Cancer prevention is action taken to lower the chance of getting cancer. To prevent new cancer from starting, scientists look for risk factors and protective factors. Anything that increases the chance of developing cancer is called a cancer risk factor and anything that decreases the chance of cancer development is called protective factor. For example smoking is a risk factor while a healthy diet is a protective factor.

Prostate cancer is the most common cancer diagnosed in men. In general doctors recommend that men with an average risk of prostate cancer make choices that benefit the overall health of the person.

Following are the best preventive measures for prostrate cancer:

  • Choosing a low fat diet and full of fruits and vegetables may reduce the risk of prostate cancer. Food that contains fats like meat, nuts, oils and dairy products must be avoided. This is because men who consume the highest amount of fat each day have a tendency to grow obese. This over weight increases the risk of prostate cancer.
  • Reducing the amount of fat intake helps control weight and also keeps the heart healthy. Reduction of fat or oil while cooking, eating lean meat and low fat dairy products are some of the precaution that men can take to prevent prostate cancer.
  • Eat more fat from plants than animals. The use of plant based fat is healthier than animal fat that include lard and butter.  For example cooking food with olive oil is better than using butter. It is advisable to garnishing salads with nuts or seeds instead of cheese.
  • Increase the intake of fruits and nuts each day. Fruits and vegetables are full of vitamins and nutrients that are thought to reduce the risk of prostate cancer. Eating more fruits and vegetables also leaves less room for other foods.
  • The fat in fish which contains a fatty acid called omega-3 is the only animal fat that can be taken as a preventive for prostate cancer. Fishes like- tuna, salmons, sardines and trout’s are rich in this fatty acid.
  • Reduce the intake of dairy products each day. Studies prove that men who depended more on dairy products and included milk, cheese and yogurt in their everyday diet ran the risk of prostate cancer.
  • Foods like soya beans, green tea are healthy substitutes.

Over the centuries we the human being have shifted from a simple diet of fruits, vegetables, meats and grains to a rather harmful diet that consists of more fats, oils and complex carbohydrates. Nutritional excesses and nutritional deficiency are the cause of a number of chronic diseases in today’s modern world. This has brought in the necessity of herbal medicine to eradicate the excess toxin in the body accumulated due to imbalanced/improper diet.

Herbal medicines or “Herbal remedies” for prostate cancer has in a randomized clinical trial has proved to be a highly regarded approach. However combination of herbal remedies in the market should be approached cautiously as they have reported a number of serious side effects like venous thrombosis, loss of libido (desire for sex) etc. For example a popular supplement used by men with prostate cancer called PC-SPES was taken off market as it was said to other drugs that caused serious health problems.

Many herbs (including astragalus, dong quai, Echinacea and Asian ginseng) boost the immune system of the body and so shore up the body from future or existing cancer.

Studies suggest that shiitake or maitake mushrooms, mistletoe, extracts of the Venus flytrap and various botanical therapies used in the traditional Chinese medicine may help treat certain forms of cancer. Ginger helps relieve a patient from nausea that often accompanies conventional cancer therapies.

Mistletoe (Viscum album L.) is a semi- parasitic plant that lives with trees like oak, pine, fir, elm and apple. Its extracts have been used since ancient times. It is being used in today’s modern laboratory to kill cancer cells and stimulate the immune system of the body

Only the European species of mistletoe is used to treat cancer. It has been reported to reduce tumor size and improve quality of life.  Three components in it – ‘lectins, alkaloids and viscotoxins’ are responsible for the biological effects. Mistletoe is typically given by a subcutaneous injection close to the tumor

Saw Palmetto is a short palm tree found in the southeastern region of US. Its berries are dried and powdered and used as a tea or in capsules. It is prescribed for benign prostate hyperplasia (BPH).It controls the tendency of frequent urination. Its extract is effective for controlling prostate gland enlargement.

There are various drugs that are used for treatment of prostate cancer. As this disease invariably crops up at an older age, doctors think that the use of some effective drugs would save the patient from unnecessary surgery.

