An Examination of Prostate Cancer
Running head: PROSTATE CANCER
An Examination of Prostate Cancer
Matthew Kelly
Red River College
Table of Contents
Prostate Cancer..................................................................................................4
Symptoms.......................................................................................................5
Diagnosis.........................................................................................................6
Treatment.......................................................................................................7
Prevention.......................................................................................................9
Conclusion................................................................................................... 11
References.....................................................................................................12
Biblography...................................................................................................13
Abstract
Prostate cancer is an escalating concern for men in society. This form of cancer is a complex disease that affects three out of ten men in their thirties and forties. Pain, erectile dysfunction, incontinence and weight loss are only some of the issues that men with prostate cancer and their families must deal with on a daily basis. The etiology of prostate cancer is still unknown, but some of the risk factors include age, race, sexual activity levels and diet. Preventive measures are important for men and their families to make themselves aware of as there are risk variables that they can control. There are currently several treatment options available to men suffering with prostate cancer such as monitoring, radiation, surgery and hormones.
An Examination of Prostate Cancer
Prostate cancer is the most common malignancy in men and fourth leading cause of cancer death amongst the male population worldwide (Landis & Retal, 1998). Parkin, Feraly, Raymond, and Young (cited in Crowe & Costello, 2003). Stated that prostate cancer is also the most common type of cancer diagnosed in males in the western world and the second leading cause of male deaths worldwide associated with cancer. The early warning signs of malignant prostate cancer are often difficult to differentiate from benign prostate enlargement (Boswick, MacLennan, & Larson, (1996). However, some of the early warning signs include "difficulty or pain passing urine; needing to pass urine more often; weight loss; soreness in their bones or pelvis; and/or blood in their urine or semen" ("Conditions", 2002, p.9). If a male is presenting with these symptoms it is recommended that he be tested for prostate cancer. Currently, there are several tests that physicians can use to detect the presence of an enlarged prostate. The most common tests are a digital exam, a prostate-specific antigen test, biopsy and transrectal ultrasound (Boswick, MacLennan, and Larson, 1996).
The symptoms and diagnosis of prostate cancer are only the beginning stages of most men's journey through the experience of dealing with prostate cancer. The treatment of prostate cancer is often the most difficult and painful for patients and their families. This stage of their experience is not uncomplicated due to the hugely debated position on best practice for early stage prostate cancer. To date, there are three options for doctors when treating prostate cancer. These options are monitoring, radio therapy and prostate removal, also known as radical prostectomy ("Conditions," 2002). After a formal diagnosis of prostate cancer, it is important for patients and their partners to be prepared for the side effects of treatment. As well they need to be educated on the preventative measures that they can engage in to decrease their risk of the cancer returning. This paper will explore and discuss the symptoms, diagnosis, treatment and prevention that surround prostate cancer.
Symptoms
The prostate is a sex gland only found in men that has several different functions. The prostate is part of the urinary and reproductive systems (also known as the urogenital system). It also produces prostatic fluid and acts as a valve that allows sperm and urine to travel in the correct direction out of the urethra. The prostate is not a vital organ but if given the choice, most men do not want it removed due to the possibility of erectile complications (Boswick, et al., 1996).
Calabrese (2004) stated that the early stages of ...
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Symptoms
The prostate is a sex gland only found in men that has several different functions. The prostate is part of the urinary and reproductive systems (also known as the urogenital system). It also produces prostatic fluid and acts as a valve that allows sperm and urine to travel in the correct direction out of the urethra. The prostate is not a vital organ but if given the choice, most men do not want it removed due to the possibility of erectile complications (Boswick, et al., 1996).
Calabrese (2004) stated that the early stages of prostate cancer could have no symptoms at all and easily go undetected without regular tests. The symptoms of early stage prostate cancer can mirror other explainable conditions that are no cause for alarm such as frequent urination, hesitancy in urination and/or pain in the abdominal area. In the later stages, some men may have pain while urinating, blood in their urine, pain in their back or weight loss Calbrese (2004).
The article called Condition (2002) stated in most men, prostate cancer has few or no symptoms until it becomes well advanced. The lack of symptoms being present in the early stages is one of the main reasons that prostate cancer goes undetected in so many men. Another factor of prostate cancer not being diagnosed in the early stages is that "there is no single test that accurately diagnoses early prostate cancer, and there is no national screening process" ("Conditions, 2002, p. 9).
One significant area to examine when reviewing symptoms is age. Although age is not a specific symptom, it is an important risk factor for prostate cancer. A common and dangerous myth that has long been associated with prostate cancer is that only old men suffer from this disease. This myth is dangerous for two reasons. One being that it implies that medical resources and research money should not be wasted on older men. Secondly and more importantly, it is not true. Medical doctors and researchers now know that prostate cancer can and does effect younger men. Research has shown that up to 30% of men in their thirties and forties, have signs of pre-cancer or already have cancer in their prostate (Boswick et al., 1996).
