Natural Cures For Prostate Cancer

The 21 Day Prostate Fix

21 Day Prostate Fix written by Radu Belasco is a healthier alternative to drugs and invasive medical procedures. Radu Belasco is an early prostate problem sufferer, with a family history of prostate pain, problems and cancer. Using a unique system of natural remedies, he fixed his prostate problems and wrote them in his smash hit eBook The 21 Day Prostate Fix. It is about miraculous herbs and fruits from all over the world. These unique foods have the power to cure your prostates inflammation in record time and shrink it to a healthier size. Also, you will learn how to concoct the miracle elixir that will not just cleanse your prostate, but also burn body fat. Aside from these, youll get topnotch information on nutrition, so you can keep your prostate healthy and your sex drive at its peak. Plus, youll learn other health conditions that might be contributing to your prostate issues, so you can also remedy them and get your body in its best shape ever.

The 21 Day Prostate Fix Overview

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What are the signs and symptoms of an enlarged prostate either cancer related or benign

The prostate gland in the adult male is normally about 20 to 25 cm3 in size. Over time, the prostate gland may grow as a result of benign enlargement of the prostate, known as benign prostatic hyperplasia (BPH), or as a result of prostate cancer. Enlargement of the prostate gland may cause changes in urinary symptoms however, the severity of urinary symptoms does not correlate with the size of the prostate. In fact, some men with mildly enlarged prostates (for example, 40 cm3) may be more symptomatic than men with greatly enlarged (> 100 cm3) prostate glands. The symptoms of an enlarged prostate are caused by the prostate's resistance to the outflow of urine and the bladder's response to this resistance. Common symptoms include

Are there any other blood tests to check for prostate cancer

Early Prostate Cancer Antigen (EPCA) and EPCA-2 have been demonstrated to be plasma-based markers for prostate cancer. EPCA is found throughout the prostate and represents a field effect associated with prostate cancer, whereas, EPCA-2 is found only in the prostate cancer tissue. However, EPCA-2 is able to get into the plasma, the liquid part of the blood, allowing for it to be detected by a blood test. In preliminary studies, EPCA-2 has been able to identify men with prostate cancer who had normal PSA levels. This data, however, is preliminary and further studies are needed to validate the sensitivity and specificity of these markers. Others are investigating the ability for urinary markers to detect prostate cancer, specifically alpha-methyl-acyl-CoA racemase (AMACR) and prostate cancer antigen 3 (PCA 3) urinary transcript levels obtained from urine sediments following digital rectal examination and pro-static massage.

What is prostate cancer

Prostate cancer is a malignant growth of the glandular cells of the prostate. Our body is composed of billions of cells they are the smallest unit in the body. Normally, each cell functions for a while, then dies and is replaced in an organized manner. This results in the appropriate number of cells being present to carry out necessary cell functions. Sometimes there can be an uncontrolled replacement of cells, leaving the cells unable to organize as they did before. Such abnormal growth of cells is called a tumor. Tumors may be benign (noncancerous) Prostate malignant growth of the glandular cells ofthe prostate. As with most cancers, prostate cancer is not contagious.

Transurethral Resection of Prostate

In 1988, Davies demonstrated the feasibility of the robotic transurethral resection of the prostate using the PUMA 560 (9). The Surgeon-Assistant Robot for Prostatectomy, consisting of a small cutting blade rotating at 40,000 r.p.m., was derived from a six-axis PUMA robot to perform transurethral resection of the prostate. After further development at the Imperial College from 1993 to 1995, the Surgeon-Assistant Robot for Prostatectomy was renamed PROBOT (a robot for prostatectomy) and specifically designed to perform transurethral resection of the prostate. Studies showed that the entire resection could be successfully completed with good hemostasis (10). The major limitation of this technique was the inaccuracy in determining prostatic dimensions using transrectal ultrasound (10).

How common is prostate cancer

There are more than 100 different types of cancer. In the United States, a man has a 50 chance of developing some type of cancer in his lifetime. In American men, (excluding skin cancer) prostate cancer is the most common cancer. Prostate cancer accounts for about 33 (234,460) of cases of cancer (Table 2). More than 75 of the cases of prostate cancer are diagnosed in men older than 65 years. Based on cases diagnosed between 1995 and 2001, it is estimated that 91 of the new cases of prostate cancer are expected to be diagnosed at local or regional stages (see staging of prostate cancer), for which 5-year survival is nearly 100 . It is estimated that prostate cancer will be the cause of death in 9 of men, 27,350 prostate cancer related deaths. In the United States, deaths from prostate cancer have decreased significantly by 4.1 per year from 1994 to 2004. Most notably, the death rate for African American men in the United States has decreased by 6 . Prostate

What are the riskfactors for prostate cancer and who is at riskIs there anything that decreases the risk of developing

Theoretically, all men are at risk for developing prostate cancer. The prevalence of prostate cancer increases with age, and the increase with age is greater for prostate cancer than for any other cancer. Theoretically, all men are at risk for developing prostate cancer. Basically, every 10 years after the age of 40 years, the incidence of prostate cancer nearly doubles, with a risk of 10 for men in their 50s increasing to 70 for those in their 80s. However, in most older men, the prostate cancer does not grow and many die of other causes and are not identified as having prostate cancer before their death. Prostate cancer is 66 more common among African Americans, and it is twice as likely to be fatal in African Americans as in Caucasians. However, blacks in Africa have one of the lowest rates of prostate cancer in the world. Males of Asian descent living in the United States have lower rates of prostate cancer than Caucasians, but higher rates than Asian males in their native...

Androgen receptor function and prostate disease

The human prostate is a major site of disease, especially in elderly men. An increasing number is affected by prostate cancer and orbenign prostate hyperplasia (BPH). Established risk factors are the presence of androgens and age (Cook and Watson 1968). In addition, genetic factors and environmental influences such as high saturated fat, low fruit vegetable diet and decreased sunlight exposure (vitamin D production) and life style also influence the risk for prostate disease (Stanford et al. 1999). In benign prostate hyperplasia, the presence of the androgen DHT that stimulates prostate growth through androgen receptor activation seems to be critical and reduction of DHT levels by inhibition of 5a-reductase is a successful therapy (Bartsch et al. 2000). In addition, alterations of the AR signaling, function and structure are associated with the progression of prostate cancer from a hormone-sensitive to a therapy-refractory state.

Androgen ablation therapy of prostate cancer

Androgen withdrawal induces programmed cell death (apoptosis) in prostate cells resulting in prostate tissue involution and, after some time, only a rudimentary prostate is left that is composed mainly of stromal cells (Kyprianou and Isaacs 1988 English et al. 1989). This process is reversible. Re-stimulation with androgens results in rapid proliferation and growth of the gland to its adult size. When rats are castrated one can observe massive induction of programmed cell death starting about 24-48 hours later and continuing 7-10 days (Denmeade etal. 1996). Associated with androgen withdrawal is a rapid increase in expression of transforming growth factor-S (TGF-S), an inhibitor of prostate cell proliferation, and of testosterone-repressed message-2 (Kyprianou and Isaacs 1989). The latter encodes a glycoprotein also known as clusterin or sulphated glycoprotein-2 (SGP-2) that acts as a chaperone and has antiapoptotic properties in prostate tumor cells (Sensibar et al. 1995 Humphreys et...

What are the warning signs of prostate cancer

Prostate cancer gives no typical warning signs that it is present in your body. It often grows very slowly, and some of the symptoms related to enlargement of the prostate are typical of noncancerous enlargement of the prostate, known as benign prostatic hyperplasia (BPH). When the disease has spread to the bones, it may cause pain in the area. Bone pain may present in different ways. In some men, it may cause continuous pain, while in others, the pain may be intermittent. It may be confined to a particular area of the body or move around the body it may be variable during the day and respond differently to rest and activity. If there is significant weakening of the bone(s), fractures may occur. More common sites of bone metastases include the hips, back, ribs, and shoulders. Some of these sites are also common locations for arthritis, so the presence of pain in any of these areas is not definitive for prostate cancer. If prostate cancer spreads locally to the lymph nodes, it often...

Androgen receptor as a therapy target in hormoneresistant prostate cancer

Currently there is no efficient method available to treat patients who relapse during androgen ablation therapy and develop an androgen-independently growing tumor. Based on an improved understanding of AR signaling in therapy-refractory prostate cancer, novel therapies are being developed that target AR in advanced tumor cells. Specific antisense AR oligonucleotides were identified that inhibit AR expression. Treatment of such prostate cancer cells resulted in reduced androgen receptor levels, growth inhibition and reduced PSA production in vitro and in vivo (Eder etal. 2000 2001). Another approach is the use of derivatives of the antibiotic geldanamycin that Table 2.1 Promiscuous mutant androgen receptors in prostate cancer Table 2.1 Promiscuous mutant androgen receptors in prostate cancer Of the about eighty androgen receptor gene mutations detected in prostate cancer specimens only some have been analyzed in terms of their functional consequences. Most of these mutations result in...

What causes prostate cancer What causes prostate cancer to grow

The exact causes of prostate cancer are not known. Prostate cancer may develop because of changes in genes. Alterations in androgen (male hormone) related genes have been associated with an increased risk of cancer. Alterations in genes may be caused by environmental factors, such as diet. The more abnormal the gene, the higher is the likelihood of developing prostate cancer. In rare cases, prostate cancer may be inherited. In such cases, 88 of the individuals will have prostate cancer by the age of 85 years. Males who have a particular gene, the breast cancer mutation (BRCA1), have a threefold higher risk of developing prostate cancer than do other men. Changes in a certain chromosome, p53, in prostate cancer are associated with high-grade aggressive prostate cancer. Table 4 Common Symptom-Directed Treatment Strategies in Advanced Prostate Cancer Table 4 Common Symptom-Directed Treatment Strategies in Advanced Prostate Cancer Hormonal treatment Transurethral prostatectomy Repeated...

