Colon cancer is the 2nd leading cause of cancer deaths in North America. So far nothing we have done in terms of prevention has helped decrease the rates of colon cancer. The only way to improve mortality is to make a diagnosis of the cancer early. We do have many screening tests for colon cancer, but tests like colonoscopy and virtual colonoscopy are expensive. The Fecal occult blood test is not very specific.
In the last few years, scientists have developed Fecal DNA tests. The first generation of these tests were not great. For example, the tests would repeatedly show that you have a cancer, when in fact you did not have a cancer (false positives). Further, the tests also sometimes showed that one did not have a cancer, when in fact a cancer was present (false negative). However, the latest generation of DNA tests have been improved but they are not 100 percent sensitive or specific.
The tests involving sampling stool for DNA. A colon cancer if present anywhere in the colon can be identified roughly 88% of the time.
The Fecal DNA kits appear to be slightly better than the fecal occult blood test kits (FOBT) at detecting colon cancer.
For the time being, anyone over the age of 50, should continue with a reliable screening test for colon cancer. The fecal DNA tests will most likely be improved in the future but for the time being, the fecal occult blood test should not be chucked away. Cost is another issue. The Fecal occult blood tests can cost anywhere from $3-$25, while the DNA kits costs anywhere from $500-$1,000. Another big difference is that the FOBT only requires a stool smear; the DNA kits require collecting a whole bucket of stools.
And finally, the majority of insurance carriers do not cover costs of the Fecal DNA test. For the time being and for those who can afford it, Colonoscopy is still the gold standard screening test for colon cancer.
Tuesday, March 31, 2009
Thursday, February 19, 2009
Other Treatments for Prostate Cancer
Coping skills: Once a diagnosis of prostate cancer is made, the news is always devastating and depressing. Many individuals may not be able to cope with such news. To cope with a prostate cancer, the best way is to educate oneself. One should maintain a normal routine of lifestyle and work. One should not suffer the burden of a cancer diagnosis on their own and seek counseling from family members friends and help is even available by calling the National Cancer Organization(s). The best way to deal with the cancer is by being well informed with the cancer.
Alternative medicine: Like everything in medicine, alternative medicine is fast catching on as a treatment for all cancers. This is mainly because of the dissatisfaction of individuals with conventional medicine.
There are numerous nutrition supplements and herbs which are found in every store all over the country- all of them claiming great success in treating prostate disease and cure all other cancers. Most of the success of these products is claimed by the industry and the manufacturers.The question remains, are these therapies effective?
Anecdotal data always suggests that these products are effective but no large controlled trials are available on the majority of these products. Even though these products are widely used, there is absolutely no regulation or control of these products. The ingredients, their content or their purity is not assessed and their long term safety remains unknown. In addition, fake supplements are on the increase and buyer better beware.Herbal Supplements: There are a number of nutritional herbs claiming to be effective in the treatment of prostate cancer but there is not an iota of medical evidence that any of these substances work.
The herbs postulated to have activity against prostate cancer include chaparral, PC SPES and shark cartilage. The majority of these products have not been shown to have any benefit in humans and yet they are sold in all herbal stores.
Because it's not always easy to tell which products may be unsafe, the best advice is to seek speak to your physician. These products are by no means cheap and by having blind faith in these products, one not only tends to lose their money but also their life.
Alternative medicine: Like everything in medicine, alternative medicine is fast catching on as a treatment for all cancers. This is mainly because of the dissatisfaction of individuals with conventional medicine.
There are numerous nutrition supplements and herbs which are found in every store all over the country- all of them claiming great success in treating prostate disease and cure all other cancers. Most of the success of these products is claimed by the industry and the manufacturers.The question remains, are these therapies effective?
Anecdotal data always suggests that these products are effective but no large controlled trials are available on the majority of these products. Even though these products are widely used, there is absolutely no regulation or control of these products. The ingredients, their content or their purity is not assessed and their long term safety remains unknown. In addition, fake supplements are on the increase and buyer better beware.Herbal Supplements: There are a number of nutritional herbs claiming to be effective in the treatment of prostate cancer but there is not an iota of medical evidence that any of these substances work.
