What is the prostate?

The prostate is a gland situated between the pubic bone and the rectum and around the urethra, the tube passing from the bladder to the penis. Its function is connected with the whole urine and reproductive system. The tubes of the reproductive system through which the sperm pass, meet the urethra in the prostate. The prostate gland contracts at orgasm to fire out the sperm. In a boy the gland is the size of a pea, growing at puberty to the size of a small to medium plum. However, in the Western world it seems to grow again in men in their late forties and here lies the problem.

Many, many men have an enlarged prostate. Mostly it is benign, but in some cases it does become malignant. Even then there may be no distress for ten or more years.

The symptoms of either form are very much the same and are principally the symptoms of the enlargement.

How many cases are there

The current official figure for "lifetime risk" among men is one in thirteen. Last year there were approximately 20,000 cases.

However, the figures are confused by the issue of non-malignant prostate growth. Men in their seventies and eighties will almost definitely have a greatly enlarged prostate, and it has been estimated that at least one in three of these will be cancerous. 95% of the cancers are in men over 60. One study in the USA concluded that 40% of men over the age of 50, who had died of other causes, were also shown to have prostate cancer in autopsies!

What are the symptoms?

The UK charity "The Prostate Cancer Charity" defines them as:

Difficulty or pain when passing urine.
The need to pass urine more often.
Broken sleep due to the need to pass urine.
Waiting for long periods before the urine flows.
The feeling that the bladder has not completely emptied.
Almost all of these symptoms are shared with the non-malignant growth form (termed Benign Prostatic Hyperplasia).

With prostate cancer you may also suffer from blood in the urine, and/or lower back pain and/or dribbling. Be aware that many of the above symptoms can be caused by other factors e.g. bacterial infection.

How can I check?

Firstly your doctor can simply feel if you have an enlarged prostate (a Digital Rectal Examination). If he finds such an enlargement he will probably send you for a PSA test (prostate-specific antigen). This measures a specific protein in a man's blood, the level of which was thought to correlate with prostate cancer.

However, this test has been found to be flawed. In one research study factors found in the blood from high dairy consumption, increased PSA levels. Vigorous exercise, or riding a bicycle, can also increase PSA levels.

Indeed, the test does not seem able to fully distinguish between enlarged malignant prostates and nonmalignant ones, and one USA report concluded that as many as two thirds of those testing positive, probably are not!

But there's another problem. Even if the tumour is cancerous, to date there is no way of telling how aggressive the growth will be. The problem is that some men with small, yet rapidly growing cancers have not been spotted in time. Others with enlarged and malignant prostates may have had slow growth for ten years or more, with no spread to other tissues. New tests, reported in September's Icon, attempt to measure the levels in the blood of an enzyme only produced in cancer cells.

If all proves positive, the specialist may recommend a biopsy to fully confirm the cancer. Beware; and ask for evidence of the risks. Tissue is taken using a fine needle from ten or more places in the prostate. It leaves many patients in pain for quite a long period, can result in infection (since the needle passes through the rectum which is full of nasty bacteria) and even incontinence and impotency. And that's just from the biopsy!

If the specialist feels the cancer may have spread, he may also suggest a CT scan, an MRI scan or a bone scan. Although these are all different they can provide accurate pictures of the extent of the cancer. There are studies currently being undertaken about such scans to see if they themselves cause cancer!

It's a mess!

Well, yes this is a real problem. Many people may only have non-malignant but enlarged prostates, whilst others may have very slow growing cancers, which could continue for ten or fifteen years before any treatment is really needed. There is a serious need to fund prostate cancer properly and sort this out, because the treatment of prostate cancer is something no man wants to go through unless it is essential. But more of that later.

What causes it?

There is no definite evidence although Western diet seems the most likely culprit; indeed it may be a combination of factors.

Prostate cancer does run in families, and men who have a father or brother with the disease have a five to twenty fold increased risk, depending upon which study you read.

Men in the Far East (Japan, Thailand, South East Asia) have the lowest incidence, but this changes if they move to the West. Black people have a higher incidence than whites or Asians.

There was a Scandinavian report linking the volume of dairy consumption to the level of risk of prostate. High dairy consumption increased risk by 50%. Another report suggested the herpes virus might play a part. There is also a general view that too much red meat consumption doesn't help.

No one really knows, but it definitely seems connected to Western lifestyle and diet.

How can I protect myself?

Beta-carotene, vitamin A, and especially selenium and vitamin F each seem to reduce the risk of prostate cancer. Our vegetables are becoming poorer sources of Vitamin E all the time, so it is wise to supplement as well as eating large quantities of fresh and steamed vegetables.

In a USA test amongst people deficient in Vitamin E, a S0mgm daily supplement reduced prostate cancer by 20%. The UK diet is often poor in selenium, so supplementation is essential. In other USA tests, levels of 200 micrograms per day for five years cut prostate cancer by 50%.

Zinc is important. The prostate seems to store zinc and zinc is an active participant in maximising the effect of several antioxidants.

Lycopene is the much talked about antioxidant where prostates are concerned. It actually binds to fats and lipids in the blood stream helping overcome our Western diets. One study stated that seven to ten helpings of tomatoes per week reduced risks by 40%; another suggested that 40% of prostate cancer sufferers eating those quantities showed relief of symptoms. Whatever the study, Lycopene is a strong antioxidant and can be obtained from all tomato products e.g. sauces, soups and especially cooked tomatoes.

