9-Sep

Prostate Awareness Month

Get yourself checked

A prostate cancer diagnosis can be scary and confusing, leaving you with more questions than answers. The Prostate Cancer Foundation helps by arming you with the right questions to ask your specialist, so you can make informed choices about your health.

Here are 10 key questions to ask your specialist: 

  1. Do I have prostate cancer and is it treatable?
  2. What is the best treatment option for me?
  3. What are the chances the treatment will work?
  4. How long will my treatment take?
  5. Are there any side effects to this treatment?
  6. What should I do to prepare for treatment?
  7. What happens following treatment?
  8. At any point in time, who is my day-to-day contact?
  9. Where can I get support and information?
  10. What happens if my cancer comes back?

New Zealand Quick Statistics

Five Steps to Prostate Cancer Prevention:
Five Steps to Prostate Cancer Prevention:

Five Steps to Prostate Cancer Prevention:

  • Test Annually:
    Men should undergo annual prostate specific antigen (PSA) blood test and digital rectal exams (DRE) starting at age 50 or earlier. High-risk groups should begin testing at age 40.
  • Listen to Your Body:
    A change in the frequency, urgency and pressure during urination, painful urination or the presence of blood in urine are all warning signs.
  • Regulate Diet & Alcohol Intake:
    Eat healthy, balanced meals rich in fruits, vegetables and whole grains. Consume no more than two drinks per day as studies show regular heavy drinking increases risk.
  • Maintain a Healthy Weight:
    Obesity may effect hormone levels related to prostate cancer risk.
  • Exercise Regularly:
    At least 30 minutes of aerobic exercise three to seven times per week.

The Structure and Function of the Prostate Gland

The prostate is one of the male sex glands. The other major sex glands are the testicles and seminal vesicles. Together these glands secrete the fluids that make up semen.

The normal prostate is about the size of a walnut. It lies just below the bladder and surrounds the beginning of the urethra. The urethra is the tube that runs through the penis. It carries urine from the bladder and semen from the sex glands.

As the prostate is a sex gland, its growth is influenced by male sex hormones. The chief male hormone is testosterone, which is produced mostly by the testicles.

Screening and Early Detection of Prostate Cancer

Early detection of prostate cancer (PCa) is important as this cancer is most treatable when detected while contained within the prostate gland before it spreads to other parts of the body.

The New Zealand Ministry of Health Prostate Cancer Management and Referral Guidance indicates the procedures for men looking to be tested for prostate cancer.

Regular prostate checks are important for men who:

  • Are over the age of 40 if there is a family history of prostate cancer;
  • Are older than 50, but younger than 70.

There are two simple tests for prostate cancer and it is recommended that both are done each year.

  1. The PSA blood test is a simple test than can be done in conjunction with other blood tests (e.g. cholesterol) as part of a routine health check-up.
  2. The Digital Rectal Examination (DRE) is a physical examination where the doctor checks the size, shape and hardness of the prostate gland by inserting a gloved finger in to the rectum.

Men having any problems such as pain, fever, swelling of the prostate and, blood and pus in the urine, or problems passing urine should consult their doctor without delay.

The most insidious thing about PCa, and what makes it so dangerous, is that in its early stages it does not usually exhibit symptoms. When symptoms begin to appear then it is frequently too late for effective curative treatment. This is why regular check-ups are so important.

Symptoms of Prostate Problems

Many men begin to have problems with their prostate as they get older. Most problems are caused by simple enlargement of the prostate, but a few are caused by cancer. To get checked for Prostate Cancer consult with your GP.

Usually the first sign of trouble is with passing urine. A man may notice one or more of the following symptoms:

  • trouble getting the flow of urine started, especially if in a hurry
  • trouble stopping the flow of urine (“dribbling”)
  • the stream of urine is weak, or it stops and starts
  • needing urgently to pass urine at any time
  • feeling a need to pass urine more often during the day, even though not much comes out
  • getting up at night to pass urine more than once
  • feeling a need to pass more urine, even though none comes out
  • pain and/or burning when passing urine; this may be a sign of infection

Benign Enlargement of the Prostate

In men with prostate problems, nine out of ten will have a prostate which has grown too big. This puts pressure on the urethra and may squeeze it enough to block outflow of urine.