Bisphosphonate is the most common drug used to eliminate almost all kinds of cancer. Several clinical trials have proved that ‘Bisphosphonates’ have clinical value in the treatment and management of skeletal metastases derived from advanced prostate cancer. Researchers have studied the effects of Bisphosphonate treatment on the growth of prostate cancer cells in three line stages. Treatment of PC3, DU145 and LNCap cells with ‘pamidronate’ or zoledronate significantly reduce the growth of all three cell lines.

Using flow cytometry, ‘pamidronate’ treatment induces significant amount of cell deaths while ‘zoledronate’ in the dosage of 100µm obstructs the growth of cancer cells in the presence of fetal bovine serum.  Though both the drugs reduce cancer cell growth in the presence serum, zoledronate is more potent. A dosage as low as 25µm ‘zoledronate’ only needs be administered in the presence of 5% bovine serum. Therefore the use of these two drugs in managing skeletal metastases as helps in direct inhibition of prostate cancer cell growth in the bone microenvironment.

Casodex™ monotherapy is next alternative drug that is used for confirmed metastatic (M?) and locally advanced prostate cancer. A dosage of 150mg has to be taken daily for a period of 100 weeks. However it has to be used in combination with castration to make it more effective.

Use of ‘Casodex’ helps improve quality of life by retaining sexual interest in the patient. It is an option for patients with M? prostate cancer for whom surgical or medical castration is not indicated or acceptable.

Taxol anti cancer drug is used for the treatment of bcl-2 prostate cancer. Treatment of prostate cancer cell lines expressing bcl-2 with ‘Taxol’ induces bcl-2 ‘phosphorylation’ and programmed cell death. The drug however does not work on bcl-2 negative prostate cancer cells. It does not induce apoptosis. The bcl-2 phosphorylation inhibits its binding to ‘bax’.

A number of cytotoxic agents and drugs are used for chemotherapy of prostate cancer, but these drugs and agents have proved to be more harmful than effective; calling for new approaches.

Men who receive treatment for prostate cancer may suffer from various side effects. These side effects may include- incontinence (inability to control urination), bowel problems, impotence (inability to get an erection), infertility (inability to father a child), hormonal changes and side effects of chemotherapy such as fatigue.

It is important for the patient to talk to his doctor or a support and counseling group to help manage any of the side effects that he may suffer from.

Incontinence:

There are four types of incontinence:

  • Men with stress incontinence leak urine when they cough, laugh, sneeze or do some exercise.
  • Men with urge incontinence have a sudden urge to urinate.
  • In continuous incontinence men lose all ability to control their urine.

Some measure may help the patient manage incontinence:

  • Limiting the intake of coffee and alcohol.
  • Urinating before bedtime and strenuous activity.
  • Technique called Kegel exercise tone the pelvis muscles that hold urine.
  • Medicines like ‘oxybutynin’ and ‘tolterodine’ help both stress and urge incontinence.
  • Patient can use diapers to control leakage.
  • Surgery to increase the size of the urinary bladder or to implant an artificial urinary sphincter (valve that controls the flow of urine) is a permanent treatment for incontinence.

Bowel problems:

Bowel problem arises after radiation therapy. Possible problems are:

  • Diarrhea
  • Gas
  • Loss of control of bowel movements
  • Bleeding with bowel movements

These can be controlled through medication.

Impotence:

Surgery, radiation or hormone therapy can cause men to become impotent. While surgery leads to permanent impotence. Effects of hormone therapy and radiation are temporary which can be treated with medication or the implanting some artificial device (VCD-Vacuum constriction device close/over the penis for erection.

Infertility:

Surgery, chemotherapy, radiation may cause permanent or temporary infertility in men. Medical procedure such as ‘sperm banking’ or ‘testicular sperm extraction’ helps in preserving fertility.

Hormonal changes:

This side effect is related to hormone therapy. Common side effects are impotence and decreased desire to have sex. The patient may even suffer from:

•           Hot flashes

•           Growth of breast tissue

•           Depression

•           Weight gain

•           Loss of muscle mass

•           Osteoporosis (bone thinning)

•           Low blood cell counts, which can cause anemia.

