option, there is a 19% chance of
metastases developing in his next 10 years
For men with Stage III prostate cancer, the
prognosis is 50-50 that the cancer will progress in the next 10 years and result
in death.
Stage IV prostate cancer is called metastatic
prostate cancer and the most widely used treatment is hormonal which might stave
off the disease for another two to three years. The likelihood of fatality
within 10 years is very high.
NATURAL TREATMENT OPTIONS FOR BPH
It may seem as though we have come full
circle, but even if your diagnosis leaves you free of prostate cancer, you may
still have Benign Prostate Hypertrophy. Rather than using hormonal or alpha
blockers, many men have opted for a natural approach to avoid some of the
unpleasant side effects of the drug therapy.
The two prescription drugs, inasteride
(Proscar) and terazosin (Hytrin) make lots of money for drug companies because
they are the only two approved by the FDA to prevent prostatic proliferation
(the growth of new prostate cells that cause BPH in men over 50).
Before beginning an exploration of natural
treatment options, it must be perfectly understood that there is no substitute
for your physician. These options are presented as just that... options and
you should consult your physician before undertaking any new treatment options
whether medical or homeopathic.
First we will look at 7 different therapy
options. These options are Ayurveda, Reflexology, Food Therapy, Imagery,
Hydrotherapy, Vitamin and Mineral Therapy and Yoga. We present you with a brief
synopsis of each therapy as it relates to prostate problems.
Ayurveda
The Ayurvedic approach to all disease is to
first make certain that you have received an appropriate diagnosis from a
medical professional.
If the prostate diagnosis is benign the
"flowing" approach can be used. Mix the following herbal powders: Punarnava,
Gokshura and Shilajit. Ingest just 1/4 teaspoon a day either dry or added to
warm water. An alternative is to drink any one of horsetail, ginseng or
hibiscus tea, consuming as much as you wish each day. All of these herbs should
be available at your health food store or by mail order.
Reflexology
Reflexology is the pratice of directing
energy toward specific pressure points in the body. Reflexology sessions begin
with relaxing the total body then shifting the focus of the reflex to those
areas of greatest need. For our purposes that would be the prostate, endocrine,
pituitary, parathyroid, thyroid and adrenal glands as well as the pancreas with
the reflex in the hands or feet. You can find reflexology charts that give you
the reflex points at most health food stores or schedule a session with a
professional reflexologist.
Food Therapy
The key to affecting positive change in the
prostate by eating specific foods is including any foods high in zinc. The
properties in zinc have been proven beneficial in shrinking an enlarged
prostate. Take a daily supplement of zinc. In addition to a low-fat diet,
particularly avoiding saturated fats, consider adding one or two tablespoons per
day of flaxseed oil to your diet as well as pumpkin and sunflower seeds, both
know for their high content of zinc.
Imagery
Imagery is closely associated to hypnosis,
both practices incorporating positive visualization techniques to effect
positive changes. Here is one exercise proven beneficial for our purposes
here:
Close your eyes; breathe out three times and
imagine entering your body through any opening you choose. Find your prostate
and examine it from every angle. Next, envision putting a thin golden net
around the gland. This net has a drawstring that you can tighten. Cinch the
drawstring so that the net is wrapped snugly around the prostate. As you do
this, picture the prostate shrinking to its normal size. Then imagine using
your other hand to massage your prostate. Sense that urine can now flow evenly
and smoothly.
The recommendation for this exercise is to
practice it twice a day, three to five minutes per session for six cycles of 21
days on and 7 days off.
Hydrotherapy
A hot sitz bath comes highly recommended for
the treatment of an inflamed prostate. Sit down in a tub filled with
comfortably hot water to a depth of your navel. Soak for twenty to forty-five
minutes and follow with a cold bath or shower. This treatment should be done
once a day for thirty days or until the symptoms are gone.
