Prostate Cancer

The prostate is a gland approximately the size of a walnut located just below the bladder in men. It promotes proper sexual function by contributing fluid to the ejaculate. Because prostate cancer is usually a slow growing cancer, many men diagnosed with the disease will die from causes unrelated to their prostate cancer, but aggressive variants of prostate cancer do exist. Differentiating between those types is very important.

Symptoms

Most commonly, prostate cancer causes no symptoms other than an abnormal blood test that measures the presence of prostate specific antigen (PSA). Other, but more rare, presenting symptoms can include difficulty urinating or pain in the back, hips or legs.


Causes and Risk Factors

Although the cause of prostate cancer is unknown, several factors are associated with an increased risk of developing this cancer.

  • Age. About 80 percent of these tumors are discovered in men older than 65.
  • One in six men will develop invasive cancer of the prostate during his lifetime, though not all of these cancers will be life-threatening and require aggressive treatment.
  • Family history. Men with relatives who have prostate cancer are at greater risk, especially if those relatives were diagnosed before the age of 60. If these relatives are first degree (i.e. father, brother), the risk is even higher.
  • Black men are twice as likely to develop prostate cancer as Caucasian men and are more likely to develop an aggressive form of the disease
  • High-fat diet and obesity

Diagnosis

Screening tests have made it easier to detect early-stage prostate cancer when it is generally most responsive to cure. These tests include:

  • Prostate Specific Antigen (PSA) test. PSA is a substance that is normally secreted by prostate cells. Cancer cells may sometimes produce higher levels of PSA than normal cells, allowing the diagnosis of cancer to be made. An elevated PSA, however, does not always mean a person has prostate cancer. The latest recommendations state that all men should begin yearly PSA screening at age 40.
  • Digital rectal exam. This should be a regular part of yearly physical exams for men beginning at age 40.
  • Biopsy. This is the only sure way to determine whether prostate cancer is present. The urologist inserts a needle into the prostate gland, with the assistance of ultrasound, to remove small pieces of tissue from different areas of the gland. These will be examined by a pathologist under a microscope. If prostate cancer is present, additional testing may be required to help determine whether the disease has spread to surrounding tissues or beyond. These tests may include computed tomography (CT or CAT scan), magnetic resonance imaging MRI or a nuclear bone scan. We offer technology to take MRI images of the prostate and fuse them to the prostate ultrasound and increase the precision of the biopsy.
  • Gleason Grading and Score. Gleason grading is an analytic tool used to determine how likely a cancerous tumor is to spread outside of the prostate or within the body. Gleason scores range from 2 to 10 and a lower score likely means a tumor is less likely to spread. A higher Gleason score likely means the cancerous cells are more aggressive and have a higher propensity to spread.
  • Prostate CT Scan. A computed tomography (CT) scan can aid doctors in understanding prostate cancer disease progression. This scan also can tell if prostate cancer has spread to nearby lymph nodes or if the disease has spread to the pelvis or other organs.
  • Prostate Ultrasound. A prostate ultrasound is used to evaluate abnormal results from either a Digital Rectal Exam (DRE) or Prostate-Specific Antigen (PSA) test. Using a probe that is inserted into the rectum, the ultrasound produces high-frequency sound waves that are recorded and transformed into video or images of the prostate gland.

Treatments

Prevent Prostate Cancer With Proper Nutrition

A comprehensive approach to cancer care warrants the inclusion of a nutritional approach to disease prevention and treatment. It is important to remember that the research on nutritional approaches to prostate cancer is at a preliminary stage. While significant evidence does exist, more research must be completed before the specific effects of diet on prostate cancer can be entirely proven. Furthermore, most of the available data on nutrition have been derived from studies that monitored the consumption of food rather than nutritional or herbal supplements.

Current studies are focusing more on nutrition as an integral part of treatment. Several nutrients have been studied for their role in the progression of prostate cancer. The following sections give general information about these nutrients, including the results of medical research on each nutrient and recommendations for individuals with this disease.