Simple relaxation technique can help ease the stress and anxiety of prostate cancer diagnosis and treatment. A patient may experience stress, anxiety and depression with a diagnosis of prostate cancer and its treatment and its side effects. It is when stress, anxiety and depression get out of hand that the patient can try the relaxation techniques.

Learn Relaxation Technique:

“Relaxation, breathing, meditation and guided imagery are all great ways for the patient to learn to help themselves”, says Mary Beth a behavioural health therapist. Fear and anxiety cause short breathing patterns, which creates more anxiety. If the patient can learn to relax and modify that he can live in a calmer manner.

The beauty of these tools is that they can help the patient to get through anything. Meditation in the morning helps center a person with a goal in mind to focus on during the day. Staying focused on that goal helps create some balance and sense of calm.

Prostate cancer patients have many ways to teach their bodies to relax and release stress.

Relaxation:

The patient has to visualize peace and relaxation. This is also called guided imagery. Whenever the patient feels anxious and stressed he has to create a picture of peace and calmness in his mind, using all the senses. He has to think of things that smell sweet, looks and sounds good.

Next he has to learn to relax his muscles. The patient can do this exercise anywhere. He has to start by tightening his muscles first and then relaxing them. This makes him realize how nice it feels to have relaxed sensation. He should take up this exercise from the toe and gradually reach the head and neck.

Breathing:

A rhythmic inhaling and exhaling of air helps in exhaling the toxin and inhaling positive energy into the body.

Meditation:

Meditation can be done anytime and anywhere. While meditating the patient’s mind should be clear. The patient can practice deep breathing, chanting, reading or just thinking of something good. The patient can also take up yoga after consulting the doctor.

The patient can also relax by taking a ‘tai chi’ or massage or take out sometime to listen to his favourite music.

Stress reduction can lower, blood pressure level/s, slow heart and breathing rates and increase blood flow in blood vessels.

Cryosurgery is a relatively new prostate cancer treatment. Also referred to as ‘Prostate Cryotherapy’ or cryoablation’, it is a minimal invasive surgery capable of using controlled freeze and thaw cycle to destroy the diseased/cancer cells.

Cryosurgery’s role in the Treatment of Prostate Cancer:

As cryosurgery is new and lacks survey records of survival, it is not used as often as radiation therapy for primary treatment. It is however effective in treating prostate cancer cases that are radio resistant and recur as a result. Some doctors believe that the use of freezing temperature rather than strong doses of radiation therapy is more effective for radiation resistant prostate cancer.

The Process:

Cryosurgery works with the freezing of cancer cells. This freezing helps in the formation crystals inside and around them. The freezing and thawing process destroys cancer cells through dehydration, drastic changes in pH levels or prevention of the flow of red blood cells. Subjecting the prostate gland to freezing temperatures, specifically negative 40 degree Celsius, also activates an anti-tumor response in the body. The anti-tumor response begins with the production of antibodies that work to eradicate the tumor.

History of Cryosurgery:

Cryablation which literally means “destruction of tissue by cold” dates back to the 19th century when mixtures of ice and salt were applied to the breast and cervix for the treatment of cancer. Modern Cryosurgery began in 1966 when doctors used liquid nitrogen in place of ice. A perineal incision was made through which an instrument called cryoprobe was placed. Liquid nitrogen was circulated through the probe to freeze the gland. In 1974 doctors started using a transperineal approach.

Today, 3rd generation needles are used more effectively through the guidance of the transrectal ultrasound. The use of argon and helium gas and cryoneedles help the doctors to carefully place and form an ice ball that will destroy the prostate cancer tissue.

Advantages and Disadvantages of Cryosurgery:

Cryosurgery is an effective primary treatment for those who are in the early stage of prostate cancer with low risk of tumor extension. It may be an excellent alternative for those patients who are not fit for prostatectomy. Cryosurgery may be used if EBRT fails and the cancerous cells are radio resistant. The patient experiences only minimal blood loss. The patient has to spend just a day or overnight stay in the hospital.