Vitamin D is present in small quantities in our food. It has been proven to significantly reduce the incidence of prostate cancer. Vitamin D is however very susceptible to the effects of protein and calcium both of which stop its action. Perhaps here lies the connection to the Western diet and its high levels of protein and dairy.

Vegetarians do get far less prostate cancer, and one report stated that consuming two glasses of soya milk per day also cut the risk by 40%. Prostate cancer is hormonally driven, and meats and dairy will also influence natural hormone levels.

Finally a combination of rather odd ingredients has been reported to have an effect. Several prostate cancer books recommend that sufferers of enlarged prostates take:

saw palmetto oil (about 3SOmgs)
panax ginseng (about 3-Sings)
pygeum bark (about 1 Oomgs)
A few years ago, an importer in California brought in a Chinese Herb mix, which he named PCSPES. Word of mouth grew and grew. PC-SPES relieved pain and symptoms of those with prostate cancer, especially advanced cancer.

Researchers from California to the Czech Republic however, recently found that apart from the eight natural herbal ingredients, the mix also contained DES (a synthetic oestrogen), indomethacin (an anti-inflammatory drug) and warfarin (an anticoagulant). Apparently, pre 1999, along with the saw palmetto, ginseng, chrysanthemum, liquorice, etc., the Chinese had been adding the three compounds before shipment, and latterly just the warfarin.

Doctors had been using PS-SPES with great success but noticed side effects like breast enlargement (typical of taking oestrogen). When some people had blood clots and bleeding problems, investigations started. The doctor behind these tests, Dr Nagourney of Long Beach, California, believes PC-SPES is now dead and he is turning to DES. One wonders why they can't ask the Chinese to provide pure PC-SPES and test that; would it have worked without the DES? In Europe, there is a herbal product called Prostasol with many of the same ingredients but no results to date.

What are the treatments?

I've left the worse until last; the squeamish should not read on.

If you need treatment the specialists will recommend a combination of surgery, radiotherapy and hormone treatment. If the cancer has spread they may recommend chemotherapy.

Surgery

One method, mainly with benign tumours, takes place using microsurgery through the penis, down the urethra. When the tumour is malignant, specialists prefer to go through the abdomen often removing the prostate, the seminal vesicles and the pelvic lymph nodes. This route allows the specialist to see how far the disease has spread. This is major surgery, and as patients tend to be older it is risky, with the chances of complications growing as you age. After surgery there is a 70% risk of impotence and a 5% risk of incontinence.

In 1998 The Lancet reported that it was possible the operation itself spread the cancer. All operations involving anaesthetic deplete the immune system, weakening the body in its fight to neutralise possible secondaries as they move through the blood and lymph.

Radiotherapy

There are two types of radiotherapy. External radiotherapy requires six weeks of treatment, doesn't hurt but kills all fast reproducing cells in its line of fire. It is commonly used for men over 70. Diarrhoea and cystitis are common side effects, there is possible damage to the bladder and rectum, incontinence and 20-30% of men report impotence.

Brachytherapy involves implanting "radiation" seeds into the prostate; this 2-day treatment is more localised, and can cause a burning sensation on urination, It is growing in support in the USA, but the UK has few centres. Long term issues have not yet been noted.

Hormone Treatment

This method is often used as prostate cancer is hormonally driven and testosterone makes the prostate grow. It is mostly used if the cancer is advanced and spreading to other tissues. It is usually prescribed indefinitely.
Injections may be given to block testosterone production, or tablets to neutralise the hormone; an operation may be recommended to remove the testes; or oestrogen tablets may be recommended to balance the testosterone.

All forms of hormone treatment have the same side effects. Impotence, loss of sex drive, hot flushes, even breast swelling and osteoporosis.

The final Word

If you've read this far, you will have realised prevention is better (far, far better) than cure! Start by taking a serious look at your diet; you may cut red meat and dairy; you may eat far more vegetables and soya; you may cut down on protein and take supplements. If prostate cancer runs in your family you should definitely take all possible steps.

Shyness is a big problem. If women find a lump in their breast they don't hesitate to go to the doctor. But men feel talking about the prostate is embarrassing, and so tend to avoid a visit to the doctor until it may be too late.
Under-funding is another result of this shyness. Men should be shouting about prostate cancer more than women do about breast cancer. Although the UK Government has increased funding to £4 million plus, it is woefully short of the near £40 million put into breast cancer research from the government and via breast cancer charities. The biggest UK prostate charity was only founded in 1996.

The small budget is, however, starting to work. Already new treatments like cryosurgery (freezing the prostate to kill cancer cells) or building viruses that attach the cancer cells and leave the healthy ones alone, are being developed.

But the fact is we have one of the worst survival rates in Europe. Unless new and successful treatments are developed, the poor diagnostic techniques, the horrendous nature of the current treatments with their side effects and the lack of an understanding of the real cause, make having no treatment a real option. This is not merely the view of Icon, it is in the charities' web pages as one of their options!

Meanwhile the final word is simple. PREVENT.