Prostate Cancer Alert

-- Men and concerned wives and daughters pay attention: The startling fact is that one in five men will develop prostate cancer at some point during his life. It is the second leading cause of cancer death in men after lung cancer. New York City Mayor and U.S. Senate hopeful Rudolph Giuliani announced Thursday that he has been diagnosed with this disease. His public statement serves as a reminder that not even renowned tough guys like the Big Apple's mayor should put off screenings. Friday's edition of The Early Show looked at how Giuliani's announcement affects politics. But start here to find out more about prostate cancer and how to screen for it.

Risk Factors

Anything that increases a person's chance of developing a disease. Many people with one or more risk factors never even develop cancer, while others with this disease have no known risk factors.

• AGE: Chances increases rapidly after age 50. More than 80 percent of all prostate cancers are diagnosed in men over 65.

  
  

• RACE: It's nearly twice as common among African-American men as it is in white American men.

  
  

• GEOGRAPHY: The disease is most common in North America and northwestern Europe. It is less common in Asia, Africa, Central America, and South America.

  
  

• DIET: Men who eat a lot of fat in their diet have a greater chance of developing prostate cancer.

  
  

  • Those with a high-fat diet tend to eat fewer fruits and vegetables, yet they eat more dairy products. These factors may be responsible for increasing risk rather than the amount of fat itself.

    
    

  • Recent research suggests that a diet high in calcium and low in fructose (fruit sugar) increases risk.

    
    

  • Lycopenes, found in high levels in some fruits and vegetables (such as cooked or raw tomatoes, grapefruit, and watermelon), seem to lower prostate cancer risk, as does the mineral selenium.

    
    

  
  

• EXERCISE: Regular physical activity and maintaining a healthy weight may help reduce prostate cancer risk.

  
  

• GENETICS: It runs in some families, suggesting a genetic factor. Having a father or brother with prostate cancer doubles a man's risk of developing this disease.

  
  

• VASECTOMY: Men who've had a vasectomy may have a slightly increased risk for prostate cancer, though studies have not been conclusive. Some studies found this risk highest in men who were younger than 35 when they had the surgery.

  
  

Prevention

The exact cause is not known, but one risk factor that can be changed is diet. A diet low in fat and consisting mostly of vegetables, fruits, and grains is associated with reduced risk of prostate cancer. Eat five or more servings of fruits and vegetables each day. Bread, cereals, grain products, rice, pasta, and beans are also recommended.

These guidelines on nutrition provide an overall healthful approach to eating that also helps lower the risk for some other types of cancer.

Some studies suggest that taking 5milligrams of vitamin E daily can lower risk by 32 percent. Other studies found vitamin E to be of no benefit, but reasonable doses have no significant side effects and are not expensive.

On the other hand, some studies suggest that taking vitamin A supplements may actually increase prostate cancer risk. Vitamin supplements should be used with caution, avoiding excessive doses.

The Prostate Cancer Prevention Trial is studying more than 18,000 men to determine whether medications to lower androgen (a male hormone) levels can reduce prostate cancer risk.

Causes

People with certain types of cancer have DNA mutations they inherited from a parent. These genetic changes appear to be responsible for about 10 percent of prostate cancers.

The DNA mutations related to prostate cancer usually develop during a man's life rather than having been inherited before birth. Every time a cell prepares to divide into two new cells, it must duplicate its DNA. This process s not perfect and sometimes copying errors occur.

Acquired mutations in some organs may result from exposure to radiation or cancer-causing chemicals, but these factors have not been proven to be important causes of mutations in prostate cells.

Benefits of Early Detection

Prostate cancer is unlike many other cancers in that it often grows very slowly. For men with cancer that is proven not to have spread beyond the prostate gland, the five-year relative survival rate is near 100 percent. Overall survival rates for all stages of prostate cancer combined have increased from 67 percent to 89 percent over the past 20 years.

Before early detection tests were widely used, most men with prostate cancer were diagnosed with advanced disease, and most died within a few years of the diagnosis.

The American Cancer Society recommends that health care providers offer yearly screenings, beginning at age 50, to men who have at least a 10-year life expectancy, and to younger men (45-years-old) who are at high risk, such as those with two or more affected first degree relatives (father and a brother, or two brothers) or African Americans.

• Prostate-Specific Antigen Blood Test (PSA)
  The American Cancer Society recommends that this blood test to measure PSA (a protein which is made by prostate cells) be offered annually by health care providers.

  
  PSA levels estimate how likely a man is to have prostate cancer but the test does not provide a definite answer. Men with a high PSA result are advised to have a biopsy.

  
  

• Digital Rectal Exam (DRE)
  The American Cancer Society recommends that health care providers offer the digital rectal exam as part of their annual physical check-up. During the exam, a doctor inserts a gloved, lubricated finger into the patient's rectum to feel for any irregular or abnormally firm area that might be a cancer. The prostate gland is located next to the rectum, and most cancers begin in the part of the gland that can breached by a rectal exam. While it is uncomfortable, the exam causes no pain and only takes a short time.

  
  

• Transrectal Ultrasound (TRUS)
  TRUS uses sound waves to create an image of the prostate on a video screen. Sound waves are released from a small probe placed in the rectum. The sound waves create echoes as they enter the prostate. The same rectal probe detects the echoes that bounce back from the prostate and a computer translates the pattern of echoes into a picture. Because prostate tumors and normal prostate tissue often reflect sound waves differently, this test may be useful in detecting tumors, even those which might be too small or located in areas of the gland that cannot be felt by DRE.

  
  

Signs and Symptoms

Most cases of early prostate cancer cause no symptoms and are found by a PSA blood test and/or DRE. Some prostate cancers may be found because of symptoms in the urinary system. These symptoms are not specific to cancer, and can also be caused by benign diseases of the prostate, such as nodular hyperplasia.

Symptoms of advanced prostate cancer include

• frequent urination (especially at night)
  
• weak urinary stream
  
• inability to urinate
  
• interruption of urinary stream (stopping and starting)
  
• pain or burning on urination
  
• blood in the urine

  
  

Diagnosis

If certain symptoms or the results of early detection tests have raised the possibility of prostate cancer, your doctor will use other tests to decide whether the disease is present.

• The Prostate Biopsy
  A biopsy is a surgical procedure in which a sample of tissue is removed for examination under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. Under transrectal ultrasound guidance a doctor inserts a narrow needle through the wall of the rectum into the area of the prostate gland that appears abnormal or suspicious. The needle then removes a cylindeof tissue, usually about 1/2 inch long and 1/16 inch across, which is sent to a lab to see if cancer is present.

  
  The procedure usually takes about half an hour. Though it sounds painful, it normally causes little discomfort because the biopsy gun inserts and removes the needle in a fraction of a second.

  
  

• Grading the Prostate Cancer
  If cancer is found in a prostate biopsy specimen, it will be graded to estimate how aggressive it is likely to become (i.e. how fast it is likely to grow and spread). Grading is done by the pathologist examining the tissue sample taken during the prostate biopsy.

  
  Cancers with a high Gleason score are more likely to have already spread beyond the prostate gland at the time they are found. For this reason, the Gleason score is useful in considering treatment options and selecting additional tests to be done before choosing a treatment.

  
  Go to the American Cancer Society Web site and Prostate.com for more in-depth explanations of testing procedures and research.
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