This condition of enlarged prostate is called “Benign Prostatic Hyperplasia” or BPH. Benign means it is not cancer, and hyperplasia means “too much tissue”.

BPH occurs with ageing. It affects more than half of all men older than 50.

Medicines or surgery are used to treat it but only when symptoms become troublesome. Remember, BPH is not prostate cancer even though most of the symptoms are the same when passing urine.

Infection of the Prostate

Infection of the prostate is called Prostatitis. It can cause pain, fever, swelling of the prostate, and blood and pus in the urine.

It may have symptoms similar to BPH. Prostatitis is usually treated with antibiotics. Infection of the bladder usually occurs at the same time as infection of the prostate. If blood appears in the urine (Haematuria), contact your doctor for an appointment.

Diagnosis of Prostate Problems

The doctor will need to determine whether the patient’s problems are due to BPH, prostatitis, prostate cancer or some other cause.

The doctor may do the following tests:

Digital Rectal Examination (DRE)

The doctor wears a rubber glove and inserts a finger into the anus to feel the prostate through the wall of the rectum. This is called a digital rectal examination or DRE. The doctor checks the size, shape and hardness of the prostate.

Prostate Specific Antigen (PSA)

PSA is a small protein released into the blood by the prostate. If the amount of PSA in the blood is above the normal levels, it may be due to an enlarged prostate or prostatitis. If the PSA level is high, it is more likely to be due to prostate cancer. The PSA test does not diagnose prostate cancer, it is an indicator that there may be abnormalities in the prostate gland. The important measure associated with regular PSA testing is the change, or rate (velocity) of change that may indicate a problem. This is why it is important to have at least an annual PSA test so that any changes can be noted and acted upon.

Results from a PSA test alone cannot confirm whether prostate cancer is present. Other tests need to be done. Different laboratories use different tests to measure PSA levels in the blood. This can result in different values of PSA levels for the same man. The doctor will take this into consideration when keeping track of a patient’s PSA levels.

Biopsy

A biopsy is the removal of very small pieces of prostate tissue using a fine needle. A local anesthetic may be given first. Several samples may be taken. Men say the discomfort is mild.

The tissue is then looked at under a microscope to see if cancer cells are present. A biopsy is the only way to show for certain whether or not the man has prostate cancer.

Some doctors like to take a picture of the prostate and nearby organs before they do a biopsy. This is done with an ultrasound probe. By producing a picture of the prostate and nearby organs, ultrasound guides biopsy.

Prostate Cancer

To get checked for Prostate Cancer consult with your GP.

The human body is made up of billions of tiny building blocks called cells. Sometimes, cells reproduce in an uncontrolled way and grow into a lump, or tumour.

There are two kinds of tumours: noncancerous (benign) and cancerous (malignant). Benign tumours do not spread to other parts of the body and are not life threatening (except in very rare situations).

Cancerous tumours can attack nearby cells and destroy them. Cancer cells can also get into body fluids and spread to other parts of the body. This is called a secondary cancer or metastasis. Blood and lymph are the fluids which transport cancer cells to other parts of the body. Lymph is a nearly clear fluid that travels through lymph vessels and small oval structures called lymph nodes. Lymph fluid eventually mixes with blood which travels throughout the body.

Cancer is not a single disease with one cause and one type of treatment. There are more than 200 different types of cancer. Each has its own natural course of development and response to treatment.

Cancer of the Prostate

In New Zealand, prostate cancer is the most common cancer in men, around  3,000 registrations each year and about 600 deaths from prostate cancer each year (based on the statistics from the Ministry of Health 2007 – 2009 which show an average of 3082 registrations and 602 deaths).

