Prostate Cancer is a very dangerous disease that until recently did not get nearly the attention it deserved. This is a slow growing tumor at its onset, and its metastitic potential is related to the size degree of differentiation. At the time of diagnosis though most patients have advanced disease. One comparison often made is that this deadly disease is to men what breast cancer is to women. The only difference is that women came out and made breast cancer an issue to be dealt with, while men have held back in embarrassment from discussing prostate cancer issues. Men are embarrassed of this disease for multiple reasons. One reason is that the examination is rather awkward. As Siberner explains, In order to assess whether or not someone has prostate cancer the patient must either kneel, lie on his side, or bend over and the doctor then inserts a gloved finger into the rectum. The doctor presses through the rectal wall against the prostate, feeling for the soft, bulky growth of an enlarged prostate or the small, hard lump of a cancerous tumor (1989). Although this process sounds degrading and uncomfortable it is really simple, quick, and hardly deserving of the dread it seems to produce. And believe it or not it is certainly faster and less uncomfortable than a gynecological exam. The second reason men are so uneasy about discussing prostate cancer is the side affects that can result from surgery or radiation. Many times men are left impotent and without control of their bladders. Most men are not only shying away from discussing this topic, but they are also shying away from receiving the examination all together. According to Siberner, only 208 of 1,017 men in a recent survey by the National Cancer Care Foundation, a nonprofit support group for people with cancer, had had both a physical and a rectal exam during the previous year. These conditions are extremely uncomfortable for men to face and discuss, but if anything is going to be done men need to lay this issue out on the table.
Prognosis for prostate cancer is not very good right now, especially if it not caught at an early stage. The reason for this is because this malignancy spreads so rapidly to nearby organs such as the bladder and rectum. The cancer then invades the lymph and blood vessels and metastasizes to the bone and other organs. This quick spreading is why prostate cancer is the second leading cause of cancer deaths among men in the United States, according to Littrup, Lee, and Mettlin (1992). In fact, roughly 1 man in 11 will get cancer of the prostate and 20 percent of its victims are 65 or younger. This dispels the myth that only older men get prostate cancer says Siberner (1989). As stated earlier, if caught early though there is a good chance it can be stopped and removed before it metastasizes. Hines declares that due to widespread screening with prostate-specific antigen there is more cases of local cancer being diagnosed in men in their 40s and 50s, often before the tumor is palpable (1999). The three main treatments for prostate cancer at this early stage are surgery, radiation, and watchful waiting. Surgery requires going into the prostate and removing the cancerous tumor. The main problem with this method is that during surgery the removal of the tumor usually results in the destruction of the nerves that control erections and urination, leaving most men impotent and many incontinent. The second treatment is radiation. There are two types of radiation treatment being used today. One type is external beam; this method requires the patient to go to the hospital for high-energy linear radiation treatments for 5 day a week treatments for 6 to 7 weeks. This usually can effectively wipe out the cancer for many. It is for the most part painless, yet it can irritate the bladder and make urination difficult. It can also cause diarrhea and intestinal ulcers, which eventually do clear up. One advantage of this type of radiation though is that it does not cause hair loss like many other types of radiation. Another type of radiation is brachytherapy. With this type of radiation a source of radiation is implanted into the prostate and in direct contact with the tumor. This is much more convenient than external beam treatments because it requires only a one-time visit to the hospital for an outpatient surgery to make the implementation. Finally, the third type of treatment is watchful waiting, or in other words, not doing anything. Just simply going to the doctor and getting frequent check-ups to make sure the cancer isnt getting any worse. Older men who do not feel that they long to live anyway and dont feel they are up to going through surgery prefer this treatment. Many physicians lately have been recommending this method even though it has been under extreme scrutiny. Lu-Yao, McLerran, Wasson, and Wennberg believe that the watchful waiting fails to demonstrate that it is more effective then active treatment, such as radiation and surgery. They claim that all information collected before on this subject neglected to take into account the whole spectrum of prostate cancer patients, it instead over represented patients most likely to die of other causes (1993).
The causes of prostate cancer are still not totally determined. The experts do have some idea of the causes though. Both genetic and environmental factors have shown to play some part in determining who is more susceptible to developing a cancerous tumor in the prostate. To be more specific, Starr tells us that there are 2 groups of men who have emerged as prominent high-risk populations: those with positive family history of prostate cancer and those of African American descent (1998). The significance of a positive family history has been firmly documented. While it is accepted that African American heritage is a significant prostate cancer risk factor, there is considerable debate regarding the explanation for this observation. Starr goes on to explain that in a study done to track whether or not family history played a role in contracting prostate cancer, men with an affected first-degree relative (brother or father) were found to have twice the risk of contracting the disease themselves (1998). The other factor that has been found to determine who obtains prostate cancer, racial descent, is really quite puzzling. Men of Asian descent, for example, have a very low incidence of prostate cancer and a low mortality rate, while African American men have the highest incidence and mortality from prostate cancer in the world. Starr tends to believe that although the explanation is bound to be multifactorial, a central point of debate is whether socioeconomic status or true biological differences are responsible for most of the disparity (1998).
When found prostate cancer falls into one of four stages. Siberner describes these stages as stage A, stage B, stage C, and stage D. In stage A a rectal exam does not reveal the presence of cancer, but cancerous cells are found in tissue removed when an enlarged prostate is surgically reduced. Most deaths of these patients are unrelated to prostrate cancer. Proportion of men alive after five years, with treatment is 77 percent. In stage B a cancerous tumor can be felt in a rectal exam, but has not spread beyond the prostate. Proportion of men alive after five years, with treatment is 65 percent. In stage C the cancer has spread, but just to the area around the prostate. Proportion of men alive after five years, with treatment is 48 percent. Finally in stage D, the cancer has spread to the lymph nodes or to other parts of the body. Proportion of men alive after five years, with treatment is 21 percent (1989).
Prostate Cancer is not just simply found in one spot in the prostate. Many times it is undetectable at its onset because of its location in the prostate. Littrup, Lee, and Mettlin tell us that 70 percent of prostate cancers arise in the periphera zone of the prostate; 20 percent, in the transitional zone; and 10 percent in the central zone. Up to 40 percent of cancers may arise anterior to the midline of the prostate and are therefore out of reach of the examining finger (1992). This causes the survival rate of the patient to drop drastically because it allows the tumor to grow undetected, and the larger the tumor the less chance someone has to live.
There have been many new advances in the field of prostate cancer research. Some of these new technologies are prostate-specific antigen, Digital rectal examination, and transrectal ultrasound. With these new developments doctors are hoping to provide a more cost-effective treatment of prostate cancer. In fact, they are hoping to be more effective on a per-cancer-diagnosed basis than is screening for either breast or cervical cancer. Littrup, Lee, and Mettlin say that many of these new technologies by themselves arent going to do much in terms of stopping prostate cancer, yet when combined they provide a powerful weapon in the fight of helping to find a cure (1992). The only true cure for prostate cancer now is public awareness. Because there are very few warning signs of prostate cancer in its early stages men are in disbelief that anything could be wrong with them. By informing the public about this silent disease hopefully men will get the point that they need to start getting regular rectal exams. With these exams we will be able to catch more prostate cancer cases at earlier stages and then be able to help men get rid of the tumor before it metastasizes. One of the most dangerous things Ive heard a man say is, if it aint broke, dont fix it, says Peter Weaver, a 63-year-old whose prostate cancer was diagnosed after an annual physical in late 1987. You dont know if its broke unless you check it.
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