Where does prostate cancer spread

As the prostate cancer grows, it grows through the prostate, the prostate capsule, and the fat that surrounds the prostate capsule. Because the prostate gland lies below the bladder and attaches to it, the prostate cancer can also grow up into the base of the bladder. Prostate cancer can also grow into the seminal vesicles, which are located adjacent to the prostate. It may continue to grow locally in the pelvis into muscles within the pelvis into the rectum, which lies behind the prostate or into the sidewall of the pelvis. The spread of cancer to other sites is called metastasis. When prostate cancer spreads outside of the capsule and the fatty tissue, it usually goes to two main areas in the body the lymph nodes that drain the prostate and the bones. The more commonly involved lymph nodes are those in the pelvis (Figure 5), and bones that are more Glandular structures that are located above and behind the prostate. They produce fluid that is part of the ejaculate. Figure 5 Lymph...

What is prostate cancer screening

The goal of any screening is to evaluate populations of people in an effort to diagnose the disease early. Thus, the goal of prostate cancer screening is the early detection of prostate cancer, ideally at the curable stage. Prostate cancer screening includes both a digital rectal examination and a serum PSA. Each of these is important in the screening process, and an abnormality in either warrants further evaluation. Only about 25 of prostate cancers are revealed by rectal examination most are detected by an abnormal PSA. Some studies suggest that even with PSA-based prostate cancer screening, up to 15 of men will have undetected prostate cancer. Newer screening tools, such as EPCA and EPCA-2, are being investigated (see Question 6). Because the prostate gland lies in front of the rectum, the back wall of the prostate gland can be felt by putting a gloved, lubricated finger into the rectum and feeling the prostate by pressing on the anterior wall of the rectum (Figure 6). The rectal...

What does a TRUS guided prostate biopsy involve

Is in place and completely goes away when the probe is removed. Men who have had prior rectal surgery, who have active hemorrhoids, or who are very anxious and cannot relax the external sphincter muscle may have more discomfort. Once the probe is in a good position, the prostate will be evaluated to make sure that there are no suspicious areas on the ultrasound. Ultrasound looks at tissues by sound waves. The probe emits the sound waves, and the waves hit the prostate and are bounced off the prostate and surrounding tissue. The waves then return to the ultrasound probe, and a picture is developed on the screen. The sound waves do not cause any discomfort. Prostate cancer tends to cause less reflection of the sound waves, a trait referred to as hypoechoic, so the area often looks different in an ultrasound image than the normal prostate tissue. After the prostate has been evaluated, biopsies are obtained. The transrectal ultrasound allows the urologist to visualize the location for the...

Are all prostate cancers the sameAre there different grades

Not all prostate cancers are the same. Prostate cancers may vary in the grade of the cancer and the stage of the cancer. The grade of a cancer is a term used to describe how the cancer cells look. That is, whether the cells look aggressive and not very similar to normal cells (high grade) or whether they look very similar to normal cells (low grade). The grade of the cancer is an important factor in predicting long-term results of treatment, response to treatment, and survival. With prostate cancer, the most commonly used grading system is the Gleason scale. In this grading system, cells are examined by a pathologist under the microscope and assigned a number based on how the cancer cells look and how they are arranged together (Figure 7). Because prostate cancer may be composed of cancer cells of different grades, the pathologist assigns numbers to the two predominant grades present. The numbers range from 1 (low grade) to 5 (high grade). Typically, the Gleason score is the total of...

Prostate development and malignancy

The prostate is an androgen-regulated organ and androgen receptor co-activators such as ARA24 and p160 are expressed in prostate tissue (see Chapter 12). Binding of these co-activators to the CAG repeat tract, which represents the androgen receptor's co-activator binding site, is reduced with increasing length of triplet numbers. Hence, the prostate should be an organ, in which effects of the CAG repeat polymorphism are visible. In general, there is a substantial difference in the incidence of prostate cancer between ethnic groups, with African Americans having a 20-to 30-fold higher incidence than East Asians (Hsing et al. 2000b). Such disparity cannot be explained entirely by screening bias in different populations. Also after multiple adjustments for ethnic and screening differences a significant contrast in incidence rates between African Americans, Caucasians and Asians is found (Platz etal. 2000 Ross etal. 1998). It can be assumed that a polymorphism of the AR with the capacity...

What is prostate cancer staging

By staging your cancer, your doctor is trying to assess, based on your prostate biopsy results, your physical examination, your PSA, and other tests and X-rays (if obtained), whether your prostate cancer is confined to the prostate, and if it is not, to what extent it has spread. Studies of large numbers of men who have undergone radical prostatectomy and pelvic lymph node dissections have provided for the development of nomograms predicting the pathologic stage of CaP based on clinical stage (TNM), PSA, and Gleason score (Table 5). It was initially thought that magnetic resonance imaging (MRI) would be very helpful in determining whether capsular penetration and extracapsular disease were present however, it has only proved to be useful in centers that perform large numbers of MRIs. Similarly, the use of computed tomographic (CT) scanning in assessing whether or not the cancer has spread to the pelvic lymph nodes has been disappointing. Knowing the stage (the size and the extent of...

What options do I have for treatment of my prostate cancer

After finally realizing that, despite feeling great, I did indeed have prostate cancer, I had to figure out what the best treatment for me was. When faced with the option of leaving my prostate in place or removing it, I knew that, even though I was petrified of surgery, it would be the best thing for me in the long run. I knew that I could not live with my prostate gland and the continuous question of whether there were any viable cancer cells remaining in my prostate after interstitial seeds or radiation therapy. An alternative to immediate treatment for men with presumed low-risk prostate cancer. Involves close monitoring and withholding active treatment unless there is a significant change in the patient's symptoms or PSA. Various treatment options are available for prostate cancer, each with its own risks and benefits (Table 7). The options available may vary with the grade of tumor, the extent of tumor spread, your overall medical health and life expectancy and your personal...

Prostate Specific Antigen

Prostate-specific antigen (PSA) is a glycoprotein protease enzyme produced by the epithelial cells of the prostate. This protein circulates in the serum and can become elevated because of benign and malignant conditions of the prostate. From 50 to 90 of PSA is protein bound and the remainder is free. PSA is used as a tumor maker for the screening, diagnosis, and management of prostate cancer. PSA lacks specificity for cancer, however, because it can be elevated in benign conditions such as benign prostatic hypertrophy (BPH). Estimates suggest that a PSA higher than 4 ng mL has sensitivity of 70 to 80 and specificity of 60 to 70 for prostate cancer. Factors other than prostate cancer can affect the PSA level (Table 15-21). Controversy surrounds the effect of the digital rectal examination (DRE) on PSA. Theoretically, digitally palpating the prostate gland should elevate the serum PSA. However, it appears that PSA elevations after DRE are probably not significant, so there is no...

What is a radical prostatectomyAre there different types

It has been 10 years since my radical prostatectomy, and I feel great. I am doing all of the things that I had done before the surgery and more. So far, my PSA has remained unde-tectable, and it is very reassuring to hear this at my urology clinic visits. Radical prostatectomy is the surgical procedure whereby the entire prostate is removed, as well as the seminal vesicles, the section of the urethra that passes through the prostate, the ends of the vas deferens, and a portion of the bladder neck. After the prostate and surrounding structures are removed, the bladder is then reattached to the remaining urethra. A catheter, which is a hollow tube, is placed through the penis into the bladder before the stitches that attach the bladder to the urethra are tied down. The catheter allows urine to drain while the bladder and urethra heal together. In open radical prostatectomy a small drain is often placed through the skin of the abdomen into the pelvis. This drain allows for drainage of...

What is an open prostatectomy

An open prostatectomy is the removal of the obstructing portion of a benign prostate through a surgical incision. Open prostatectomies are usually reserved for large prostates that weigh more than 100 grams. The open prostatectomy allows for the greatest amount of prostate tissue to be removed, but the morbidity is greater than less invasive options because it is an open surgical procedure. The most common approach to performing an open prostatectomy is through a lower abdominal incision that extends from the symphysis pubis to the umbilicus (belly button) (Figure 23). Figure 23 Types of surgical incisions for simple prostatectomy suprapubic or retropubic approach and perineal approach. After the surgeon enters the abdomen through this incision, he or she has two surgical choices. The first is to make an incision in the front wall of the bladder to approach the prostate. This is called a suprapubic prostatectomy. After the surgeon has entered the bladder, he or she can enucleate, or...

What is a transurethral prostatectomy TURP

A transurethral prostatectomy (TURP) is an operation designed to remove the prostate through the urethra no external incision is made. A TURP is performed using a resectoscope, which scrapes out the center of the prostate by using an electrical current to cut out the tissue with a loop. This procedure is ideal for men with small to moderate size prostate glands. It is difficult to perform in men with extremely large prostates, i.e. those 100 grams or larger, due to the duration of time that it takes to resect the prostate tissue and the risks incurred with the lengthy resection. Lengthy resections pose the risk of absorbing too much of the irrigation fluid and lowering the salt level in the blood stream (hyponatremia) In severe cases, hyponatremia can cause neurologic symptoms, including seizures. Fortunately, these complications occur vary rarely. TURPs are usually limited to prostate glands of 100 grams or smaller.

Prostatespecific Membrane Antigen

Prostate cancer cells overexpress a well-characterized surface antigen, prostate-specific membrane antigen (PSMA) (Tasch et al., 2001). An RNA selection was conducted against the extracellular component of PSMA called sPSM (Lupold et al., 2002). After six rounds of SELEX, two aptamers were identified. The two aptamers named xPSM-9 and xPSM-10 inhibited xPSM with a Kj of 2.1 and 11.9 nmol L respectively. Aptamer xPSM-10 was truncated (xPSM-10-3) and fluor-escently end-labeled to evaluate its ability to bind PSMA-expressing cancer cells. Using PSMA-positive LNCaP and a PSMA-negative PC-3 prostate cancer cell line, xPSM-10-3 bound to LNCaP cells but not PC-3, showing specificity for PSMA and its potential in therapeutic development for this target.

Detrimental Effects of ROS in Patients with Prostatitis

In patients suffering from prostatitis, a negative association with sperm motility and morphology has repeatedly been shown because this condition is also associated with increased leukocyte infiltration in semen. 109, 110 . Accordingly, significantly increased seminal oxidative stress has been observed in patients with prostatitis categories NIH I, NIH II, NIH IIIA and NIH IV 111, 112 . However, even in prostatitis categories NIH III (chronic abacterial prostatitis) and NIH IIIB (non-inflammatory chronic pelvic pain syndrome), elevated ROS concentrations accompanied by decreased anti-oxidant levels are present in the semen causing oxidative stress irrespective of the presence of leukocytes 113 . This oxidative stress could be triggered by cytokines 26 and is thought to prompt acrosomal dysfunction in terms of significantly reduced inducibility of the acrosome reaction 59 , possibly via destabilization of the sperm plasma membrane by LPO.