Vitamin and Mineral Therapy
The ideal vitamin and mineral treatment for
prostate problems incorporates herbal medicine. The following regimen is
recommended to help control symptoms:
- 400 international units of Vitamin E per day
- 30 milligrams of zinc twice a day
- 1 milligram of copper twice a day
- One tablespoon of flaxseed oil a day
- 160 milligrams of saw palmetto twice a day
Flaxseed oil and saw palmetto are easily
obtainable in any health food store.
Yoga
Certain Yoga poses can increase blood flow to
the groin, thereby relieving certain prostate problems. You can find books on
Yoga that include these poses, as well as many others, at any herbal or
homeopathic store. The two poses that will benefit prostate problems are the
"knee squeeze" and the "seated sun" along with the "stomach lock." To do the
"stomach lock," lie on your back and take a deep breath. Breathe out until all
air is expelled from your lungs, then pull in hard on your buttocks, groin and
stomach muscles. Hold this pose for a count of three then release the muscles.
It is recommended that this session is repeated two or three times a day, three
times a session to help prevent prostate trouble.
You should not use this yoga pose if you
suffer from high blood pressure, hiatal hernia, ulcers or heart disease.
More Natural Treatments
Pumpkin Seeds
Not enough can be said about the healing
power of pumpkin seeds! It seems hard to believe, doesn’t it? Why do these
little seeds have such a profound effect on prostate problems?
Did you know that pumpkin seeds contain fatty
oil that is a natural diuretic? The medical community scoffs at the idea that
increased urine flow may have anything to do with an increase in urine flow.
However, in addition to being a natural diuretic, these seeds contain as much as
eight milligrams of zinc equivalent to a half cup per serving!
Some doctors recommend taking 60 milligrams
of zinc each day as part of the regimen to combat BPH! However, make certain
you are in contact with your regular physician because this amount is way more
than the daily value.
The point is studies have proven that zinc
reduces the size of an enlarged prostate.
Those little pumpkin seeds are high in the
amino acids: alanine, glycine and glutamic acid.
According to recent study men who were taking
the supplements of these amino acids with a dose of 200 milligrams each day, BPH
symptoms showed significant relief.
Saw Palmetto
Did you know that after Proscar was approved
by the FDA, that agency banned all nonprescription drugs for BPH? According to
Varro Tyler, Ph.D., dean and professor emeritus of pharmacognosy (natural
product pharmacy) at Purdue University in West Lafayette, Indiana, the ban was
initiated for two reasons. First, the FDA purported that there was no credible
evidence to show that any over the counter (OTC) products were effective in the
treatment of BPH. Second, the agency also expressed a viewpoint that those who
used OTCs might put off getting proper treatment while their disease worsened.
“What the FDA overlooked,” says Dr. Tyler,
“was the considerable evidence in Western Europe that certain phytomedicinals
(plant based medicines) are effective in treating BPH and that people using them
experience an appreciable increase in their comfort level. Perhaps the most
popular of these is saw palmetto. The beneficial effects include increased
urinary flow, reduced residual urine and decreased frequency of urination.”
Saw palmetto can be found in southeastern
states. It is a small palm tree. The Seminole Indians ate the seeds as food.
Who knows? Maybe they found it helped their urinary problems.
The reason it works is because it contains a
compound that turns testosterone into dihydrotestosterone thus preventing the
transformation of the testosterone. It is exactly the same way that Proscar
works, but in a different way.
Half a dozen studies have proven saw palmetto
as an effective treatment. In one of them, a clinical trial of more than 2000
German men with BPH received substantial easing of PBH symptoms after a daily
does of one to two grams of saw palmetto seeds.
It is interesting to note, Science News
reports, “30% of all American men have undiagnosed prostate cancer by age 60-but
the incidence is only about 1% among Arctic Intuit men of the same age group.”
It is believed that this is a result of a diet high in fish oil. This may be
something to consider in your own diet.
SEX AFTER PROSTATE DIAGNOSIS
There is no way to sugar coat it. If you are
diagnosed with any form of prostate disease you will experience some type of
erectile dysfunction, even if it is a surgical procedure using the nerve sparing
technique.