Diagnosis
After men have experienced symptoms and sought out medical advice, the next stage in their journey of dealing with prostate cancer is the diagnosis. To date, there are several tests that physicians can use to diagnosis prostate cancer. One of the first examinations is a digital exam. This examination is done by the insertion of a finger in the anus to feel for an enlarged prostate ("Conditions," 2002). However, other tests should be taken before prostate cancer is formally diagnosed.
One of the most common tests used after the digital exam is the controversial prostate-specific antigen (PSA) blood test. This test is used to measure the levels of a protein associated with prostate cancer. If higher levels of protein are present, it is more likely that the patient is suffering from prostate cancer ("Conditions," 2002). Physicians in the United States regularly test men over the age of 45 with this type of test to diagnose prostate cancer. In the United States ,this test is regularly used for men aged over 45 ("Conditions," 2002). The PSA has had much controversy associated with the test due to proponents feeling that the screening does not change outcomes for cancer patients. As well as, the belief that the tests cause unnecessary emotional stress and financial burdens that are not cost effective or necessary (Calabrese, 2004). However, Dimah and Dimah (2003) wrote that after reviewing all the current literature on diagnostic tests associated with prostate cancer, the PSA is the least invasive and most valuable manner in which physicians can diagnose prostate cancer.
Another test commonly used and one of the most reliable ways in which doctors can achieve proper diagnosis of prostate cancer is through having a small tissue sample removed for analysis, more commonly known as a biopsy. This is usually achieved by inserting a needle through the anus or behind the testicles ("Conditions," 2002). Calabrese (2004) stated,that "Most prostate biopsies are completed because the patient has a rising prostate specific antigen (PSA) level in the blood" (p. 259)". If patients are presenting with higher levels of PSA and have had a digital exam, it is likely that their doctor will recommend a biopsy. Once the biopsy has been completed and comes back positive, the tissue is analyzed for the "two most commonly occurring patterns (grades) of tumor in the biopsy tissue and the pathologist adds those numbers together to give the cancer Gleason score" (Calabrese, 2004, p. 260)." The Gleason score gives the pathologist an assessment of how aggressive and fast growing the cancer is as well as how likely the cancer is to spread to other parts of the body (Donohue, 2004).
Other diagnostic techniques that are used to assess where the cancer has spread to and how aggressive the cancer is presenting are CT scans or computerized tomography, bone scans, magnetic resonance imaging (MRI), Intravenous pyelogram (IVP), and cystoscopy (Boswick et al., 1996).
Treatment
After men have received a clear and formal diagnosis of prostate cancer , the next stage in their journey is to decide with their physician a treatment plan. In looking at treatment plans, the best approach for early stage prostate cancer has been a debate because doctors do not know if the cancer will grow fast and be dangerous, or grow slowly and cause basically no trouble ("conditions," 2002). Currently, there are many options to treating prostate cancer. However, some of the more popular and widespread used treatments are monitoring, radio therapy and prostate removal also known as radical prostectomy ("Conditions," 2002). If monitoring prostate cancer, is the least invasive manner in which to treat the cancer then it may be the best choice and should not be considered a passive approach to dealing with prostate cancer. This manner of treatment is sometimes referred to as "watchful waiting", which often involves having frequent blood tests and examinations (Boswick et al., 1996).
The next option is radiotherapy. This type of treatment can cure the cancer but there is a higher risk of side effects and is much more invasive then monitoring. Radiotherapy, also known as radiation therapy, has shown to be associated with risks such as impotence and damage to the bladder and rectum ("Conditions," 2002). Galbraith et al(2005) also wrote, "external beam radiation (EBR) treatment for prostate cancer can cause injury to the pelvic bed and neurovasular bundle, which can produce erectile dysfunction in 6%-84% of patients" (p. E31). However, there are several positive factors associated with this type of prostate cancer treatment Such as, no surgical risks (bleeding, pain and hospitalization), fewer restrictions on work and on people's activity levels with radiation therapy, lower risk of impotence than surgery, lower risk of incontinence, advantages to men who are in poorer overall health, control pain and other local symptoms of prostate cancer (Boswick et al., 1996).
A more invasive, yet sometimes more effective manner in which to treat prostate cancer is by surgery. This type of surgery is known as prostate removal or radical prostatectomy. There are three different manners in which this surgery can be performed. The three types of radical surgery are retropubic prostatectomy which is an incision of the lower abdomen; nerve sparing radical prostatectomy which uses the same incision as the retropubic but with the intent to spare the structures and nerves responsible for erections, radical perineal prostatectomy which entails an incision in the perineal area and is recommended for men with heart or lung conditions due to surgery being less time consuming than nerve sparing radical prostatectomy (Boswick et al., 1996).
Prostate removal is common and many doctors find that this option is better than sitting and waiting. However, having this surgery has a higher risk of impotence and penile dysfunction than monitoring or radiation therapy ("Conditions," 2002). Galbraith et al. 2004) (cited in Debruyne & Beerlage, 2005) explained that "radical prostatectomy can produce impotency rates ranging from 20%-80%, even when nerve sparing procedures are used (p.E31)". Galbraith et al. (2005) further cited (Althof, 2003), "reports of sexual dysfunction following prostate cancer treatment range from 33%- 98% (p. E31). Many men and physicians elect to receive or perform this surgery, as there is professional help available to men suffering from erectile dysfunctions. Yet, it is important for patients to understand the implications of this surgery, pre and post operative, as well as, the effects that this surgery may have on their lifestyles.