Watchful Waiting or WAW (Wait and Watch) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. During this time a number of repeated tests are performed.  Usually, watchful waiting is an outpatient process and may have duration of months or years.

It is recommended in situations with a high likelihood of self resolution’ in situations where there is high uncertainty concerning diagnosis and in situations in which the risk of intervention or therapy may outweigh the benefits.

In recent years men diagnosed with prostate cancer who opt for ‘Watchful Waiting’ are in such a good condition that they consider it as a reasonable alternative to immediate treatment. It has become more popular with advent of PSA (Prostate- Specific- Antigen).

Survey conducted on patients in the US between the year 1992 to 2002 shows that there is 94% chances of survival in case of ‘Watchful Waiting’. Researchers therefore suggest that the survival rate with conservative management is so high that there may be less possibility of improvement from active treatment.

Studies prove that the vast majority of men suffering from prostate cancer detected by PSA testing have a very good prognosis and are unlikely to die of their cancer or suffer serious medical consequences from diseases spread at 10 or more years, even if not treated with surgery, radiation or hormone therapy.

Research also proves that many men are detected with prostate cancer and are treated, but seldom benefit from the treatment. It is here that the process of ‘Watchful waiting’ works, saving the patients from the harmful side effects of the rest of the treatment.

According to the US urologist Brantley Thrasher, ‘Watchful Waiting’ more appropriately known as ‘Active surveillance’ has a place in the treatment of prostate cancer, but to generalize the ‘Active surveillance’ is a good option would be both erroneous and inaccurate.

‘Watchful Waiting’ is a reasonable option for patients who are more than 75 years and have low grade tumors that are clinically localized with low PSA levels, and who have other health problems. Whereas patients with high grade tumor, and if the patient is younger and is in good health; in that situation active treatments like a radical prostatectomy could be more beneficial.

There has been a reduction in mortality with the advent of ‘Watchful waiting’

Radical Prostatectomy is an operation to remove the cancer affected prostate gland and some of the tissues around. It is done to remove prostate cancer. This operation may be done by open surgery or it may be done by laparoscopic surgery.

Open Surgery

In open surgery, the surgeon makes an incision to reach the prostate gland. Depending on the case this incision may be made either in the lower belly or in the perineum between the anus and the scrotum. When incision is done in the lower belly, it is called retro pubic approach. In this procedure the surgeon may also remove lymph nodes in the area so that they can be tested of cancer.

When the incision is made in the perineum it is called perineal approach. The recovery time after this surgery may be shorter than retro pubic approach. However if the surgeon wants to remove lymph nodes around the prostate he has to make another incision. If the lymph nodes are believed to be free of cancer based on the grade of cancer and the result of PSA test, the surgeon made not remove the lymph nodes.

Laparoscopic Surgery

For laparoscopic surgery the surgeon makes several incisions in the belly. A lighted viewing instrument called the laparoscope is inserted through one of the incisions. The surgeon uses special instruments to reach and remove the prostate through the other incisions.

Robotic-assisted laparoscopic radical prostatectomy is a surgery through small incisions in the belly with robotic arms that translate the movement of the surgeon’s hand motion into finer and more precise action. This surgery requires specially trained doctors.

The main goal of either open or laparoscopic surgery is to remove all the cancer cells. The tumor is therefore removed using a nerve sparing technique, which enables the patient to maintain his sexual vitality.

What to expect after surgery?

The patient has to use a catheter for urination both during and after the operation; which has to be used for 1 to 3 weeks after the operation under the doctor’s guidance. Even after the operation the patients regular checkups make include:

  • Physical examination.
  • Prostate- specific antigen (PSA) test.
  • Digital rectal exams.
  • Biopsies as needed.

Why is the operation done?

It is done to remove cancer tissues in and around the prostate gland. It is also used to relieve urinary obstruction in stage III cancer.