What is laser therapy of the prostate

Since the 1980s, several generations of lasers have been used to treat obstructive prostate symptoms. LASER is an acronym for light-amplification stimulated emission resonance. In practical terms, this means that the light energy is very focused and allows powerful and precise application of the light energy to tissue.

Role of testosterone in the development and maintenance of the prostate

The urogenital sinus is the embryonic anlagen from which the prostate develops in utero. For the prostate to develop normally, a critical level of androgenic stimulation is required at specific times during its development in utero (Wilson 1984). In the developing male, the fetal testis secretes testosterone into the fetal circulation at sufficient levels to stimulate the differentiation and growth of a portion of the urogenital sinus tissue, producing the definitive prostate gland. This usually begins during the first three months of fetal growth. If sufficient serum testosterone is not present at this critical state of intrauterine development, the prostate does not develop (Wilson 1984). After birth, serum testosterone levels decrease to a low baseline value until puberty, when they rise to the adult range (Frasier et al. 1969) (Fig. 12.2). Until puberty, the prostate remains small (approximately 1-2 g) (Isaacs 1984a). During puberty, the prostate grows to its adult size of...

Testosterone metabolism in the prostate

Quantitatively, the major circulating androgen in the blood is testosterone. Within the prostate, however, testosterone is enzymatically converted to 5a-dihydrotestosterone (DHT) (Wilson 1984). The class of enzymes responsible for the irreversible conversion of testosterone to DHT are the membrane-bound NADPH-dependent A4-3-ketosteroid 5a-oxidoreductases (i.e., 5a-reductases) (Bruchovsky and Wilson 1968). Biochemical studies have demonstrated that the irreversible conversion of testosterone to DHT by 5a-reductase (Fig. 12.1), involves a sequential series of steps (Levy et al. 1990). Initially, reduced nicotinamide-adenine din-ucleotide phosphate (NADPH) cofactor binds to the 5a-reductase enzyme to form a 5a-reductase-NADPH complex. Once formed, testosterone binds to this 5a-reductase-NADPH complex. Electrons are stereospecifically transferred from NADPH to reduce the A4 double bond of testosterone, producing a 5a-reductase-oxidized NADP+-5a-DHT complex. After 5a-DHT is produced, it...

Paracrine androgen axis in the normal prostate

In contrast to the regulation of transcription of the prostate differentiation marker proteins, AR in the nuclei of the secretory luminal cells does not directly regulate the survival of these cells nor does it positively regulate the proliferation and survival of the prostatic epithelial stem and transit amplifying cells. Instead, survival of the secretory luminal cells and the proliferation of the transit amplifying cells requires the androgen-dependent production of peptide growth factors by the prostatic stromal cells (Cunha etal. 1987 Hayward etal. 1992 Kurita etal. 2001). These processes are initiated by testosterone diffusing from the capillary bed in the stromal compartment of the normal prostate across the basement membrane (BM) to enter the basal epithelial cells. These basal cells express 5a-reductase type I and II proteins which enzymatically convert testosterone to 5a-dihydrotestosterone (Bonkhoff etal. 1996). Once formed, DHT diffuses both into the secretory luminal...

Androgen in benign prostatic hyperplasia

One explanation is that AR signaling in the nuclei of the prostatic secretory lumi-nal cells and the subset of AR expressing transit amplifying cells actively inhibits proliferation of these cells even in the presence of continuous andromedin stimulation (Geck etal. 1997 Ling etal. 2001 Whitacre etal. 2002). This mechanism has been documented experimentally using both human (Ling et al. 2001) and rodent (Whitacre et al. 2002) prostate epithelial cells. These latter studies have demonstrated that when AR negative prostatic epithelial cells are transgenically induced to express AR, and are then exposed to physiological levels of androgen, their in vitro proliferation is profoundly inhibited even in the presence of andromedins with no effect upon cell survival (Ling et al. 2001 Whitacre et al. 2002). These results demonstrate that for non-malignant prostatic epithelial cells, the ligand-occupied AR functions as a growth suppressor via its ability to inhibit andromedin-induced...

Role of androgen in prostate cancer

In order to appreciate the therapeutic relevance of these mechanistic distinctions, an understanding of the cellular heterogeneity and responsiveness of prostate cancer cellular subtypes is required. Androgen ablation therapy, whether by surgical or medical means, induces the elimination of only testosterone-dependent prostate cancer cells since these cells require a critical level of physiological androgen for their continuous proliferation and survival (Gao and Isaacs 1998 Gao etal. 2001 Kyprianou etal. 1990). Unfortunately, androgen ablation is not curative because, once clinically detected, prostate cancers are heterogeneously composed of clones of androgen-dependent cancer cells and also malignant clones which are androgen-independent (Isaacs 1999). These latter cells are androgen-independent since androgen occupancy of their nuclear AR is not required for their survival (Isaacs 1999). There are two basic subtypes of such androgen-independent prostate cancer cells. One subtype...

How is prostatitis treated

The treatment of bacterial prostatitis is with antibiotics. Patients with acute bacterial prostatitis may require a short stay in the hospital for intravenous antibiotics and then continue on antibiotics for 2 to 4 weeks. Men with chronic bacterial prostatitis may require a longer course of antibiotics. In those men with recurrent chronic bacterial prostatitis, the doctor may prescribe a low dose of antibioctics for 6 months to prevent recurrent infections. Often bacterial prostatitis is treated with a class of antibiotics called quinolones (for example, ciprofloxacin, norfloxacin, ofloxacin). For men who are allergic to quinolones alternative antibiotics may be used, depending on the sensitivity results of the urine culture. Such alternative antibiotics include doxycycline, minocycline, trimethoprim-sulfamethoxazole, and trimethoprim. If there is an increase in the number of bacterial colonies seen in either EPS or VB3, a diagnosis ofbacterial prostatitis is made, and treatment is...

Prostate and seminal vesicles

The prostate and seminal vesicles are androgen-sensitive organs and are small in hypogonadal patients. Their volumes increase under testosterone therapy. Testosterone induces their normal functions, as indicated by the appearance of seminal fluid. Well-substituted patients should have ejaculate volumes in the normal range (i.e. > 2 ml). There is much concern about the effects oftestosterone with regard to the development of benign prostatic hyperplasia (BPH) and carcinoma of the prostate and this issue is specifically dealt with in Chapters 2 and 21. A widely accepted theory on the pathogenesis of BPH suggests that prostatic enlargement is mediated through the action of 5a-DHT and that these alterations are related to intraprostatic events rather than to increases in serum concentrations of testosterone or 5a-DHT (Meikle et al. 1997 Morgentaler et al. 1996 Nomura et al. 1988). Furthermore, estrogens may be involved in hormonal regulation of prostatic tissue (Thomas and Keeman 1994)....

Prostate Sparing Laparoscopic Radical Cystectomy

Prostate- and seminal-sparing cystectomy may be an option in young patients whose preservation of urinary continence and sexual potency are fundamental (26). In carefully selected patients, this procedure was proposed in open surgically resulting in more than 90 of patients being potent, while nearly all are totally continent, with no additional oncologic risk. In 2003, Guazzoni et al. reported the initial three cases of laparoscopic nerve- and seminal-sparing cystectomy with extracorporeally created orthotopic ileal neobladder (27). The operative time was 410 to 480 minutes, blood loss was 150-300 mL, and hospital stay was eight to nine days. All three patients were fully continent and had normal sexual functions at three months after surgery. Cathelineau et al. reported the largest experience with laparoscopic radical cystectomy in 84 patients, including cystoprostatectomy in 31, and prostate-sparing cystectomy in 40 (28).

Indications Of Laparoscopic Radical Prostatectomy

The indications for the radical laparoscopic prostatectomy are the same as that for the open procedures including treatment of men with localized prostate carcinoma and a life expectancy of 10 years or more. TABLE 1 History and Technical Modifications of Laparoscopic Radical Prostatectomy The first reported case underwent laparoscopic radical prostatectomy Laparoscopic approach to seminal vesicles for its diseases and perineal radical prostatectomy with dissection of these structures Laparoscopic radical prostatectomy is not alternative to open counterpart due to technical difficulty and longer operation time Feasible to perform extraperitoneal laparoscopic radical prostatectomy with 2 cases As a feasible alternative, Transperitoneal laparoscopic radical prostatectomy was promoted as the Montsouris technique based on the same principle previously described by Gaston At another center in Paris, the Creteil technique committed to a similar technique of transperitoneal laparoscopic...

Step 5 Apical Dissection of the Prostate

Incision of venous complex is performed following additional bipolar coagulation and then incising tangentially to avoid incision of the anterior surface of the prostate. An avascular plane of dissection separating the urethra from the venous complex must be found underneath the venous complex. This plane allows complete identification of the prostate limits and urethra. Rectourethral muscle appears relatively attenuated with this approach and represents the final attachment of the prostate. Division of the rectourethral muscle close to the prostate completely frees the specimen. The excised prostate is entrapped immediately in an endobag, which is temporarily positioned in the upper abdomen.

Laparoscopic Radical Prostatectomy Current Status

Department of Urology, Sidney Kimmel Center for Prostate and Urologie Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A. PROSTATE SURGERY Since its first description 12 years ago, laparoscopic radical prostatectomy has gained increasing importance in the laparoscopic urologic oncology field and became an established treatment for organ-confined prostate cancer.

Acute Bacterial Prostatitis

Acute bacterial prostatitis should be suspected in men presenting with symptoms of UTI. Age and immunodeficiency contribute to men having UTIs, so prostatitis is more likely in otherwise healthy men with these symptoms (Lipsky, 1999). Patients may have UTI symptoms (e.g., dysuria, frequency, urgency) and typically systemic symptoms of acute illness, such as fever, chills, and myalgias. Local discomfort in the form of pelvic or back pain is also typical. Examination reveals a tender, boggy prostate. Most experts have recommended against prostate massage in acute prostatitis because it would be very uncomfortable and theoretically could disseminate the infection (Benway and Moon, 2008 Wagenlehner and Naber, 2003).

