Prostate
Cancer As A Source Of Abdominal Pain Introduction This
cancer is the most common cancer of men men above 50 in the United States. It
is for men what breast cancer is for women and this is true even on a histological
level, as both cancers are mostly glandular cancers (=adenocarcinomas) and both
are responding to hormones, breast cancer to estrogen and prostate cancer to testosterone.
About 200,000 new cases of prostate cancer are diagnosed in the U.S. every
year. The cancer grows slowly for a long period of time inside the very tough
prostatic capsule. Often it switches to the other prostatic lobe (there are two
lobes of the prostate gland). Next it breaks through the capsule and invades the
adjacent structures such as the seminal vesicles, the urethra, bladder, pelvic
lymph glands, the pelvic bone and via the blood stream enters bones such as vertebral
bodies or ribs. Prostate Cancer Symptoms
In the beginning of prostate cancer there are no symptoms. This is why an annual
prostate examination and annual PSA blood test should be done once a year on every
man 50 years or older. In case of early prostate cancer the physician would
pick up a hard lump in the prostate on rectal examination and often the PSA would
be positive (greater than 5). A late sign of prostate cancer is when there is
a bladder outlet obstruction with urgency, frequent urination or blood in the
urine. At this point the prostate capsule is likely ruptured with local invasion,
which would be a stage C out of 4 stages (stage A to D). When the cancer invades
into the pelvic bone there would be pain in that area. With vertebral bone metastases
spontaneous compression fractures can develop, with other bone metastases pathological
fractures can spontaneously occur. Prostate Cancer Tests In
the beginning there might be no symptoms. This is where the question of PSA screening
has been discussed among physicians for a long period. Some consensus seems
to be developing. As the PSA test is very sensitive, but not specific (as mentioned
before, BPH also often shows a positive PSA test), efforts are made to make the
test more specific by measuring the proportion of free versus protein bound PSA.
The physician also will likely order a transrectal ultrasound (=TRUS), which would
show hypoechoic lesions where the examining finger feels hard lumps. Another blood
test, the serum acid phosphatase test, is useful as it correlates well with lymph
gland invasion, but it is not specific for prostate cancer alone. Other
conditions such as multiple myeloma or hemolytic anemia would, for instance, also
give a positive test. However, a negative serum acid phosphatase test is reassuring
that the prostate cancer has not yet metastasized. The definitive test for prostate
cancer after all the other tests is a TRUS (=transrectal ultrasound) guided transrectal
needle biopsy. This can be done in a clinic without an anesthetic and
usually 6 separate locations throughout the prostate are sampled to increase the
accuracy. The pathologist will then analyze these biopsy samples. This method
is very accurate and very specific and must be done to confirm or rule out prostate
cancer. As in all cancers a tissue diagnosis is the only way
how to diagnose cancer of the prostate, this is a "must". Prostate
Cancer Treatment In stage A or B cancer, where the prostate
cancer has not extended beyond the prostate capsule, a radical selective prostatectomy
can be performed, which will safe this man's life. Let me explain: In the
past many urologists were of the opinion that there would be a "clinically
irrelevant" prostate cancer entity, as it often takes very long for prostate
cancer to metastasize. This is quite contrary to breast cancer where the cancer
metastasizes early. The difference is that in breast cancer there is no capsule
that confines the cancer, but in prostate cancer there is a very tough prostate
capsule, which confines the cancer cells until late stage B prostate cancer. One
of the big reasons why a man may not want to go for surgery is the fear that he
may lose his ability to have sex. Similar to the TURP procedure, where loss of
impotence is an issue (see chapter on "enlarged prostate") this concern
is very much in the mind of the man who is advised to have a radical selective
prostatectomy. In the past with a radical prostatectomy the nerves supplying
impulses to the penis for erection were severed. However, now the urologist can
explain that with the help of new technology using an operating microscope, in
most cases the selective radical prostatectomy
can preserve the nerves to the penis and therefore preserve potency after the
surgical procedure is done. However, the urologist can only do what is technically
possible and unfortunately there will be some cases where cancer tissue that has
to be removed has encased the nerve supply. In such a case in the interest of
the survival of the man's life, the nerves might have to be severed as the cancer
is removed. Overall the statistics show that about 85% of stage A and B
prostate cancer patients can have a successful selective radical prostatectomy
and only 15% lose their potency. For stage C cancer local radiotherapy treatments
or radioactive seed implants will likely slow cancer growth for a period of time,
but survival rates are much worse than for patients after a selective radical
prostatectomy. Occasionally the urologist might combine the two. In late stage
C and D prostate cancer patients hormone therapy aimed at removing testosterone
from the system can often buy significant survival time. The most effective
method is a bilateral orchiectomy (=removal of both testicles). A medical castration
can also be achieved with luteinizing hormone-releasing hormone analogues. The
urologist will explain, which therapy would be the best fit for a particular patient.
In late stage D patients emphasis is placed on pain relief with local radiotherapy
to bone metastases and possibly some chemotherapy to slow down cancer growth. Pain
Control: There is an FDA approved non-drug method available, IceWave
patches from Lifewave, which will control pain. This is mentioned in the
book "Breakthrough" by Suzanne Somers (Ref. 9) where newer insights
of antiaging medicine are also reviewed. Although the patches are placed over
acupuncture points, there are no needles involved. Nanotechnology, a newer technology,
was used in the manufacturing of these patches and infrared (heat) waves from
body heat are utilized to stimulate an acupuncture point, which modifies pain
perception and reduces pain to half or less. Medically this would be considered
an excellent pain reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the US a 5 pack of the
IceWave spray is available that can be directly sprayed onto the skin in the area
where the pain is located. Click at this link for a more detailed review of
prostate cancer.
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