With an annual death toll numbering some 500 men, prostate cancer claims more lives than the road toll. Not only is it the most common type of cancer found in men with more than 2,500 new diagnoses each year, it is also the third most common cancer contributing to premature death among males. To address this issue is Blue September, whose efforts alongside the Prostate Cancer Foundation is working to spread awareness about prostate cancer in New Zealand for the past 6 years.
As with most cancers, early detection is a man’s safest bet. Though it is estimated that one in 10 men will develop prostate cancer within their lifetime, the disease can be treatable. However, the relatively widespread nature of prostate cancer along with the genetic factor maintains prostate cancer’s status as a primary health concern for men. It is clearly a significant burden to men’s health, and it is not an exaggeration to say that it is one of the most pressing health concerns for Kiwi men. But what exactly is it?
The prostate is a small gland located under the bladder responsible for producing some of the fluid that comprises semen. Located behind the prostate are glands called seminal vesicles that produce the rest of the fluid in semen. Passing right through the prostate is the urethra, the tube through which semen and urine pass. Prostate sizes vary depending on age, but on average are about the size of a walnut in younger men and can grow to be as large as a decent grapefruit later on in life. Due to the prostate’s location, an enlargement can constrict the urethra which can then cause a weak stream and pain. For the most part, an enlarged prostate is due to simple prostatic hyperplasia – an increase in the cell count of normal, prostate cells. A secondary effect of an enlarged prostate is the thickening of the bladder wall, which in turn manifests as frequent urination, the need to ‘go’ at night along with the aforementioned weak stream.
A given prostate cancer can develop in different ways, but are divided into three general categories: high risk, aggressive prostate cancer can spread though the body and shorten someone’s life. Conversely, there are non-aggressive cancers that never cause any trouble in a man’s lifetime. And in between the two categories is cancers described as intermediate risk: prostate cancers that show signs of having the potential to turn aggressive. “It is important to realise that prostate cancer is not like other cancers,” says Dr. Chris Parker of the Institute of Cancer Research UK. “In particular, it is the only one that often requires no treatment at all. Some men can live with prostate cancer for decades without it causing any problems whatsoever.”
Though it is true that the prevalence of the aggressive form of the cancer is relatively low when compared to other types of cancer (lung, liver, pancreas, etc), early detection is key and close monitoring of the prostate cancer’s development can mean the difference between life and death.
Ideally, a screening test would detect only aggressive prostate cancer but unfortunately no such test exists. What is currently available and standard for detecting prostate cancer is the Prostate-Specific Antigen (PSA) test, which is a routine blood test alongside a Digital Rectal Exam (DRE). Evidence suggests diet plays a key role in the formation, development and aggressiveness of prostate cancer. Like all cancers, prostate cancer in simple terms is the abnormal and uninhibited growth of cells. A key difference between this type of growth and the previously noted prostatic hyperplasia is that cancerous cells serve little to no function – they are literally a waste of space. These cells multiply to a point where they can form masses (tumours), and if left untreated, can spread (metastasise) to other parts of the body. Upon metastasis, the cancer cells replicate and deprive the surrounding, healthy cells of nutrients and disrupting normal organ function that leads to death. Fortunately, this process of progression in prostate cancer is relatively slow. Even more encouraging is that in many cases the progression is so slow that all that is required of addressing the cancer is regularly assessing whether or not it has progressed or spread. Despite this, we should be wary as it still is the most common cancer among men. To put it another way, a non-smoking bloke is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers – combined. Of course, not all prostate cancers are aggressive nor do they call for immediate action. However, that does not change the fact that prostate cancer is, without a doubt, common.
“Prostate cancer is exceptionally common as men get older,” Dr. Parker continues. The men most likely to get diagnosed with prostate cancer are older men, and men with a family history of the disease.
“If I was diagnosed with prostate cancer, the first thing I would want to know is the extent. I would want to know whether the cancer had spread to what parts of the body. If the cancer is localised as they are initially, then the next thing I’d want to know is the risk group… The risk groups are based on three things: what the prostate feels like when the doctor examines you; what the tissue sample looks like under the microscope and what the PSA – Prostate Specific Antigen – level is. At the other end of the scale, if the prostate feels very abnormal (in size, hardness etc) and the tissue samples look aggressive under the microscope and PSA level is high, that’s high-risk localised prostate cancer.”
PSA is a protein produced by the prostate gland and detectable in a a simple blood test. However it is not a tool for diagnosis – it is simply and indicator of possible health issues with the prostate gland. To effectively detect prostate cancer a biopsy is taken if there is evidence from a PSA test, and a DRE that prostate cancer is a possibility.
“This is why it is important to have a regular check-up for prostate cancer,” says Graeme Woodside, Chief Executive of the Prostate Cancer Foundation of New Zealand. “Prostate Cancer that is detected early, and confined within the prostate gland is very treatable. We encourage all men over 50 to discuss having a check-up with their GP.”
Factors that might affect PSA levels
The PSA level can also be increased by a number of factors other than prostate cancer, such as:
Enlarged prostate: The most common culprit is benign prostatic hyperplasia (BPH), which affects many men as they grow older, may raise PSA levels.