Chronic Bacterial Prostatitis

Chronic bacterial prostatitis may manifest with irritative voiding symptoms, prostatitic obstruction, or recurrent UTIs (Lipsky, 1999). Patients may have microscopic pyuria but negative cultures. Other symptoms include hemospermia, penile discharge, and systemic symptoms. Longer courses of antibiotics are generally considered standard practice. Options include TMP-SMX and fluoroquinolones for 4 to 6 weeks (Lipsky, 1999). Alpha-adren-ergic blockers have limited evidence of benefit when added to antimicrobials for category II prostatitis (Erickson et al., 2008). Patients with recurrent symptoms may need longer antibiotic courses, urologic consultation, or reconsideration of their diagnosis.

Oxidative Stress and Chronic Bacterial Prostatitis

Bacteria responsible for prostate infection may originate from the urinary tract or can be sexually transmitted 28, 29 . The OS observed during chronic bacterial prostatitis is the result of elevated ROS production and or reduced total antioxidant capacity 20, 30 . Indeed, infecting microorganisms trigger an inflammatory defense reaction in the prostate with a resulting OS due to ROS overproduction Shahed and Shoskes 36 showed that sperm OS in symptomatic patients with chronic bacterial prostatitis related to both ROS overproduction (especially with positive cultures) and reduced antioxidant capacity in men with category III prosta-titis. Furthermore, the observed increased levels of OS markers and their decrease after treatment with antimicrobials (category II) or with the antioxidant dietary supplement (category III) suggested that Gram-positive bacteria in the EPS of some men with chronic pelvic pain syndrome may represent true pathogens on the basis of the clinical response to...

Laparoscopic Prostatectomy

Radical prostatectomy is the most common therapy for patients with prostate cancer and accounts for approximately half of the 1.7 billion cost of prostate cancer treatment (30). In evaluating the cost of radical retropubic prostatectomy as compared to laparo-scopic and robot-assisted prostatectomy, we found that radical retropubic prostatectomy was the least expensive approach with a cost advantage of 487 and 1726 over laparoscopic radical prostatectomy and robot-assisted prostatectomy, respectively (Table 2) (7). Even if the initial cost of purchasing a robot is excluded, the cost difference between radical retropubic prostatectomy and robot-assisted prostatectomy is 1155. TABLE2 Individual and Overall Costs for Radial Retropubic Prostatectomy, Laparoscopic Radical Prostatectomy, and Robot-Assisted Prostatectomy Abbreviations RRR radical retropubic prostatectomy LRR laparoscopic radical prostatectomy RAR robot-assisted prostatectomy NA, not applicable. Source From Ref. 7. Radical...

Oxidative Stress in Benign Prostate Hyperplasia

Abstract The greatest risk factor for developing benign prostatic hyperplasia (BPH) is advanced age. Potential molecular and physiologic contributors to the frequency of BPH occurrence in older individuals include the oxidative stress, chronic inflammation, and alterations in tissue microenvironment. As BPH and aberrant changes in reactive oxygen species become more common with aging, oxygen species signaling may play an important role in the development and progression of this disease. Increased oxidative stress is a result of either increased reactive oxygen species generation or a loss of antioxidant defense mechanisms. Oxidative stress is associated with several pathological conditions including inflammation and infection. Oxygen species are byproducts of normal cellular metabolism and play vital roles in stimulation of signaling pathways in response to changing intra and extracellular environmental conditions. This review is aimed to explore the mechanism of oxidative stress in...

The Prostate Cancer Research Program

The Prostate Cancer Research Program is run by the U.S. Army under the Department of Defense. Its origins are a classic Washington tale. Observing the success of the breast cancer lobby, advocates for prostate cancer research decided to follow suit. A dinner was arranged to which, according to one participant, ''several members of Congress were invited who just happened to have prostate cancer.'' In 1997 Congress allocated 45 million to the Department of Defense for what became known as the Prostate Cancer Research Program (PCRP). Since 1997 Congress has continued to fund this research in 2006, the allocation was 80 million. Through 2005, a total of over 600 million had been spent on more than fourteen hundred research projects. A prominent part of the program is the Center for Prostate Disease Research, an excellent clinical program for military veterans with prostate cancer directed by Col. David E. McLeod, M.D., at the Walter Reed National Medical Center. Another important...

Aging Oxidative Stress and Prostate

Aging is associated with many metabolic disorders and with increased incidence of various cancers 50, 51 . Prostate cancer is a major age-related malignancy. Many theories have been formulated to explain the molecular and biochemical aspect of aging, but Harman in 1956 proposed free radical theory of aging in which the author suggested that the accumulation of damage to biomolecules caused by free radicals plays a major role in human aging 52, 53 . It is also believed that cellular oxidative stress increases with age and the increase in mitochondrial mutations can lead to further increase in ROS generation due to defective oxidative phosphorylation and electron transport 54 . Thus, it is possible that the increase in ROS leads to a self-perpetuating cycle with an ever-increasing oxidative challenge placed on the cells. Moreover, most of the cells in the prostate tumor express the androgen receptor and respond to androgens at an early stage, to facilitate their growth. Age-related...

Steroid Hormones Oxidative Stress and Prostate

Prostate development, maturation, and normal function depends on the activity of the androgens testosterone and its derivative dihydrotestosterone (DHT). DHT, synthesized from testosterone in the prostate by 5a-reductase, has a more potent effect due to its higher affinity to the androgen receptor (AR) 81 . The AR in turn binds to androgen receptor elements (ARE) present in the promoter regions of many genes involved in cellular proliferation 82 . Traditionally, the initial stages of prostate cancer are controlled by androgen deprivation therapy however, aberrant AR activity in prostate tumors finally leads to the development of a highly malignant state of disease unresponsive to androgen control 83 . Many studies have dwelt on the increased oxidative damage in cells due to ROS as a result of abnormal and increased androgen stimulation of androgen-sensitive prostate cancer cells 84, 85 . Though studies have not pointed out a potential mechanism for the increased levels of ROS after...

Michael Milkens Prostate Cancer Foundation

Ironically, both Giuliani and Milken were subsequently diagnosed with prostate cancer and became friends and national advocates for prostate cancer sufferers. Milken was diagnosed with prostate cancer in 1993, shortly after his release from prison. Just 46 years old, he had a Gleason score of 9, a PSA of 24, and the cancer had already spread to his lymph nodes. He was treated with beam radiation and hormones and began a very strict diet thirteen years later he remains in remission. Milken approached prostate cancer in the same manner he had approached Wall Street securities. ''I decided that I had to change the course of history,'' he recalls, and proposed ''a Manhattan Project'' for prostate cancer to discover the causes and better treatments.5 He pledged 25 million of his own funds and in 1993 began CaPCURE (cancer of the prostate cure), a foundation that in 2003 was renamed the Prostate Cancer Foundation (PCF). Milken has accomplished a remarkable...

What is a transurethral incision of the prostate TUIP

A transurethral incision of the prostate (TUIP) is exactly that an incision rather than a resection of the prostate. Using a special knife-like instrument, a Colling's knife that is placed through the same resectoscope sheath used for TURPs two incisions are made at 5 o'clock and 7 o'clock through the bladder neck and prostate to the verumontanum where the ejaculatory ducts exit. A TUIP is a quicker, easier procedure than a TURP. TUIPs tend to be used in younger men with smaller prostate glands. The incidence of retrograde ejaculation after TURP ranges from 50 to 95 , whereas the incidence is from 0 to 37 with TUIP. In properly selected patients, those with small glands, the rate of symptom relief with TUIP approaches that of TURP.

What is the prostate gland and what does it do

The prostate gland is actually not a single gland. It is comprised of a collection of glands that are covered by a capsule. A gland is a structure or organ that produces a substance used in another part of the body. The prostate gland lies below the bladder, encircles the urethra, and lies in front of the rectum. Because it lies just in front of the rectum, the posterior aspect of the prostate can be assessed during a rectal examination. The normal size of the prostate gland is about the size of a walnut (Figures 1 and 2). The prostate gland is divided into several zones, or areas. The prostate gland is divided into several zones, or areas. These divisions are based on locations of the tissue, but they also have some significance with respect Prostate Urethra Prostate Urethra From Prostate and Cancer by Sheldon H.F. Marks. Copyright 1995 by Sheldon Marks. Reprinted with permission of Perseus Books Publishers, a member of Perseus Books, LLC. From Prostate and Cancer by Sheldon H.F....

Evaluation of Books About Prostate Cancer

The following, listed alphabetically by author, are assessments of forty-seven books about prostate cancer published in the past seven years (asterisks indicate those I have found most valuable). Also included are a few volumes published earlier that are of special interest. Books on prostate health in general are not included. Alterowitz, Ralph, and Alterowitz, Barbara. The Lovin' Ain't Over The Couples Guide to Better Sex After Prostate Disease. Westbury, N.Y. Health Education Literary Publisher, 1999. Written by a man who has had prostate cancer and his wife, this book focuses exclusively on impotence. It explains the complexities of erections and orgasms and outlines options for couples faced with varying degrees of impotence. Baggish, Jeff. Making the Prostate Therapy Decision (rev. ed.). Los Angeles Lowell House, 1998. Originally published in 1995, this book was said to have been revised in 1998. The changes, however, appear to have been minimal and the book is now outdated....