The herbs postulated to have activity against prostate cancer include chaparral, PC SPES and shark cartilage. The majority of these products have not been shown to have any benefit in humans and yet they are sold in all herbal stores.
Because it's not always easy to tell which products may be unsafe, the best advice is to seek speak to your physician. These products are by no means cheap and by having blind faith in these products, one not only tends to lose their money but also their life.
More Treatments for Prostate Cancer
Cryotherapy: Cryotherapy involves use of freezing temperatures to destroy the cancer cells. Cryotherapy has been used to treat prostate cancer in the past. It involves the use of a probe placed through the rectum and freezes the prostate.
The freezing action destroys the cancer cells. However, previous results were poor and associated with a number of complications including damage to surrounding structures such as the bladder and rectum. Bladder incontinence was a major complication of Cryotherapy.
Observation: The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose observation as a treatment option. With observation, one has to have regular follow-ups, frequent blood tests, repeat rectal exams and possibly biopsies to monitor the progression of the early cancer.
Prevention: Unfortunately prostate cancer can’t be prevented but one can take measures to decrease the risks or slow its progression. The most important steps one can take to maintain good health is to well, be physically active and get regular check up from the doctor.
The freezing action destroys the cancer cells. However, previous results were poor and associated with a number of complications including damage to surrounding structures such as the bladder and rectum. Bladder incontinence was a major complication of Cryotherapy.
Observation: The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose observation as a treatment option. With observation, one has to have regular follow-ups, frequent blood tests, repeat rectal exams and possibly biopsies to monitor the progression of the early cancer.
Prevention: Unfortunately prostate cancer can’t be prevented but one can take measures to decrease the risks or slow its progression. The most important steps one can take to maintain good health is to well, be physically active and get regular check up from the doctor.
Additional Treatments for Prostate Cancer
Orchidectomy: A few men elect to undergo an orchidectomy. The testes are a major source of testosterone and surgical removal of the testes eliminates the hormone. This mode of therapy is usually for individuals with advanced prostate cancer and is quite effective. The procedure is not as painful as it sounds. The surgery is done under general/local anesthesia and takes 30-45 minutes. Most patients are discharged home the same day.
Radical prostatectomy: Surgical removal of the prostate gland is another option for patients with prostate cancer. This is a major surgical procedure which removes the entire prostate and adjacent lymph nodes. The surgeon tries to preserve the nerves and muscles which control urination and sexual function. Both have been designed to prevent the complication to the adjacent organs, however, a fair number of individuals continue to have complications. Complications of surgery include impotence and urinary incontinence.
Chemotherapy: Chemotherapy drugs are frequently used to treat prostate cancer. These toxic drugs kill the rapidly growing cancer cells. This form of therapy is not curative but can help control the spread. However, chemotherapy is associated with more side effects and is generally given to men who have prostate cancer which did not respond to hormonal therapy. Today, various combinations of chemotherapeutic drugs are used and may even be combined with hormones. Early results are positive but long term resulting are not available.
Future therapy: Current trials are evaluating use of stem cells, gene therapy and immune therapy in the treatment of prostate cancer which has already spread. These newer treatments are currently only available at major cancer centers.
Radical prostatectomy: Surgical removal of the prostate gland is another option for patients with prostate cancer. This is a major surgical procedure which removes the entire prostate and adjacent lymph nodes. The surgeon tries to preserve the nerves and muscles which control urination and sexual function. Both have been designed to prevent the complication to the adjacent organs, however, a fair number of individuals continue to have complications. Complications of surgery include impotence and urinary incontinence.
Chemotherapy: Chemotherapy drugs are frequently used to treat prostate cancer. These toxic drugs kill the rapidly growing cancer cells. This form of therapy is not curative but can help control the spread. However, chemotherapy is associated with more side effects and is generally given to men who have prostate cancer which did not respond to hormonal therapy. Today, various combinations of chemotherapeutic drugs are used and may even be combined with hormones. Early results are positive but long term resulting are not available.
Future therapy: Current trials are evaluating use of stem cells, gene therapy and immune therapy in the treatment of prostate cancer which has already spread. These newer treatments are currently only available at major cancer centers.