Men who develop prostate cancer are mostly over the age of 65. It rarely occurs in men younger than 55. About one in 13 men will develop prostate cancer before the age of 75. In very elderly men, prostate cancer often grows very slowly and may cause no symptoms.

Some men are more at risk of getting prostate cancer than others, but the most important risk factor is ageing. Men with a family history of prostate cancer have a higher risk; that is, if the father, an uncle or a brother has had prostate cancer.

Doctors do not know what causes prostate cancer. They do know, however, that the growth of cancer cells in the prostate is stimulated by male hormones, especially testosterone. Most prostate cancer growth is influenced by testosterone.

The speed at which prostate cancer grows varies from man to man. In some men the cancer grows very slowly; in other men, it grows more rapidly.

A cancer is often very hard to find when it is located only within the prostate. This is because it may not cause symptoms and may be too small for a doctor to feel during a routine rectal exam.

A man with slow growing prostate cancer may live for many years and die of other causes, without ever having symptoms of prostate cancer. If the cancer grows too much, however, the prostate usually squeezes the urethra, which it surrounds. Symptoms may then start, such as difficulty in passing urine. As the same symptoms can be caused by other problems, difficulty in passing urine does not always mean that prostate cancer is present.

A growing cancer can affect cells close to the prostate. At the same time, cancer cells may get into the blood and spread to other parts of the body, especially the bones. A man may not have any symptoms during the early period of cancer spread.

Prostate cancer tends to spread to lymph nodes, bones (especially ribs and bones around the hip and lower back), liver and lungs. Cancer cells that have spread to other parts of the body will grow, causing symptoms such as bone pain, one of the most common problems.

Gleason Score

The pathologist examines the biopsy specimen and grades it on a scale of 2 to 10. This “Gleason Score” indicates how aggressive the cancer is and how fast it is growing; the higher the score, the more aggressive and faster growing the cancer is.

Clinical Stages of Prostate Cancer

The TNM System and Common Treatment Choices

This next section is a little technical, but you may wish to read it to understand how doctors define the stages of prostate cancer.

The most commonly used staging system is the TNM System, which stands for:

  • Tumour (indicates the size or involvement of a malignant tumour)
  • Node (indicates whether lymph nodes have cancer cells in them)
  • Metastasis (indicates whether cancer has spread to other parts of the body)

The stages are called T1, T2, T3 and T4, N0 and N1, and M0, and M1.
T1, T2, T3 and T4 have substages: T1a, T1b and T1c; T2a, T2b and T2c; T3a, T3b and T3c; and T4a, and T4b.

Where an ‘X’ is shown, it indicates that either lymph nodes or metastases cannot be evaluated. Your doctor can tell you more about staging and its importance to the treatment options. The doctor will estimate how much cancer is in the prostate and may be able to estimate how fast the cancer is growing. This information will influence the doctor’s advice about which treatment is likely to be best.

The A, B, C and D System

Instead of the TNM System, some doctors talk about stages A, B, C and D. Sometimes these stages are called 1, 2, 3 and 4, respectively.

STAGE A (STAGE 1)
In Stage A, the tumour is confined to the prostate gland only and cannot be felt during a prostate examination via the rectum.
If found at all, it is usually found by chance during treatment for BPH, prostatitis, or some other prostate problem.
Cancer cells may be found in only one area of the prostate or in many areas of the prostate.

STAGE B (STAGE 2)
The tumour is located within the prostate only but can be felt during a prostate examination via the rectum. The man may or may not have symptoms. Blood levels of PSA are usually increased.

STAGE C (STAGE 3)
The tumour has spread from the prostate to other nearby tissues.
The seminal vesicles, the glands that produce semen, may have cancer in them. Difficulty in passing urine is a common symptom.

STAGE D (STAGE 4)
The tumour has spread to other parts of the body, most often the lymph nodes, bones, liver or lungs. Difficulty in passing urine, bone pain, weight loss and tiredness are common symptoms.

The above was sourced at https://prostate.org.nz/ – check out there web-site for more valuable information and support them for the incredible work they do.

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