Older age: PSA levels normally increase slowly with age, even if there is no prostate abnormality.
Prostatitis: This term refers to infection or inflammation of the prostate gland, which may raise PSA levels.
Ejaculation: This can cause a transient increase in PSA; for an accurate PSA test, some doctors recommend abstinence for at least 48 hours prior to testing.
Cycling/biking: Some studies indicate cycling or riding a motorcycle can raise PSA levels, though there is no consensus on the correlation.
Other tests: Some procedures such as a prostate biopsy or DRE may result in a brief increase in PSA levels for a short time.
Medication: Prescribed hormone therapies like testosterone (or other medicines that raise testosterone levels) may cause a rise in PSA.
Some things might lower PSA levels even if cancer is present. Therefore it is recommended that your GP is notified accordingly if you take the following:
Anti-baldness drugs: Certain hormone-based drugs that promote hair growth may lower PSA levels.
Herbal mixtures: Some mixtures that are sold as dietary supplements may also mask a high PSA level.
Aspirin: There is some indication that taking aspirin regularly lowers PSA levels.
Statins: Cholesterol-lowering drugs (statins) are linked to lower PSA levels if taken for extended periods.
Thiazide diuretics: Thiazide diuretics are a type of water pill often used to treat high blood pressure.
Blue September recommends that if you are over the age of 40, you should get a blood test to check your PSA level and/or get a digital examination. Preferably both. The reason should be obvious: prevention is the best form of treatment.
On the off chance that one is diagnosed with prostate cancer, there are several options available depending on how much the cancer has progressed. Since most prostate cancer progress is relatively slow compared to other cancers, one option to address it is to place the patient under an active surveillance programme. Treatment options include surgery, radiation therapy, hormone therapy and chemotherapy, but are considered only if the cancer is confirmed to be aggressive, and each procedure has its own pros and cons. Dr. Parker states that the treatment protocols vary significantly across the risk groups. “Men with low-risk localised prostate cancer are often observed rather than treated immediately. During that period of observation, they have regular blood tests to measure the PSA.
“They usually have repeat biopsies every few years and as long as the cancer doesn’t progress then they continue with observation. On the other hand, if the PSA rises significantly or the biopsies show cancer progression, then other treatment options will be discussed.”
The slow nature of prostate cancer means that you can choose to just have doctors keep an eye on it and not go straight into treatment. While you may avoid any side-effects from actions to deal with the disease, you still have to live with a cancer and that can be a tough decision to make. The more invasive approaches all carry the potential of developing serious side effects but as is the case with most medical treatments, what is best for one man may not be best for another so it is important to discuss with a doctor which option is right for you.
All invasive treatments – external beam radiotherapy, seed implant radiotherapy and surgery – can cause adverse effects. Such side effects include impaired bladder, bowel, and sexual functions. Taking into account the fact that prostate cancers progress gradually, this is why not all men with prostate cancer require treatment; if treatment had no side effects it makes sense to treat all men, but the fact is that treatment can have significant adverse effects and thus healthcare professionals aim to treat men who actually need it.
After first starting here in 2008, Blue September was expanded into Australia in 2009 and now the campaign is achieving international awareness with promotion in both the US and the UK. The decision to create the campaign stemmed from the fact that September is international prostate cancer awareness month so for the Prostate Cancer Foundation it was only appropriate that a project be developed to increase public knowledge on the subject. Since its 2008 launch Blue September has had the support of a number of famous Kiwis including All Blacks, actors, broadcasters and other familiar faces all banding together to encourage Kiwi men to get themselves checked up. Because the fact is, we are a little lax when it comes to taking care of ourselves.
Perhaps the most damaging aspect of prostate cancer – or any health affliction for that matter – is that we blokes have this ‘she’ll be right’ attitude. Even with the characteristic signs of prostate cancer such as a weak stream and having to go to the men’s room more often, we’re likely to assume it’s just something we ate and that it’ll be fine. And while that attitude might earn some macho points from your company of friends and acquaintances, you owe it to your family to stay on top of your health. After all, it is this general apathy and lack of concern for our health that continues to claim far too many fathers, sons, brothers, uncles, and grandfathers. At this point one might be wondering if he is at risk. Prostate cancer, like all cancers, does not have a definitive cause – one event does not trigger a cell to suddenly convert into a cancer cell. However, there are firmly established risk factors.
Age: The risk of developing prostate cancer is proportional with age; the older you get, the more at-risk you become.
Family history: If you have a relative that has had prostate cancer, you are more at risk.
Beyond getting a medical examination, there are a number of things a bloke can do to prevent prostate cancer from forming.
1 Get caffeinated
Whether you like a flat white, a latte or a long black, decaf or as a frap, Harvard researchers say they all help. Several studies have found that men who regularly drank coffee were 59 percent less likely to develop advanced prostate cancer than those who did not partake. It should be noted however that the evidence is still somewhat lacking as to what exact component of the brew helps.