There is no need to repeat the treatments
we’ve already covered, but let’s take a moment to review some of the
possibilities that are available to men AFTER being diagnosed with prostate
disease who experience erectile dysfunction:
·
There are now numerous erectile dysfunction
drugs (EDDs) available. These drugs promote erections by increasing blood flow
to the penis.
·
There is a substance called Prostaglandin E1
that can produce erections. It is produced naturally and can be injected almost
painlessly into the base of the penis before sex.
·
A penile implant or prostheses can restore an
ability to achieve an erection.
·
There are vacuum devices that are designed
especially to create an erection by placing around the entire penis before sex.
While erectile dysfunction will most likely
begin immediately following surgery for prostate removal, if the technique of
nerve sparing is used there is a possibility of recovery within a year of the
procedure. If non-nerve sparing is used the recovery from erectile function is
highly unlikely.
There are studies that report sparing nerves
on both sides of a prostate have regained erectile function in 60 – 70% of men.
Also, erectile dysfunction drugs appear to work for up to 43% of men whose
prostate was removed surgically. This shows a promising trend.
There is some difference when radiation
therapy is used. The man will also experience erectile dysfunction but it
usually doesn’t happen until six months after beginning treatment. However,
there is also good news here showing that as many as 50-60% of men regain
erections with the use of EDDs.
When hormonal treatment is the route taken,
erectile dysfunction will usually occur between two and four weeks after
beginning treatment and is linked with decreasing sexual desire. Unfortunately
the studies do not show the same results as the previous two treatments having
little or no impact on erectile dysfunction. The good news, however, is that
normal erectile function returns when the hormonal therapy is ended.
CONCLUSION
Whatever type of prostate
disease you experience, it need not be an immediate death sentence. Every day
new strides are being made in the detection and treatment of prostate ailments.
More important than the
prostate gland is the other organ that can control your prognosis. It’s the one
that fills the space between your ears.
No matter how dark the day may
appear, there is always another chance to experience a brighter day tomorrow.
Avoid too many idle hours.
Develop a positive mental
attitude and outlook. Your mind is powerful medicine when used appropriately.
Fill your days with healthy
food, happy people, good friends and family.
Use the natural therapy
technique of Imagery and see yourself alive, well, whole and enjoying everything
this world has to provide. You are more than a diseased prostate!
References
(Natural Treatment Options):
-"Natural Prescriptions", by
Robert M. Giller, M.D. and Kathy Matthews
You can obtain information about clinical
trials from:
The National Cancer Institute at:
http://www.cancer.gov/clinicaltrials
Other resources:
National Centers for Disease Control and
Prevention's (CDC's) – Online at
http://www.cdc.gov/
Contact them offline, too, for more
information at:
CDC/DCPC
4770 Buford Hwy, NE
MS K64, Atlanta, GA
30341
Toll-free information
line: 1-888-842-6355
FAX: 1-770-488-4760
E-mail
cancerinfo@cdc.gov
U. S. Department of Health and Human Services
–
The U. S. Food and Drug Administration will
give you information about “natural therapies as well as the stringent
guidelines that drug companies must follow in order to certify a drug and earn
FDA approval. Contact them at: http://fda.gov/
Food and Drug
Administration
5600 Fishers Lane
Rockville, Maryland
20857
1-888-INFO-FDA
(1-888-463-6332)
*********
DISCLAIMER: This information is not
presented as being from a medical practitioner and is for educational and
informational purposes only. The content is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. Always seek the advice of
your physician or other qualified health provider with any questions you may
have regarding a medical condition. Never disregard professional medical advice
or delay in seeking it because of something you have read.
Since natural and/or dietary supplements are not
FDA approved they must be accompanied by a two-part disclaimer on the product
label: that the statement has not been evaluated by FDA and that the product is
not intended to "diagnose, treat, cure or prevent any disease."
*********
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