Prostate Cancer Support

Prostate Cancer Support Group Prostate Cancer Survivor's Support Group The Prostate Forum, Fullerton Prostate Cancer Support Group Palo Alto VA Prostate Support Group San Jose Prostate Cancer Support Group Santa Clara County African American Prostate Cancer Support Group Santa Cruz County Prostate Cancer Support Group Silicon Valley Prostate Cancer Support Simi Valley US TOO Prostate Cancer Support Group Prostate Support Association VFW Prostate Cancer Support Group of DelMarVa Prostate Support Group Prostate Cancer Support Association of New Mexico, Inc. (PCSA of NM) Prostate Cancer Support of Lee County US TOO Prostate Cancer Support Group of Wake County US TOO Prostate Support Group Wake County Prostate Cancer Support Group A support group for gay men dealing with prostate cancer in the Prostate Cancer Support Action (PSA) Group Affiliation National Cancer Association of South Africa Southern Cross Hospital, First Floor Seminar Room (021) 788-6280

Diagnostic and Staging and Classification Systems Worktip ior Prostate Cancer

Prostate-specific antigen (PSA) The prognosis for patients with prostate cancer depends on the histologic grade, tumor size, and local extent of the primary tumor. The most important prognostic criterion appears to be the histologic grade because the degree of differentiation ultimately determines the stage of disease. Poorly differentiated tumors Table 92-4 Staging and Classification Systems for Prostate Cancer The desired outcome in early stage prostate cancer is to minimize morbidity and mortality due to prostate cancer. The most appropriate therapy of early stage prostate cancer is a matter of debate. Early stage disease may be treated with surgery, radiation, or watchful waiting. While surgery and radiation are curative, they are associated with significant morbidity and mortality. Since the overall goal is to minimize morbidity and mortality associated with the disease, watchful waiting is appropriate in selected individuals. Advanced prostate cancer (stage D) is not currently...

Benign Neoplasia Benign Prostatic Hyperplasia

Benign prostatic hyperplasia is a common problem for men. More than 50 of men older than 60 years have BPH, and this reaches 80 by 80 years of age (Dull et al., 2002 Thorpe and Neal, 2003). The exact pathogenesis of BPH is uncertain, but it is characterized by epithelial and stromal cell proliferation in the periurethral prostate tissue. The LUTS syndrome (see earlier) overlaps with BPH because up to 30 of men have lower urinary tract symptoms (Thorpe and Neal, 2003). The symptoms defining LUTS were once thought to be solely indicative of BPH. However, LUTS may arise from other disorders (e.g., detrusor dysfunction), and there is a lack of symptomatic correlation with prostate size. However, outflow obstruction from an enlarged prostate may contribute to the development of detrusor dysfunction and urinary retention, referred to as LUTS-BPH. Diagnosis focuses on patient history, rectal examination, and impact on quality of life. Symptoms can vary over time, even without treatment...

Hormonal Regulation Prostate

Hormone Found The Prostate Gland

The prostate gland is a solid, rounded, heart-shaped organ positioned between the neck of the bladder and the urogenital diaphragm (Fig. 92-1). The normal prostate is composed of acinar secretory cells arranged in a radial shape and surrounded by a foundation of supporting tissue. The size, shape, or presence of acini is almost always altered in the gland that has been invaded by prostatic carcinoma. Adenocarcinoma, the major pathologic cell type, accounts for more than 95 of prostate cancer cases. ' Much rarer tumor types include small-cell neuroendocrine cancers, sarcomas, and transitional cell carcinomas. Prostate cancer can be graded systematically according to the histologic appearance of the malignant cell and then grouped into well, moderately, or poorly differen-23 24 FIGURE 92-1. The prostate gland. (From DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy A Pathophysiologic Approach, 6th ed. New York McGraw-Hill, 2005 1856.) FIGURE 92-1. The prostate gland. (From...

Palpate the Prostate Gland

The prostate gland lies anterior to the wall of the rectum. The size, surface, consistency, sensitivity, and shape of the prostate gland should be assessed. The prostate is a bilobed, heart-shaped structure approximately 1.5 inches (4 cm) in diameter. It is normally smooth and firm and has the consistency of a hard rubber ball. The apex of the heart shape points toward the anus. Identify the median sulcus and the lateral lobes. Note any masses, tenderness, and nodules. Only the lower apex portion of the gland is palpable. The superior margin is usually too high to reach. The examination of the prostate is illustrated in Figure 17-37. The size of the prostate in relation to the examiner's finger is illustrated in Figure 17-38. A hard, irregular nodule produces asymmetry of the prostate gland and is suggestive of cancer. Carcinoma of the prostate frequently involves the posterior lobe, which can easily be identified during the DRE. Carcinoma of the prostate is the third leading cause of...

Transurethral Resection of the Prostate Skills A Potential Training Crisis

Transurethral resection of the prostate remains the gold standard surgical procedure for successfully treating medically refractory lower-urinary tract symptoms of benign prostatic hyperplasia or benign enlargement of the prostate (50,51), a chronic and potentially Transurethral resection of the prostate outcomes vary widely in the community and are probably technically dependent. Transurethral resection of the prostate is challenging to teach and learn. Performing this procedure involves the ability to work in a small three-dimensional space while receiving two-dimensional visual feedback requiring the operator to have or develop unique visual-spatial abilities. It also requires that the operator have adept psy-chomotor abilities, as one has to continuously and simultaneously navigate the scope and the loop while managing the electrical current with the use of both hands and a foot pedal. Additionally, the procedure is performed in a fluid environment and the field is often visually...

Rectal Injury During Radical Prostatectomy

Rectal injury during radical prostatectomy converts the case from a clean contaminated to a contaminated procedure and may increase the risk of septic complications, such as wound infection, pelvic abscess, peritonitis, rectourethral fistula, and death. The reported incidence of rectal injury during open radical prostatectomy ranges from 0 to 9 . The average incidence of rectal injuries reported in the larger series of laparoscopic radical prostatectomies is 1.7 (28 1647 procedures) (42). Guillonneau et al. reported 13 rectal injuries (1.3 ) in their first 1000 laparoscopic transperitoneal radical prostatectomies (42). None of these patients had previous prostatic surgery, or had received preoperative radiotherapy or hormonal therapy. Of the 13 rectal injuries, 11 were diagnosed intraoperatively and primarily repaired. Of the 11 intraoperative rectal repairs, nine healed primarily without colostomy. Two patients who had intraoperative rectal repair by a single-layer closure developed...

The Anatomy and Function of the Prostate Gland

Sitting in the center of this anatomical assemblage is the prostate, a reddish-brown organ approximately an inch and a half in diameter. It lies at the bottom of the pelvis, with the penis below, the bladder above, the pelvic bone in front, and the rectum behind (Figure 3). This last juxtaposition is especially important, because feeling the prostate through the rectal wall the much-maligned digital rectal exam is the only way a physician can physically assess this organ. Fortunately, the majority of cancers develop in the posterior portion of the prostate, thereby making them detectable to a skilled examining finger. The prostate has been variously described as looking like a walnut, a chestnut, or a small plum. In a young man, it weighs approximately 20 gm, then increases in size as the man ages. It contains muscles and glands, the latter secreting fluid that assists and protects male sperm. One component of the prostate fluid is prostate specific antigen (PSA), described in Chapter...

What is microwave therapy of the prostate

Microwave energy has been used to treat BPH using both transrectal and transurethral approaches, but most modern machines use the transurethral route. Current machines deliver microwave energy to the prostate via a transurethral catheter, and a transrectal balloon monitors rectal temperature simultaneously.

Zonal and cellular organization of the prostate

Fig. 12.5 Cellular heterogeneity within the normal prostate Histological architecture of the prostate is comprised of blood vessels that provide nutrients, including androgen, to the fibrous stromal layer which consists primarily of fibroblasts and smooth muscle cells, and to the epithelial layer. Epithelium can be subdivided into a basal epithelium, which contains AR negative proliferating cells, and secretory luminal epithelium, which consists of fully differentiated AR and p27Kip1 positive, nonproliferating cells. Fig. 12.5 Cellular heterogeneity within the normal prostate Histological architecture of the prostate is comprised of blood vessels that provide nutrients, including androgen, to the fibrous stromal layer which consists primarily of fibroblasts and smooth muscle cells, and to the epithelial layer. Epithelium can be subdivided into a basal epithelium, which contains AR negative proliferating cells, and secretory luminal epithelium, which consists of fully differentiated AR...

Chronic Nonbacterial Prostatitis

The term prostatitis means prostate inflammation but often also implies infection (infectious causes are discussed later). However, prostatitis encompasses many different clinical entities (Table 40-7). Chronic nonbacterial prostatitis, also Table 40-7 NIH and NIDDK Classification System for Prostatitis Acute bacterial prostatitis Acute prostate infection Chronic bacterial prostatitis Recurrent prostate infection Chronic nonbacterial prostatitis inflammatory chronic pelvic pain syndrome Chronic nonbacterial prostatitis noninflammatory chronic pelvic pain syndrome Asymptomatic inflammatory prostatitis No subjective symptoms white cells in prostatic secretions or prostate tissue From McNaughton-Collins M, Joyce GF, Wise M, Pontari MA. Prostatitis. In Litwin MS, Saigal CS (eds). Urologie Diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)....

Clinical studies with finasteride in men with benign prostatic hyperplasia

Early studies with finasteride in men with benign prostatic hyperplasia (BPH) were designed to confirm the biochemical efficacy of the drug. Prior studies had identified the predominance of DHT, compared to testosterone, within the prostate due to intraprostatic type 2 5aR activity (Bruchovsky and Wilson 1968). In several studies evaluating the ability of finasteride to reduce DHT formation within the prostate, suppression of intraprostatic DHT levels up to 95 , exceeding the maximal suppression of serum DHT ( 70 ), were demonstrated in a dose-dependent manner (Geller 1990 McConnell etal. 1992 Norman etal. 1993). 18.4.1 Efficacy based on prostate volume and symptoms Several controlled studies have established the utility of finasteride 5 mg in the treatment of men with benign prostatic hyperplasia. Early clinical efficacy studies with finasteride in men with BPH demonstrated that the biochemical efficacy of the drug, defined by reductions in serum and intraprostatic DHT levels, were...

The History Of Laparoscopic Radical Prostatectomy

The goals of laparoscopic radical prostatectomy, as in retropubic radical prostatectomy, are lifelong oncologic control of localized prostate carcinoma while maintaining continence and potency functions with minimizing of operative morbidity that contribute to a global quality of life. Transperitoneal laparoscopic radical prostatectomy with ascending approach was first performed by Schuessler et al. (1) and presented in 1992. However, the technical difficulties did not allow widespread application of this procedure. An initial series with nine patients was published in 1997 by the same authors, but they concluded that the procedure was not feasible due to the excessive operation time and multiple technical difficulties (2). The authors stated laparoscopic radical prostatectomy is not efficacious alternative to open radical prostatectomy as curative treatment of clinically localized prostate cancer. Subsequently, Rabboy et al. (3) successfully performed laparoscopic radical...