Another common form of treatment available to men who have been diagnosed with prostate cancer is hormone therapy. This type of therapy may be included with, or used separate from some of the previously mentioned treatment plans. The most commonly used hormone treatment is "androgen deprivation therapy (ADT), either by orchiectomy or chronic administration of gonadotropin releasing hormone (GnRH) agonists" (Pril, Siegel, Goode, & Smith, 2002, p. 519). As with all other forms of prostate cancer treatment, ADT also has its side effects which range from regression of secondary sexual characteristic or feminization, erectile dysfunction, loss of libido, hot flashes, nausea, affect night vision, diarrhea and breast tenderness (Calabrese, 2004).
Risk Factors And Prevention
Many men and their significant others dealing with prostate cancer lack the knowledge and understanding that their treatment is not the end of their journey. It is important for people dealing with this form of cancer to understand some of the risk factors and prevention measures so that they may enable themselves to have the best quality of life possible and to reduce any controllable variables of the cancer returning.
However, some risk factors of prostate cancer are beyond the patient's control. One of these risk factors is age. Presti (cited in Calbrese, 2004) found that "a man aged 60 to 79 has a probability of 1 in 8 of being diagnosed with prostate cancer, a significant increase compared to younger men age of 40 to 59 who have a one out of 103 chance of getting prostate cancer" (p. 258).
Another factor that prostate cancer patients cannot control is their race.Calbrese(2004) wrote, "African American men are at an increased risk of getting prostate cancer although there is not a known reason for this phenomenon" (p. 258)". Other factors beyond a person's control that researchers have concluded increase men's risk of prostate cancer are family history and hormone levels (Boswick et all, 1996).
There are a number of risk factors that men and their loved ones can control and should be well informed of to decrease their risk of the cancer returning. Presti (cited in , 2004) wrote that diets, which are high in fat content, could raise a person's risk of prostate cancer. Cigarette smoking can also increase a person's risk along with alkaline and working in the welding industry although the latter is a weak risk factor. Some other risks that a person can control are environment, sexual behavior, and sun exposure (Boswick et al, 1996). Although there is nothing a man can do about the major known risk factors for prostate cancer, while looking at prevention, it is important to note that "researchers are investigating a number of chemical substances, including drugs and vitamins, that one day may be useful in the fight to prevent prostate cancer" (Boswick et al, 1996, p. 43.)
Conclusion
There are several stages to a person's journey while dealing with prostate cancer. While most people think of only the treatment stage at first, if they learn about all of the different stages to prostate cancer and all of the options available to them, they are much more likely to make informed decisions that will best suit their lifestyle's. Understanding the number of diverse stages of prostate cancer such as, symptoms, diagnosis, treatment and prevention are all pertinent and vital to dealing with prostate cancer effectively.
References
Bostwick, D. G, MacLennan, G. T., & Larson, T. R. (1996). Prostate cancer: What-
every man and his family need to know. NewYork: Random House.
Calabrese, D. A. (2004). Prostate cancer in older men. Urologic Nursing, 24(4), 258-268.
Conditions. (2002, November 22). Times (United Kingdom), p. 9. Retrieved March 19 2005, from Ebscohost.
Crowe, H., & Costello, A. (2003). Prostrate cancer: Perspectives on quality of life and
impact of treatment on patients and their partners. Journal of Urologic Nursing, 23(4), 279.
Dimah, K. P., & Dimah, A. (2003). Prostate cancer among African American men: A review of empirical literature. Journal of African American Studies, 1(7), 27.
Donohue, P. (2004, August). Many options for prostate cancer. Western Star. Retrieved March 31, 2005 from Ebscohost.
Galbraith, M. E., Arechiga, A., Ramirez, J., & Pedro, L. (2005). Prostate cancer
survivors' and partner' self-reports of health related quality of life, treatment symptoms and marital satisfaction 2.5-5.5 years after treatment. Oncology Nursing Forum, 32(2), p.E30.
Pril, W. F., Siegel, G. I., Goode, M. J., & Smith, M. R. (2002). Depression in men
receiving androgen deprivation therapy for prostate cancer: A pilot study. Journal
of Psycho-Oncology, 11(6), 519.
Biblography
Arnott, B. (2000). The prostate cancer protection plan. NewYork: Brown
Barry, H. (2005). Better quality of life after radiation prostatectomy. Journal of Family Practice Management, 12(1), 140.
Prostate Cancer. (2005). Understanding prostate cancer. Retrieved March 7, 2005, from www.prostate.com
Prostate Cancer Foundation. (2002). Prostate cancer symptoms. Retrieved March 7, 2005,from www.prostatecancerfoundation.org.
Torti, D. (2004). Exercise and prostate cancer. Sports Medicine, 34(6), 363.
Walling, D. A. (2004). Patient preferences in prostate cancer treatment selection. Journal of
AmericanFamilyPhysician, 70(11), 2215.
An Examination 1