Hormone Treatment for Prostate Cancer
Hormone therapy: Because testosterone is known to stimulate growth of prostate cancer cells, anti hormonal therapy is frequently used to treat prostate cancer. Hormone therapy either uses drugs to stop the production of the male sex hormones or the entire source of the hormone is surgically stopped by removing the testicle (orchidectomy).
Occasionally, both types of treatment are used.Hormonal therapy is most effective in men with advanced prostate cancer. The treatment does help to slow the growth and frequently shrinks the tumor. Because this therapy is effective in shrinking tumors, hormonal therapy is frequently used in the early stage of prostate cancer — often in combination with radiation and surgery.
Once the tumor size is downsized, surgery or radiation therapy can be used to destroy whatever tumor is left behind. Also available are drugs which prevent the release of signals from the brain to manufacture testosterone (LH-RH agonists). These longer acting drugs are injected every 2-3 months. The drugs can be continued for a prolonged time without undue side effects.
In the past decade, other anti testosterone drugs have become available in the treatment of prostate cancer. These medications include flutamide (Eulexin), bicalutamide (Casodex) and nilutamide (Nilandron). They can be taken orally and can be combined with LH-RH agonists.
Drug therapy, however, is not ideal for the treatment of prostate cancer. After a few years, most cancer cells develop mechanisms to resist these drugs and develop alternative mechanisms for survival. To prevent the development of drug resistance, intermittent hormone therapy programs have been developed. The PSA levels are monitored and once the levels start to drop, the drugs are stopped. If the PSA levels rise, the drugs are re-started again.
Occasionally, both types of treatment are used.Hormonal therapy is most effective in men with advanced prostate cancer. The treatment does help to slow the growth and frequently shrinks the tumor. Because this therapy is effective in shrinking tumors, hormonal therapy is frequently used in the early stage of prostate cancer — often in combination with radiation and surgery.
Once the tumor size is downsized, surgery or radiation therapy can be used to destroy whatever tumor is left behind. Also available are drugs which prevent the release of signals from the brain to manufacture testosterone (LH-RH agonists). These longer acting drugs are injected every 2-3 months. The drugs can be continued for a prolonged time without undue side effects.
In the past decade, other anti testosterone drugs have become available in the treatment of prostate cancer. These medications include flutamide (Eulexin), bicalutamide (Casodex) and nilutamide (Nilandron). They can be taken orally and can be combined with LH-RH agonists.
Drug therapy, however, is not ideal for the treatment of prostate cancer. After a few years, most cancer cells develop mechanisms to resist these drugs and develop alternative mechanisms for survival. To prevent the development of drug resistance, intermittent hormone therapy programs have been developed. The PSA levels are monitored and once the levels start to drop, the drugs are stopped. If the PSA levels rise, the drugs are re-started again.
Radiation for Prostate Cancer
Prostate cancer can be treated in more than one way. Depending on the rate of growth, age, life expectancy, stage and spread, combination therapy is often used. The most common treatments for prostate cancer include the following:
Radiation: One may either receive direct radiation therapy to the prostate or the surgeon may place small radioactive implants in the prostate. They both work by killing the cancer cells. Today, radiation therapy is applied in a very sophisticated way to prevent toxicity.
With precise focusing of radiation beams, greater doses of radiation can be given to decrease the frequency of complications. During the radiation therapy, all individuals are protected by custom-designed shields.
Radiation treatments are generally given over a 6-8 week period. Radioactive seed implants: Another radiation option is to implant radioactive seeds into the prostate gland. Implantation of these seeds is also known as brachytherapy. Unlike external beam radiation, these implanted seeds deliver a higher dose of localized radiation than do external beams over a much longer period of time.
The implantation of these radioactive seeds requires surgery under general anesthesia and takes about 1-3 hours. This therapy is generally used in men with small to moderate size low grade prostate cancers. Because the radiation exposure is limited to the prostate, there is no risk to others.
Radiation: One may either receive direct radiation therapy to the prostate or the surgeon may place small radioactive implants in the prostate. They both work by killing the cancer cells. Today, radiation therapy is applied in a very sophisticated way to prevent toxicity.