What is electrovaporization of the prostate

Electrovaporization of the prostate (TUVP) is, similar to a TURP. Rather than a resecting loop, the urologist uses a roller ball to heat and desiccate the prostate instead of actually resecting tissue (Figure 24). Electrovaporization of the prostate has been used in patients with a history of bleeding disorders or in cases in which it is desired to minimize blood loss. Electrova-porization of the prostate tends to be used in patients with small- and medium-sized glands. Like TUIP, in properly selected patients, it is an alternative to TURP.

How is prostatitis diagnosed

The patient's clinical history, general appearance, and uri-nalysis are often suggestive of acute bacterial prostatitis. A urine culture is commonly positive for a urinary tract infection. A digital rectal examination will usually identify a very tender prostate. In rare cases, fluctuance may be palpable in the prostate, if there is a prostatic abscess. In men who appear toxic or who fail to improve with antibiotic therapy, a transrectal ultrasound may be obtained to rule out a prostatic abscess. An assessment of postvoid residual is performed. The classic diagnostic maneuver for bacterial prostatitis is the three-glass test. The patient is asked to void and collect his first 10 ml of urine. This is sent for culture and is known as VB1. Then the patient is asked to collect a midstream urine sample after he voids about 200 ml. This urine sample is sent for culture and is known as VB2. Then the urologist performs a digital rectal exam and massages the patient's prostate in an attempt to...

Prostate Biopsy

An image-guided robot system has been developed and employed for transperineal prostate biopsies. Two alternative robotic projects enabling automated harvesting of prostate biopsy samples have been recently developed. Certain urologic procedures are very challenging for conventional laparoscopic surgeons due to either complex anatomy or the need for extensive intracorporeal suturing. Examples include radical prostatectomy, radical cystectomy, and pyeloplasty. Two alternative robotic projects enabling automated harvesting of prostate biopsy samples have been recently developed. In the projects proposed by the group at Johns Hopkins University, prostate biopsies are taken using a modified Percutaneous Access of the Kidney robot. In fact, current Percutaneous Access of the Kidney drive system is not strong enough to drive the needle into prostatic tissue, and also requires instrumentation to provide feedback regarding the needle position. In the modified Percutaneous Access of the Kidney...

Prostate development

The prostate is the prototype of a hormone-dependent organ. During embryogenesis dihydrotestosterone triggers its development from the urogenital sinus. In this process, the interaction of the stromal and the epithelial compartments of the prostate gland are of crucial importance. The AR is first expressed in the stromal cells, which makes the cells responsive to dihydrotestosterone to stimulate proliferation and determine differentiation of the epithelial cells in a paracrine manner through the secretion of growth factors (Cunha 1984 1992 Kratochwil 1986). Later, the AR is expressed in the epithelial cells and androgens can directly stimulate the growth of this cell type as well. The prostate finally grows to the normal size of about 20 cm3 coupled with the rise of serum levels of androgen that occurs during puberty with a prostatic weight doubling time of 2.8 years (Coffey and Isaacs 1981). Growth and function of the prostate are critically dependent on the presence of androgens and...

Prostatitis

A common complication of UTI in men is prostatitis. Bacterial prostatitis is usually caused by the same gram-negative bacilli that cause UTI in female patients 80 or more of such infections are caused by Escherichia coli. The pathogenesis of this condition is poorly understood. Antibacterial substances in prostatic secretions probably protect against such infections. A National Institutes of Health (NIH) expert consensus panel has recommended classifying prostatitis into three syndromes acute bacterial prostatitis, chronic bacterial pros-tatitis, and chronic pelvic pain syndrome (CPPS). Acute bacterial prostatitis is a febrile illness characterized by chills, dysuria, urinary frequency and urgency and pain in the perineum, back, or pelvis. The bladder outlet can be obstructed. On physical examination, the prostate is found to be enlarged, tender, and indurated. Pyuria is present, and urine cultures generally grow E. coli or another typical uropathogen. Chronic bacterial prostatitis is...

What is prostatitis

Prostatitis refers to an inflammation of the prostate gland that can be manifested in a variety of ways. Symptoms of acute bacterial prostatitis include urinary frequency, urgency dysuria or painful urination, nocturia, perineal pain, low back pain, fever, and or chills. Some men with acute bacterial prostatitis may present with inability to urinate and will require a catheter or supra-pubic tube placement until the inflammation and pain have resolved. Some men with acute prostatitis may develop a prostatic abscess that will require drainage. Chronic bacterial prostatitis may present in a similar manner, but men are typically less toxic in appearance. Prostatitis normally does not occur in children or adolescents, but can occur in adult men of any age. The diagnosis can be elusive and treatment is often empiric. What types of prostatitis are there The National Institutes of Health (NIH) has recently defined the different prostatitis syndromes Prostatitis syndromes NIH classification...

Prostate Cancer

Prostate cancer is the most common cancer diagnosed in men and is the second most common cause of cancer death in men after lung cancer. The gap between the annual numbers of diagnoses (217,730) and deaths (32,050) is wide (ACS, 2010). Major risk factors include age, African American race, and family history. Most cases occur in men older than 65. African Americans have a 60 higher incidence compared with whites and experience a disproportionate share of prostate cancer deaths (Harris and Lohr, 2002). Dietary factors may play a role, including the proandro-genic effects of dietary fat, carcinogenic compounds in grilled meats, and antioxidants in vegetables (Nelson et al., 2003). Dietary antioxidants such as lycopene show epi-demiologic links (mostly related to tomato consumption) supporting a preventive effect, with possible mechanisms including androgen inhibition (Wertz et al., 2004). However, an RCT using vitamin E and selenium, alone or in combination, failed to show any...

Prostate Surgery

During laparoscopic radical prostatectomy, precise intraoperative identification of the neu-rovascular bundle, the prostate apex, and location of cancer nodule may potentially enhance postoperative functional outcomes and surgical margin status. Transrectal ultra-sonography is currently one of the most precise imaging modalities for the prostate. Ukimura and Gill investigated the technical feasibility and utility of intraoperative realtime transrectal ultrasonography guidance during laparoscopic radical prostatectomy (50-52). The potential advantages of real-time transrectal ultrasonography guided laparo-scopic radical prostatectomy were noted to be as follows (i) visualization of the anatomical course of neurovascular bundle with special reference to its dimension and distance from the edge of the prostate, (ii) objective measurement of the physical adequacy of neurovascular bundle preservation during laparoscopic radical prostatectomy, in terms of preoperative and postoperative...

How Serious Is Your Cancer

Several questions immediately came to mind on the day I was diagnosed with prostate cancer. How serious is it Is it likely to kill me If so, when This chapter provides information you need to begin answering such questions. Those who wish to skip the more technical discussions will find a summary at the end of the chapter. Prostate cancer is cancer. It affects the walnut-sized gland that sits beneath the bladder and contributes some of the fluid making up the semen a detailed description of the prostate can be found in Appendix A. Prostate cancer should not be confused with benign prostatic hypertrophy (BPH), the other common indeed, almost universal prostate affliction of older men. For benign prostatic hypertrophy, the operant word is benign. It is an enlargement of the prostate that can cause symptoms such as frequency (having to urinate often), urgency (difficulty in holding your urine), a weak flow, and starting and stopping of the flow. Benign prostatic hypertrophy can be...

Additional Predictors Of Severity

It would be helpful if we had more accurate indicators of severity for men with newly diagnosed prostate cancers. Our treatment decisions, and even whether to pursue treatment at all, are currently based on inadequate data. If we were better able to predict which cancers are likely to remain quiescent and which are likely to progress, many men would not have to undergo treatment and could thereby avoid complications such as incontinence and impotence. The fact that we do not have valid indicators of severity results from the failure of prostate cancer research (see Chapter 14). Additional predictors of severity are available from prostate biopsies but are underutilized. These include information on the number of specimens (cores) positive for cancer, the percentage of each positive core occupied by cancer, and the percentage of Gleason grade 4 or 5 cells in each core. For example, my own biopsy included 9 probes, 5 on the right side (where the cancer had been felt) and 4 on the left...

The Procedure Seed Therapy

Compared to other treatments for prostate cancer, seed therapy is convenient a major reason for its increasing popularity. Usually, only two outpatient visits are required. On the first visit, the radiation oncologist places an ultrasound probe, similar to that used in prostate biopsies, in the rectum and then carefully maps the prostate. This allows for a calculation of exactly where seeds should be placed and how many usually fifty to one hundred will be needed. On the second visit, the man is given a regional block (spinal or epidural) or general anesthesia for a procedure that lasts approximately an hour. While he is on his back with his legs elevated and spread, long needles are inserted into the prostate through the perineum, the area between the back of the scrotum and the anus. The radioactive seeds, which are smaller than grains of rice, are inserted into the prostate through the needles. It is vital that the seeds be placed evenly, so that no areas of cancer are left...

Who Are Good Candidates

The best candidates are men who are relatively young and who do not have severe forms of prostate cancer. Cryotherapy is also commonly used for individuals who have been treated with radiation but whose cancer has recurred. Surgery cannot be performed on most men who have already had radiation treatment, because the radiation destroys anatomical landmarks and causes scar tissue to form cryotherapy is therefore one of the few options available. In order for it to be effective, the cancer must be confined to the prostate men with advanced cancers are not candidates. Men whose prostate weighs more than approximately 40 gms are also not appropriate candidates unless the prostate can first be downsized with hormone therapy.

Alternative and Experimental Therapies

Alternative therapies for medical disorders have become increasingly popular in the United States, with 42 percent of adults reporting having used one or more.1 The increasing popularity of alternative therapies has been fueled in part by rapid distribution of information on the Internet and in part by dissatisfaction with an increasingly dysfunctional traditional medical care system. Men with prostate cancer are especially susceptible to claims made for alternative therapies, since existing treatments produce a plethora of unfortunate complications. Alternative medicine covers a broad spectrum of therapies, ranging from special diets, vitamin and mineral supplements, and herbal therapies to hyperthermia, ultrasound, light therapy, gene therapy, magnets, acupuncture, moxibustion, yoga, massage therapy, relaxation exercises, and prayer. There is some evidence that specific dietary factors may be useful in preventing or slowing the growth of prostate cancer these factors, along with...