Dietary Fat and Fatty Acids for Prostate Cancer

Dietary fat provides energy and essential fatty acids for the body. In addition, fat acts as a carrier for vitamins A, D, E and K. Fats are classified loosely as saturated, monounsaturated or polyunsaturated, depending upon which type of fatty acid is predominant in the fat. Polyunsaturated fats (found primarily in vegetable oils, such as oils of corn, safflower and sunflower) contain high amounts of linoleic acid, a fatty acid that stimulates prostate cancer cell growth. Olive oil consists predominantly of monounsaturated fat and does not pose a problem. Overall, high-fat diets are linked to an increased risk for prostate cancer. During the metabolism of fat, a large number of damaging free radicals are produced. These damaging molecules can promote the growth of cancerous cells.

Dietary Fiber for Prostate Cancer

Dietary fiber is derived from the structural components of plants. It includes the storage and cell wall parts of plants that cannot be broken down by human digestive enzymes. Fiber absorbs 10 to 15 times its weight in water. Therefore, it brings fluids to the intestines and increases movement of the bowels. Dietary fiber has many functions in the body. It may bind to carcinogens and other harmful compounds and eliminate them from the body.

Dietary fiber can be soluble or insoluble. Soluble fiber can be digested, and insoluble fiber cannot be digested. Sources of insoluble fiber include some fruits, fresh and cooked vegetables, wheat bran and whole grains. Sources of soluble fiber include apples, citrus fruits, oat bran, barley and legumes. In addition, fiber can lower cholesterol levels and decrease risks for some cancers. Fiber has also demonstrated the ability to lower the risk of prostate cancer progression. In fact, fiber may have the ability to decrease levels of testosterone. By eating high levels of soluble fiber, men may be able to lower their plasma levels of testosterone. Therefore, the testosterone is not available to stimulate tumor growth.

Fruits and Vegetables for Prostate Cancer

Fruits and vegetables offer several benefits. First, they contain antioxidants, which can destroy carcinogens. Second, they contain dietary fiber, which may lower testosterone levels, thus taking away a stimulus for tumor growth. In addition, fruits and vegetables contain a wide variety of phytonutrients, which are unique substances produced by plants to protect the plant cells against damage. These substances work the same way in the body, protecting cells against damage. Each phytonutrient works differently to promote overall good health. Many of these substances exhibit anti-cancer effects. Lycopene, the red pigment found in tomatoes, is a phytonutrient that exhibits anti-cancer effects.

Green Tea for Prostate Cancer

Green tea contains antioxidants called polyphenols. One of these compounds, called EGCG (epigallocatechin gallate), has more powerful antioxidant properties than vitamins C and E.


Treatment plans depend on such factors as tumor type, grade of disease (how aggressive), the stage of disease (how far it has spread) and the patient's age and general health. Treatment options may include:

  • Surgery, including removal of the prostate and local lymph nodes. This typically includes minimally invasive approaches such as robotic-assisted surgery.
  • Radiation therapy, including traditional external beam therapy and implantable radioactive "seeds" to kill cancer cells
  • Chemotherapy
  • Active surveillance, which is a program that allows a man diagnosed with prostate cancer to actively monitor his disease and have the highest quality of life possible while delaying or even completely avoiding invasive treatments.
  • Clinical trials, which explore new treatment options.
  • Hormone therapy, also known as Androgen Deprivation Therapy (ADT), prevents the production of male sex hormones (known as androgens). Hormone therapy is used in combination with radiation therapy for men at several stages of cancer, including those with early-stage disease at high risk for recurrence or those who have advanced, recurrent or metastatic disease.
  • Prostatectomy is the surgical removal of the prostate gland, either in its entirety or in part. At Cedars-Sinai, all prostatectomies are completed using integrated, robotic technology.

Prostate cancer clinical trials underway at Cedars-Sinai are designed to explore various facets of the disease, including possible new treatment options — from surgery to radiation — as well as new diagnostic, imaging and genetic-based advancements.