High- Intensity- Focused-Ultrasound uses high intensity ultrasound waves, that are focused on a small area of between 4mm to 16mm to produce heat and energy that kills the cancer cells. To ensure that this is accurately done MRI (Magnetic Resonance Imaging) in done, both to localize the area of infection/tumor /cancer cells as well as monitor the temperature.

  • Magnetic resonance image guidance allows the radiologist to target the cancer cells with a high- intensity focused ultrasound beam.
  • Process is called ‘SONICATION’-ultrasound beam delivered to the target is converted to heat energy.
  • Technique relies on heat induced tissue necrosis (coagulative), which is achieved when the cancer cells are heated to or beyond a temperature of 57?C leading to tissue infarction/death.
  • It is vital to deflect the ultrasound beam from the bowel loop and bones.

HIFU prostate cancer treatment is the latest alternative for men with unifocal or independent prostate cancer. The tumor is the only thing that is treated in HIFU and not the entire prostate gland. The high energy focused ultrasound beam is concentrated through the side of the back path to the prostate gland to warm and terminate an exact amount of tissue.

The purpose of HIFU is to spare as much as possible the healthy tissue from getting affected. This treatment also helps in preventing any harm to the muscles that control the flow of urine encircling the constructions and erection operating nerves while even tendering cancer constrain.

Advantages of HIFU Prostate Cancer treatment

  • It’s a 20 to 90 minutes procedure where the patient need not require staying in the hospital.
  • The beam is passed through the cancer cells only and therefore has lesser side effects.
  • It prevents the chance of surgical infection since it does not need an opening.
  • Speedy life style recovery after the therapy.
  • The patient’s sexual energy is preserved.
  • It keeps the fundamental constructions and functions of the organs in the area of the gland intact.
  • The process can be done again if needed.

The patient has to go for regular checkups. 90% of the patients suffering from prostate cancer prefer HIFU treatment/therapy. The treatment can repeated, however the some conventional treatment like surgical procedure or radiotherapy is also possible after HIFU. It is appropriate for patients suffering from unifocal or unilateral disorder.

Chemotherapy is the use of certain drugs that act throughout the body to kill the rapidly dividing cells. As cancer cells are always more rapidly dividing than normal cells, chemotherapy kills cancer cells at a higher rate than normal cells.

Chemotherapy has two important properties to be aware of:

  • Chemotherapy is systemic. This means it works throughout the body and does not target specific area such as the prostate.
  • Chemotherapy is toxic. This means is causes all rapidly dividing cells in the body to die.

Therefore chemotherapy not only kills rapidly dividing cancer cells in the body but also kills the rapidly dividing normal cells.

Skin, hair follicles, bone marrow cells and cells of gastrointestinal tract are all normal cells that divide rapidly and are therefore affected by the chemotherapy. This is reason why patients undergoing chemotherapy lose their hair, have gastrointestinal issues such as nausea, vomiting and diarrhea and sometimes have low blood count.

When is chemotherapy used in prostate cancer?

Chemotherapy is not used often in prostate cancer. Rather it is the last option for treatment. However there are two sets of specific circumstances where it is employed.

  • Prostate cancer that has stopped responding to hormone therapy is said to be “hormone refractory”. Once the prostate cancer reaches this point, hormone therapy will have only minimal benefit in controlling the growth of prostate cancer cells. Therefore systemic therapy such as chemotherapy is used.
  • For advanced prostate cancer that has metastasized (spread) to other parts of the body distant from prostate gland.

Prostate cancer that has reached an advanced stage a has spread far from the prostate to other parts of the body and that which is not easily curable through other treatments like surgery, radiation and other standard treatment chemotherapy has be the last life saving option. In order to treat the cancer wherever it has spread in the body a systemic treatment such as chemotherapy is needed.

Disadvantages of Chemotherapy:

Chemotherapy has more disadvantages than advantages.  After each spell of treatment the patient becomes weaker as the whole system of the body is affected. Anemia, gastrointestinal ailments become a part of the patients life.  Patients who have reached such a stage of life where potency is not important but just want to live go for chemotherapy.