With precise focusing of radiation beams, greater doses of radiation can be given to decrease the frequency of complications. During the radiation therapy, all individuals are protected by custom-designed shields.
Radiation treatments are generally given over a 6-8 week period. Radioactive seed implants: Another radiation option is to implant radioactive seeds into the prostate gland. Implantation of these seeds is also known as brachytherapy. Unlike external beam radiation, these implanted seeds deliver a higher dose of localized radiation than do external beams over a much longer period of time.
The implantation of these radioactive seeds requires surgery under general anesthesia and takes about 1-3 hours. This therapy is generally used in men with small to moderate size low grade prostate cancers. Because the radiation exposure is limited to the prostate, there is no risk to others.
Prognosis of prostate cancer
When prostate cancer is not treated, a whole host of complications can occur. The typical complications of untreated prostate cancer include:
- Spread of cancer: Prostate cancer can spread to nearby organs and bones and can be life-threatening.
- Pain: Although early-stage prostate cancer typically isn't painful, once it spreads to bones, it may produce severe pain. In most cases the pain is severe and requires some form of treatment. These treatments may include hormonal therapy, radiation therapy or chemotherapy. If these treatments aren't successful in relieving pain, a pain management consult is required. In most cases, narcotics are required to relieve the pain.
- Urinary incontinence: Prostate cancer can cause varying degrees of incontinence. Treatments may include behavior modifications, exercises to strengthen pelvic muscles (Kegel exercises), drugs and catheters. If the above fail, complex surgery is required with no guarantee that it will work.
- Erectile dysfunction (ED) or impotence: Like incontinence, ED can be a result of prostate cancer. Various drugs and mechanical devices are available that may assist in achieving an erection. Current drugs include Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). When all these fail, surgical penile implant is the last resort to help achieve an erection.
- Depression. Whenever a diagnosis of cancer is made, it is natural for all individuals to develop depression. The severity and duration of depression may determine the treatment. When depression affects one’s ability to manage life and family, treatment is recommended. Treatment may involve psychological counseling or drug therapy. In many cases, a combination of the two therapies often is successful.
- Spread of cancer: Prostate cancer can spread to nearby organs and bones and can be life-threatening.
- Pain: Although early-stage prostate cancer typically isn't painful, once it spreads to bones, it may produce severe pain. In most cases the pain is severe and requires some form of treatment. These treatments may include hormonal therapy, radiation therapy or chemotherapy. If these treatments aren't successful in relieving pain, a pain management consult is required. In most cases, narcotics are required to relieve the pain.
- Urinary incontinence: Prostate cancer can cause varying degrees of incontinence. Treatments may include behavior modifications, exercises to strengthen pelvic muscles (Kegel exercises), drugs and catheters. If the above fail, complex surgery is required with no guarantee that it will work.
- Erectile dysfunction (ED) or impotence: Like incontinence, ED can be a result of prostate cancer. Various drugs and mechanical devices are available that may assist in achieving an erection. Current drugs include Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). When all these fail, surgical penile implant is the last resort to help achieve an erection.
- Depression. Whenever a diagnosis of cancer is made, it is natural for all individuals to develop depression. The severity and duration of depression may determine the treatment. When depression affects one’s ability to manage life and family, treatment is recommended. Treatment may involve psychological counseling or drug therapy. In many cases, a combination of the two therapies often is successful.
Grading of Prostate Cancer
Once prostate cancer has been diagnosed, further testing is done to determine if spread has occurred. The majority of men do not require these additional investigations if no other symptoms are present. Treatment of the prostate cancer is then based on the needle biopsy results.
Test to determine spread of cancer are all radiological and may include a bone scan, Ultrasound, CT or MRI. Sometimes biopsy of the lymph nodes in the pelvis is required to determine if they are cancerous.
Grading
Whenever a cancer is diagnosed, the next step is to define the grade-which allows one to determine it aggressiveness. The degree of aggressiveness can be evaluated by looking at the degree of differentiation of the prostate cells.
The degree of differentiation is then graded. With prostate cancer, a grading scale known as the Gleason score is used to define the degree of differentiation. The Gleason grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer.