Experimental Treatments

A variety of alternative therapies for the primary treatment of prostate cancer are in the experimental stages. One such therapy is hyperthermia, in which the prostate gland is warmed this treatment is thought to improve the effectiveness of radiation therapy. The warming may be done by inserting small tubes (interstitial radio-frequency) or small seeds (thermoseeds) directly into the prostate. A form of light therapy is also being studied. A chemical derived from plant chlorophyll is injected intravenously. A laser light source is then beamed into the prostate, causing the chemical to destroy the cancer cells. Gene therapy is being developed to treat both primary and recurrent prostate cancers. A virus injected into the body goes to the cancer cells, where it delivers a specific gene. This gene makes the cancer cells more susceptible to drugs, which are then administered to the patient. In addition, various drugs are being examined for possible use against prostate cancer. Included...

Seed plus beam radiation Surgery plus beam radiation

For men under the age of 65 who do not have health insurance, Medicaid is the best means of coverage. Qualifications differ widely by state. Medicaid coverage is roughly similar to that of Medicare, and you must use physicians who accept Medicaid, which many do not. A useful analysis of payment systems for covering prostate cancer treatment can be found in Prostate Cancer A Survivor's Guide, by Don Kaltenbach and Tim Richards (Seneca House Press, 2003). Once these ten factors have been considered, many men look for a definitive treatment trial to tell them what to do. Unfortunately, the definitive treatment trial is a myth. Because the treatment of prostate cancer is constantly changing and because prostate cancer progresses so slowly, the information provided by most treatment trials is out of date by the time it becomes available. In my case, I wished that twenty years ago researchers had started a comparison of surgical versus beam radiation treatment so that I would know the...

Advantages And Disadvantages Of Treatment Options

In Seeds of Hope, Michael Dorso decried the contradictory and confusing advice he found in the medical literature on prostate cancer treatments. Urologists advocated surgery, radiologists advocated radiation treatment, and ''cancer specialists who were neither surgeons nor radiation therapists were split between the two treatment modalities.'' Moreover, a panel of experts in the American Urological Association tried to objectively settle the treatment issues but ''found the data inadequate for valid comparisons of treatment. . . . Basically they gave up '' Dorso, himself a physician with prostate cancer, concluded in a note of exasperation ''What's a mother to do ''31 That is a very reasonable question. If a physician with prostate cancer has difficulty sorting out the treatment options, how can a layman be expected to do so And yet that is the message given by most prostate cancer specialists ''In the final analysis, Mr. Smith, the decision is up to you.''

Beam Radiation Therapy

Candidates Any man of any age, even if he is not in good health, has a life expectancy of less than ten years, or has cancer that has spread beyond the prostate. Not appropriate for very large prostates unless initially shrunk by hormone therapy, nor for men with chronic bowel disease. Chance of cure Good, if cancer has not spread beyond the prostate. Unknown Chances of residual prostate cancer in remaining prostate cells likelihood of another form of cancer secondary to radiation effects chances that the cancer has already spread beyond the prostate.

How I Made My Decisions

By talking to my wife and medical colleagues, I developed a plan of attack. I read two of the most widely used books on prostate cancer and checked a few websites, but was disappointed with what I found. Much of the information seemed biased toward one treatment or another, and some of the websites were openly commercial. In discussing the cancer with my family and friends, I realized that I had a strong support system already in place. I next assessed the severity of my cancer. Having a Gleason score of 7 was not advantageous, but the fact that it was 3+4 and not 4+3 was helpful. Three of my nine biopsy cores contained cancer cells, which occupied 20 percent of the core in two cases and 5 percent in the third. Gleason grade 4 cells constituted 40 percent of the cancer cells in one core and 20 percent in the second, and there were no grade 4 cells in the third. The fact that all three positive cores were in the right half of my prostate seemed to confirm the impression of my urologist...

Major Complications and Their Treatment

Incontinence and impotence are the two most-feared complications of prostate cancer treatment. They are the Scylla and Charybdis of prostate voyagers, and rare is the man who successfully sails by both without being affected by one or the other. Even men who elect watchful waiting as their option may experience them as their cancer increases in size. Although incontinence and impotence have been briefly discussed in preceding chapters, their importance for men with prostate cancer merits a chapter of their own. It is vital, however, to place incontinence and impotence in proper perspective. For men whose cancer has grown beyond the prostate or spread to other organs, incontinence and impotence do not loom so large. As Anatole Broyard noted ''In my own case, after a brush with death, I feel that just to be alive is a permanent orgasm.''1 Arguments abound about which is worse, incontinence or impotence. Walsh and Worthington, in their book Dr. Patrick Walsh's Guide to Surviving Prostate...

Urinary Incontinence The Problem

Incontinence is a problem because the male urethra, which carries urine from the bladder to outside the body, runs directly through the prostate. Thus, when the prostate is being destroyed by surgery, radiation, or cryotherapy, the urethra is inevitably affected. As detailed in Appendix A, urine flow in males is controlled by two sphincters an internal one immediately above the prostate, where the urethra exits the bladder, and an external one just below the prostate. During surgery for prostate cancer, the internal sphincter is destroyed, because it is anatomically contiguous to the prostate to preserve the internal sphincter risks leaving behind some cancer cells. That effectively leaves one working sphincter to do a job previously done by two. The average daily urine flow is approximately one-half gallon, so the task is demanding. Further, radiation and cryotherapy treatment may damage either or both sphincters. A Revolutionary Approach to Prostate Cancer Urge incontinence occurs...

What Happens if the Cancer Spreads or Comes Back

Living with prostate cancer, said one man, is ''like being trapped inside a cage with a baby lion.'' In the beginning, the lion is small and nonthreatening, but you know that the lion will grow and may eventually devour you. This man's cancer did spread and in the end did ''devour'' him.1 Prior to the PSA era, by the time of diagnosis the prostate cancer would have already spread beyond the prostate in the majority of cases. By the 1990s, this number had been reduced to one third, and by now it is presumably significantly lower than that. Prostate cancers that have spread at the time of diagnosis present many of the same treatment problems as cancers that recur after the initial treatment. In some cases, the recurrence is expected because of a Gleason score of 8 to 10, a PSA over 20, or other indicators of a large and serious cancer. In other cases, the recurrence of the cancer is unexpected, as when a man has a low Gleason score, a low PSA, and a small tumor. Some of these men are...

Will It Kill Me And If So When

The recurrence and spread of prostate cancer usually follow certain pathways. If the cancer was removed surgically, microscopic bits of cancer may have been left behind where the prostate lay (called the bed of the prostate). If the cancer was treated with radiation, it may recur in portions of the prostate that did not receive enough radiation to kill all the cancer cells. At any point, the cancer may spread beyond the prostate to the seminal vesicles, adjacent lymph nodes, or bladder this is called local spread. It may also spread more distantly, called metastasis. Bones, especially the spine, are favorite sites for prostate cancer metastases, but late in its course the cancer may also metastasize to the kidneys or virtually anywhere in the body. The predictors of prostate cancer spread include the same factors I try not to think about the number but I can't help doing it. PSA is like a clerk in a great court sitting in judgment on me, on my health or illness, my life or death. What...

Treatment Options For Recurrent Cancer

There are two goals in treating prostate cancer that has spread (1) improve the quantity of the man's life, and (2) improve the quality of the man's life. The dilemmas in treatment arise when attempts to improve quantity make the quality worse, not better. Honest assessments of treatment options are crucial to resolving these dilemmas. The mainstay for treating recurrent prostate cancer is hormone therapy, as described in Chapter 5. Prostate cancers use testosterone to grow, so blocking testosterone slows the growth. Prostate cancers contain cells that are sensitive to testosterone and other cells that are not sensitive. Over time the testosterone-insensitive cells become predominant and hormone therapy becomes ineffective. The cancer is then called androgen independent. The average duration of effectiveness for hormone therapy for a prostate cancer that has already metastasized is approximately two years,10 but during that time men often have comfortable remissions. One of the two...

Weighing Quantity Versus Quality Of Life

Prostate cancer has the reputation of being a slow-growing and indolent form of cancer. An oft-repeated saying is that many more men die with prostate cancer than die from prostate cancer. For every hundred men diagnosed with prostate cancer this year, only thirteen will die. We are lulled into thinking of prostate cancer as a rather benign male rite of passage into old age. Fortunately, for the majority of men, it is. But for a minority of men who get prostate cancer, it is anything but a benign rite. In 2005 it killed more than thirty thousand men in the United States, accounting for 10 percent of all male cancer deaths (second only to lung cancer). Prostate cancer deaths are usually not pleasant deaths. Metastases of the cancer to bones can cause bone pain that may become severe and is often worse at night. Fractures of bones secondary to the metastases are not uncommon if the fractured bone is a vertebra, it may cause compression of the spinal cord, a true medical emergency. The...

What Is Known About the Causes

Once a man has been diagnosed with prostate cancer, he inevitably asks himself What caused it Personally, I very much wanted to know. Saying that I had a disease that strikes randomly, like a bolt of lightning, was not very satisfying. It would be better if I could understand its antecedents, even if my own behavior had somehow contributed to its cause. Yet when I began searching the medical literature for answers, I was disappointed. A 2003 review of the subject stated that ''the etiology cause of prostate cancer remains virtually unknown.''1 Given that a federal ''war on cancer'' had been declared in 1971, this assessment was disquieting. Here we are, thirty-five years later, knowing little more than we knew then about the most common cancer to affect American men. In searching for causes of prostate cancer, scientists have major clues to work with. Seven of the most important are the following Prostate cancer is the most age-dependent of all human cancers. It is very uncommon in...

Viruses And Other Infectious Agents

The infectious theory of prostate cancer was fashionable twenty years ago, but most contemporary books do not even mention it. The neglect of this line of research is surprising, since approximately 15 percent of all cancers worldwide are caused by infectious agents. For example, Helicobacter pylori bacteria is associated with stomach cancer, hepatitis B virus with liver cancer, human papillomavirus with cervical cancer, Epstein-Barr virus with nasopharyngeal cancer, and human T-lymphocyte virus with some leukemias and lymphomas. Prostate cancer is also a type of cancer that increases in incidence in individuals whose immune system is suppressed this correlation is consistent with an infectious process. Furthermore, when biopsies of prostatic tissue are examined under the microscope, inflammation is frequently present, consistent with infection. For all these reasons, infectious agents should be seriously considered as possible causes of prostate cancer. The 1970s saw much interest in...