2 Red means go
The next time you fire up the grill, try some cooked tomatoes to reduce your risk of prostate cancer. The beneficial effects of tomatoes on prostate health were first discovered in the 1990s by Dr. Edward Giovannucci, who was the first among many to confirm the powerful red fruit. It’s all thanks to lycopene, a pigment in tomatoes that becomes more readily absorbed (and some say more potent) after they’re cooked. By no means are tomatoes the only source of lycopene – most red foods such as watermelon, grapefruit and guava also contain lycopene. In other words, ketchup is all good.
3 Move it
The extent to which physical exercise allays the development of prostate cancer is a difficult one to state. Be that as it may, it has been shown that regular exercise reduces the risk of fatal forms of prostate cancer by up to 41 percent. What’s more is that among prostate cancer survivors of prostate cancer, those who exercised at a moderate-high intensity (tennis, running, swimming, or biking) for 5 hours a week had a 56 percent lower risk of death from the disease. In short, more activity is more protective.
4 Oil up…
If fish had prostates, the odds are they would never get prostate cancer. The omega-3 fatty acids that are universally regarded as a veritable elixir of life, and it’s no surprise as the omega-3 found in fish oil has been linked to inhibiting the formation of tumours – and their benefits are not just limited to prostate cancer either. Furthermore, Harvard researchers found that men who ate fish three times a week reduced their risk of advanced prostate cancer by some 25 percent. Fish with appreciable amounts of omega-3 include the fatty ones such as sardines, tuna, trout, and salmon. Bear in mind that not all fats are created equal.
5 …but be selective
Men with the high levels of trans fats have more than twice the prostate-cancer risk of men with the lowest levels. Trans-fatty acids are a type of fatty acid chain that indirectly promotes inflammation and insulin resistance, both of which may play a role in prostate cancer. The most commonly available culprits with high levels of trans fats are doughnuts and cookies, though any packaged baked goods containing hydrogenated oil will have at least some trans fats. Where possible, read the label and actively reduce your level of saturated fat intake.
6 The Replacement Fillers
Sticking with the issue of fat, studies have indicated a link between the consumption of animal fats and increased risk of prostate cancer. But of course, meat is not the only source of dietary fats – animal fats are found in shortening, butter, and cheese. Reducing fat intake is a lofty goal, but fortunately there are some workaround methods: by replacing animal fats with plant-based fats.
Instead of butter, try olive oil; fruit instead of sweets; nuts and seeds instead of cheese.
7 Break a sweat
A high body mass index (BMI) is linked to a plethora of adverse health outcomes – with prostate cancer among them. Too much flesh around the midriff is therefore extra baggage that you can do without and with regular exercise a wide range of health benefits can result even beyond the scope of addressing the BMI – increased metabolism, endurance and muscle mass; lowered blood cholesterol, risk of heart disease, diabetes, and a variety of cancers.
8 Don’t let the bed bugs bite
Some sexually transmitted diseases may increase the risk of prostate cancer. Men with a history of trichomoniasis have been found to be more than twice as likely to develop advanced-stage prostate cancer as those who never had the parasite. The infection could lead to prostate inflammation, an immune response to an injury (in this case, an infection) that results in cell replication thereby increasing cancer risk and progression. Males can be infected with trichomoniasis for a number of years with no symptoms – go and see your doctor even if you’re sure you’re clear, as all it takes to remedy the infection is a single dose of an anti-parasitic drug.
9 Go Green
Your mother was right to give you helpings of veges. Broccoli for example has been found to lower the risk of prostate cancer and heart disease — in 2008, a British study found significant benefits in consuming as little as four servings of broccoli a week. Current medical and scientific literature postulates that a group of chemicals known as isothiocyanates activate genes that inhibit the chemical processes that lead to inflammation and cancer formation. While broccoli is a prime example of how vegetables can reduce cancer risk, it is by no means the only vegetable that exerts such an effect. It is thought that the compounds found across the wide variety of green vegetables help your body break down carcinogens. Another possible mechanism of cancer prevention is by giving the immune system a boost which increases successful detection of cancerous cells. All in all, the 5+ a Day mantra is valid.
10 Get busy
The principal function of prostate is concerned with the production of the fluid medium of semen. As such, one of the most satisfying facts (in more ways than one) is that maintaining optimum prostate function is a bit like using a muscle. In other words, it pays to ‘work out’. A 2004 study in the Journal of the American Medical Association analysed data collected from almost 30,000 men and found that guys who ‘peaked’ more often (at least 21 times a month) were 30 percent less likely to develop prostate cancer than those who racked up less than ten peaks a month.
11 Take Tofu
A group of nutrients called isoflavones found in some bean varieties (soy in particular) have been linked to a reduced risk of cancers, including prostate cancer and breast cancer. Tofu is made from soybeans which have a high protein content, and therefore presents a two-pronged approach to prostate cancer prevention since it can reduce (or even replace) eating meat, which means a reduction in animal fat consumption.
Sources of isoflavones other than soy and tofu include chickpeas, lentils, alfalfa and peanuts.
12 Don’t dodge the doctor
Talk to your GP about prostate health – be proactive, especially if you are over the age of 30 and have a family history of the cancer. If you present any of the symptoms of prostate cancer (see below), don’t take the macho man approach – do the right thing and discuss it with a health professional and