The Gleason scores may be helpful in determining which is the best treatment option. Once grading of the cancer has been completed, the next step is to define the stage of the cancer. This basically determines if the cancer has spread and how far the spread has occurred.
Test to determine spread of cancer are all radiological and may include a bone scan, Ultrasound, CT or MRI. Sometimes biopsy of the lymph nodes in the pelvis is required to determine if they are cancerous.
Grading
Whenever a cancer is diagnosed, the next step is to define the grade-which allows one to determine it aggressiveness. The degree of aggressiveness can be evaluated by looking at the degree of differentiation of the prostate cells.
The degree of differentiation is then graded. With prostate cancer, a grading scale known as the Gleason score is used to define the degree of differentiation. The Gleason grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer.
The Gleason scores may be helpful in determining which is the best treatment option. Once grading of the cancer has been completed, the next step is to define the stage of the cancer. This basically determines if the cancer has spread and how far the spread has occurred.
Screening and Diagnosis of Prostate Cancer
Screening tests
Since Prostate cancer does not cause symptoms in the early stage, the following screening tests are recommended and include:
- Digital rectal exam (DRE): A digital rectal exam is not fun but essential in examining the prostate. The digital exam can discover the presence of any abnormalities in the texture, shape or size of your gland.
- Prostate-specific antigen (PSA) test: This blood test analyzes the levels of a chemical released from the prostate. Higher levels are not always specific for prostate cancer because infection, inflammation or prostate enlargement may also cause an increase in this chemical.
- Transrectal ultrasound: If the above tests raise any suspicion of prostate cancer, a small probe is placed through the rectum and the gland is analyzed. The images can reveal the presence of any mass or deformity of the gland.
Prostate biopsy
If there is suspicion that a mass may be present, a prostate biopsy is the next step. The biopsy is done under ultrasound guidance. The ultrasound probe is placed through the rectum and will identify any abnormal areas.
A fine needle is then inserted for a biopsy. There is minimal pain associated with the test. The tissue specimen is analyzed by the pathologist and the grade of the tumor is determined.
Since Prostate cancer does not cause symptoms in the early stage, the following screening tests are recommended and include:
- Digital rectal exam (DRE): A digital rectal exam is not fun but essential in examining the prostate. The digital exam can discover the presence of any abnormalities in the texture, shape or size of your gland.
- Prostate-specific antigen (PSA) test: This blood test analyzes the levels of a chemical released from the prostate. Higher levels are not always specific for prostate cancer because infection, inflammation or prostate enlargement may also cause an increase in this chemical.
- Transrectal ultrasound: If the above tests raise any suspicion of prostate cancer, a small probe is placed through the rectum and the gland is analyzed. The images can reveal the presence of any mass or deformity of the gland.
Prostate biopsy
If there is suspicion that a mass may be present, a prostate biopsy is the next step. The biopsy is done under ultrasound guidance. The ultrasound probe is placed through the rectum and will identify any abnormal areas.
A fine needle is then inserted for a biopsy. There is minimal pain associated with the test. The tissue specimen is analyzed by the pathologist and the grade of the tumor is determined.
Symptoms of Prostate Cancer
In the early stage of prostate cancer, most individuals have no symptoms. However, when the cancer grows or spreads, the individual may present with a weak urine flow, frequent urination at night or blood in the urine.
Other rare features may include pain on urination or pain the lower back.
Unfortunately there are no early signs or symptoms of prostate cancer.
The general advice is that if one is 50 or older, one should undergo prostate cancer screening.
A blood test is also recommended to check for prostate-specific antigen (PSA) beginning at age 50, or earlier if one has risk factors for cancer.
A digital rectal exam as early as age 40 is also advised in individuals with risk factors.
Other rare features may include pain on urination or pain the lower back.
Unfortunately there are no early signs or symptoms of prostate cancer.
The general advice is that if one is 50 or older, one should undergo prostate cancer screening.
A blood test is also recommended to check for prostate-specific antigen (PSA) beginning at age 50, or earlier if one has risk factors for cancer.
A digital rectal exam as early as age 40 is also advised in individuals with risk factors.