Factors That May Prevent Emergence or Recurrence

Given that one in every six American men is expected to be diagnosed with prostate cancer during his lifetime, we might anticipate that major research would have been undertaken to prevent its emergence or recurrence. The National Cancer Institute and other research groups neglected prevention research for so many years that today we know remarkably little. Most prostate cancer prevention trials were initiated only within the past five years and will therefore not yield useful data for many years to come. For example, trials of selenium and vitamin E (the SELECT trial) beta-carotene and vitamins C and E (Physicians Health Study II) and the anti-inflammatory drug rofecoxib will not be completed until 2012 or later. Theories about the prevention of prostate cancer and its recurrence fall into four categories they are based on dietary factors, vitamins and minerals, medications, and lifestyle changes. Except for the first of these, remarkably few hard data are available to help men make...

Red Wine and Red Grapes

There are suggestions that red wine and red grapes may provide some protection against prostate cancer. A study conducted in Seattle compared 753 men with prostate cancer to 703 matched controls. In an extensive dietary survey, the controls were found to have consumed more red wine but not white wine, beer, or liquor. For each glass of red wine consumed per week, there was a 6 percent reduction in risk for prostate cancer. According to the researchers, ''consumption of 8 glasses or more of red wine per week significantly reduced the relative risk of more aggressive prostate cancer by 61 .''5 Like soy, red wine contains flavonoids that may exert an anticancer effect through their estrogen-like properties. Red grapes contain resvera-trol, a compound closely related to flavonoids that also has anti-oxidant and anti-inflammatory properties. These studies should be confirmed before men make major changes in their alcohol intake. Michael Milken was a prominent Wall Street financier who was...

Vitamins And Minerals

Vitamins and minerals have attracted much attention as possible preventive factors for prostate cancer, with many websites featuring them prominently. But anecdotes heavily outweigh facts. The vitamins and minerals that have been most studied in relation to the prevention of prostate cancer are selenium, vitamin E, vitamin A, beta-carotene, and vitamin D. Selenium. Selenium is a trace metal and a necessary component of several enzymes, especially one (glutathione peroxidase) thought to prevent free-radical damage to cell structures. Selenium is thought to work closely with vitamin E and is theorized to have antioxidant properties, enhance immune function, and decrease testosterone. A longitudinal study of aging men in Baltimore reported that men with lower levels of blood selenium were more likely than others to develop prostate cancer. In contradiction, however, the area of the world where men are most likely to be selenium deficient is China, where the incidence of prostate cancer...

Choose foods that help maintain a healthful weight

When diet and lifestyle changes are combined and adhered to faithfully, there is evidence that they may slow the progression of prostate cancer. A controlled study, published in 2005, randomized into two groups ninety-three men who had early-stage prostate cancer and who had elected watchful waiting. The men in one group

So What Should You Do

Taking into consideration everything that is known about the emergence and recurrence of prostate cancer, what should you do Most important, realize that remarkably little is known with certainty, and what is unknown far outweighs what is known. Weigh quantity of life against quality of life. Making some dietary or lifestyle changes after being diagnosed with prostate cancer may not be difficult, whereas you may find making other changes to be quite hard. I have modified my own diet modestly but not radically. I eat tomatoes in one form or another with each dinner, and I drink tomato juice with lunch. Red grapes are now a staple snack item in our home, always available. I have not given up red meat altogether but have continued to decrease my consumption of it, a trend I had begun several years before being diagnosed with prostate cancer. I increasingly drink green tea and may, if I live long enough, come to like it. I am exploring red wines and have been surprised to discover that...

Urinary Incontinence The Solutions

The good news about urinary incontinence caused by treatment for prostate cancer is that in most cases the problem improves over time. This is especially true of incontinence due to surgery, which initially may be a serious difficulty. Most studies suggest that incontinence continues to be a long-term major problem for approximately 5 to 10 percent of men treated for prostate cancer but can be improved with help. Table 6. UCLA Prostate Cancer Index for Urinary Function Most urologists encourage patients undergoing prostate cancer treatment to do Kegel exercises to increase continence. These exercises were developed by Arnold Kegel in the 1940s for use by women who wanted to strengthen the muscles in the pelvis after childbirth. The difficulty is locating the correct muscles to be exercised. One set is used to stop urine flow halting the flow in midstream and holding it for several seconds is the recommended way to identify these muscles. The other set is used to tighten the buttocks....

Subtract 2 if you had addon adjuvant radiation treatment

There are three main stages in the recurrence and spread of prostate cancer 2. Progression from PSA rise to metastasis The single best predictor of the continuing progression of recurrent prostate cancer is the PSA doubling time. As the name implies, this is the time it takes for the PSA level to go, for example, from 1.1 to 2.2 or 4.2 to 8.4. The shorter the doubling time, the worse the prognosis for men treated by either surgery or radiation. If the PSA doubles in less than six months, it is likely that the cancer has already metastasized to bones or other organs if it doubles in more than twelve months, the cancer is probably still localized near the prostate bed. Charles Pound and his colleagues at Johns Hopkins University developed predictions of how long it takes recurrent prostate cancer to metastasize once the PSA has risen, based on the PSA doubling time, Gleason score, and whether the initial PSA rise occurred sooner than two years after surgery (see Table 8).7 Having a...

Pcspes A Cautionary Tale

The most popular herbal treatment for prostate cancer has been PC-SPES, the name being an abbreviation of prostate cancer and the Latin word for hope. It was commercially available from 1996 until 2002, when its manufacturer, BotanicLab in Brea, California, abruptly shut down. At the time, it was estimated that approximately ten thousand men with prostate cancer were taking PC-SPES and a bottle of sixty capsules was selling for 108. The recommended dose ranged from six to twelve capsules per day, depending on the severity of the man's cancer.8 If all the men had been taking six capsules a day, sales would have totaled 3.2 million each month. PC-SPES was formulated by Sophie Chen, a Taiwanese immigrant who trained in chemistry and initially worked at several large drug companies. She also held an adjunct faculty position at New York Medical College. Her principal collaborator was Xuhui Allan Wang, an herbalist who claimed that his great-grandfather had been court physician to a Chinese...

Surgical Treatment

The surgical removal of prostate cancer has for many years been the most common treatment of the disease. It has been controversial, with proponents arguing that surgery is the only real hope for permanently curing the cancer, and opponents claiming that the main effect of surgery is to produce incontinence and impotence without any clear evidence, compared to other forms of treatment, that it actually lengthens men's lives. The surgical removal of enlarged prostates, both those caused by benign prostatic hypertrophy and those resulting from cancer, has a long history. Until the middle of the twentieth century, the operation was carried out through an incision in the perineum, the area between the back of the scrotum and the anus. During the past halfcentury it has become more popular to surgically remove cancerous prostates through an abdominal incision, an operation referred to as a radical retropubic prostatectomy. The term radical is used because lymph nodes and other tissues...

Complications

Surgical removal of the prostate carries the same risk of complications as does all major surgery. These include infection, post-op bleeding, and the ultimate complication, death. The death rate in the first thirty days following prostatectomy, according to a 2005 Canadian study, is less than 2 in 1,000 for men under age 60, and 6 in 1,000 for men 60 to 79.11 The most important cause of death is thrombosis (clots) of the veins in the legs, which often causes tenderness in the calf or leg swelling when clots break free, they may travel to the lungs and heart as emboli and cause shortness of breath, chest pain, and sometimes sudden death. The best prevention is to get patients up and walking soon after surgery and to maintain regular walking and leg exercises for several weeks. The three most common complications of all treatments for prostate cancer are urinary incontinence, impotence, and bowel dysfunction. Incontinence rates after surgical removal of the prostate vary widely and are...

Outcome

Many men believe that if their prostate cancer is removed surgically and if there are no signs that the cancer has spread, then they are cured. This belief has been fostered by enthusiasts for prostate cancer surgery and by media presentations. The author of a 1996 Time magazine article about prostate cancer claimed that surgical treatment is ''the only one that can virtually guarantee a cure if the cancer has not metastasized. . . . If the cancer has not spread beyond the prostate wall and the gland is removed, the cancer is gone. Period.''20 Unfortunately, that is not always true. Recurrence of prostate cancer following surgery is not a rare event. Two factors strongly influence the chance of recurrence the age of the man and the stage of the cancer. The younger the man is at the time of surgery, the better his chances that the cancer will be curable. In one study of The stage of prostate cancer is determined by the Gleason score and other pathological features, as described in...

Radiation Treatment

After surgery, radiation is the most frequent treatment of prostate cancer in the United States. Its popularity increased after Andy Grove, chairman of Intel, published a 1996 Fortune magazine cover story account of why he had selected radiation treatment for his prostate cancer. An analysis of Medicare data found that radioactive seed therapy (brachytherapy) ''is replacing radical prostatectomy as the treatment of choice for early-stage prostate cancer.''1 Radiation is, of course, used to treat many forms of cancer. It works by disrupting the deoxyribonucleic acid (DNA) of cancer cells, which grow more rapidly than do normal cells both types of cells are damaged, but cancer cells are damaged more severely. Radiation has been used to treat prostate cancer since the early years of the last century. One of the originators of the idea was Alexander Graham Bell. In 1903, while president of the National Geographic Society, Bell wrote to a physician who was treating cancer ''There is no...

The Procedure

The procedure is carried out in a hospital, and the patient usually remains overnight. It is performed under local (spinal or epidural) or general anesthesia, with techniques similar to those used in implanting seeds in radiation seed therapy. Long needles are inserted into the prostate through the perineum. A freezing substance (liquid nitrogen was utilized in the past, but argon gas is now used) is inserted through the needles and the prostate is frozen into what is memorably referred to as an ice ball. An ultrasound probe is inserted into the rectum so that the urologist can carefully place the needles and ensure that tissue outside the prostate is not frozen. Because the urethra runs directly through the prostate, a catheter carrying warm, circulating water is inserted through it so that the urethra will not also be frozen. Following the procedure, a urinary catheter is left in place for approximately two weeks, during which time most men do not go back to work. The complications...