Risk Factors for prostate cancer
Risk factors
Knowing the risk factors may help to prevent or delay the onset of prostate cancer. In addition, knowledge about risk factors may also help one undergo early screening. The risk factors identified to cause prostate cancer include:
- Age. As one gets old, the chances of having prostate cancer increase. It is recommended that after age 50, men should have regular prostate evaluation.
- Ethnicity. Of all ethnic groups, blacks have the highest risk of prostate cancer.
- Hereditary. If anyone in the family has prostate cancer, the chance of a family member developing the cancer are greatly increased
- Nutrition. A high-fat diet and obesity have been associated with an increase in prostate cancer. It is believed that fat stores are important for production of testosterone, and thus reduction in a fatty diet may reduce the risk of developing prostate cancer.
- Vasectomy: Although it has been suggested that vasectomy may be a risk factor for prostate cancer, there is no conclusive evidence to substantiate this fact.
- High levels of testosterone. Men who have high levels of testosterone are at high risk for prostate cancer. Long term testosterone treatment has been linked to benign prostate hypertrophy and there is a concern that these individuals should undergo regular screening for prostate cancer.
Knowing the risk factors may help to prevent or delay the onset of prostate cancer. In addition, knowledge about risk factors may also help one undergo early screening. The risk factors identified to cause prostate cancer include:
- Age. As one gets old, the chances of having prostate cancer increase. It is recommended that after age 50, men should have regular prostate evaluation.
- Ethnicity. Of all ethnic groups, blacks have the highest risk of prostate cancer.
- Hereditary. If anyone in the family has prostate cancer, the chance of a family member developing the cancer are greatly increased
- Nutrition. A high-fat diet and obesity have been associated with an increase in prostate cancer. It is believed that fat stores are important for production of testosterone, and thus reduction in a fatty diet may reduce the risk of developing prostate cancer.
- Vasectomy: Although it has been suggested that vasectomy may be a risk factor for prostate cancer, there is no conclusive evidence to substantiate this fact.
- High levels of testosterone. Men who have high levels of testosterone are at high risk for prostate cancer. Long term testosterone treatment has been linked to benign prostate hypertrophy and there is a concern that these individuals should undergo regular screening for prostate cancer.
Prostate Cancer Part 1
All men over the age of 50 are at a risk for prostate cancer. Although prostate cancer rarely occurs in young males, the disorder is primarily seen in older men and the risk of prostate cancer increases with age. More than 70% of men over the age of 65 are annually diagnosed with prostate cancer.
Prostate cancer is the most commonly diagnosed cancer among North American men and accounts for 25% of cancers in men. Epidemiology shows that incidence rates for prostate cancer vary geographically. In North America there are variations in incidence rates within the population: the black population has a significantly higher rate than the white population and the Asian population have the lowest rate.
The prostate is a small, walnut-shaped organ located in the rectal area. It surrounds the base of the bladder through which runs the urethra. The primary function of the prostate is to produce seminal fluid which provides nourishment and transports sperm.
Prostate cancer is generally a slow growing tumor and typically starts off in the periphery of the gland. In the early stages, prostate cancer causes no symptoms. However, if left untreated, it can grow and invade adjacent organs and spread to other parts of the body. What causes prostate cancer and why some subtypes behave differently remains unknown. It is believed that a multitude of factors such as heredity, ethnicity, hormones, diet and environment may play a role in the cause of prostate cancer.
Prostate cancer is the most commonly diagnosed cancer among North American men and accounts for 25% of cancers in men. Epidemiology shows that incidence rates for prostate cancer vary geographically. In North America there are variations in incidence rates within the population: the black population has a significantly higher rate than the white population and the Asian population have the lowest rate.
The prostate is a small, walnut-shaped organ located in the rectal area. It surrounds the base of the bladder through which runs the urethra. The primary function of the prostate is to produce seminal fluid which provides nourishment and transports sperm.
Prostate cancer is generally a slow growing tumor and typically starts off in the periphery of the gland. In the early stages, prostate cancer causes no symptoms. However, if left untreated, it can grow and invade adjacent organs and spread to other parts of the body. What causes prostate cancer and why some subtypes behave differently remains unknown. It is believed that a multitude of factors such as heredity, ethnicity, hormones, diet and environment may play a role in the cause of prostate cancer.
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