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Dr. Connie Hernandez
Women's Health

the prostate, urinary and reproductive systemsProstate Cancer
Questions and Answers

What is the prostate gland and where is it?

The prostate is most often described as a somewhat muscular walnut or chestnut-sized gland that surrounds the male urethra at the neck of the bladder
(< see cross-section diagram - the prostate is colored red)
.

What is the function of the prostate gland?

The prostate is a storeroom for an alkaline, milky fluid that makes up about a quarter to a third of the volume of semen. The alkalinity that the prostate adds to semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm.

What is prostate cancer?

The National Cancer Institute defines prostate cancer as a disease in which malignant (cancer) cells form in the tissues of the prostate. Prostate cancer is found mainly in men over 50 years of age.

What are the symptoms of prostate cancer?

In its earliest stages, there are no prostate cancer symptoms. Once the tumor starts to grow, the most frequent symptoms include:

  • Frequent urination, especially at night;
  • Difficulty starting a flow of urine;
  • Decreased force in the flow of urine;
  • Difficulty in achieving or maintaining an erection;
  • Painful ejaculation;
  • Blood in urine or semen; or
  • Pain or stiffness in the lower back, hips, or upper thighs.

It is important to note that these symptoms are also found in enlarged prostate (BPH) and prostatitis, so a thorough work-up by a physician is absolutely essential if you experience any of these symptoms at all.

What is the survival rate for prostate cancer?

The good news is that when detected early, prostate cancer is curable. According to the Mayo Clinic, the overall five-year survival rate for prostate cancer is 98 percent. Of all men diagnosed with prostate cancer, 98 of every 100 were living five years after diagnosis.

What is a prostatectomy?

A prostatectomy is the surgical removal of a man's prostate and the diseased seminal vesicles as well, if the cancer has spread outside of the prostate; otherwise only the full prostrate will be removed. This is fully discussed in my book.

Why has public interest and awareness
of Prostate Cancer increased recently?

There are several reasons why public interest in prostate has increased cancer in recent years. The main one is that the baby boomer men are now entering their golden years when prostate cancer is more common.

Secondly, famous figures like Harry Belafonte, Bob Dole, and Norman Schwartzkopf have gone public after being struck by prostate cancer. By doing so, they have spurred public interest and rallied support for increased research and better treatment choices.

Finally, more men are living to older ages-when prostate enlargement is common and prostate cancer becomes more likely-and huge numbers of previously unsuspected, symptom-free prostate cancers are being identified through simple blood-screening tests.

Should you have an annual prostate cancer screening?

The answer to this question is rather complicated and is addressed in great detail in my book. In general, all men over 50, men of African or Caribbean descent over the age of 40, and men over the age of 40 with a family history of prostate cancer or breast cancer should work out a screening schedule with their primary care providers.

What kinds of questions should someone concerned about prostate cancer ask his doctor?

It is important that men and their significant others do enough research before seeing their doctors so they can formulate a list of questions to ask during the office visit. Included in the list of questions should be:

  1. What is causing my prostate symptoms?
  2. Are they a sign of cancer?
  3. What tests do you recommend? Why?
  4. If I don't have cancer, what can I do about my symptoms? What if they get worse?
  5. If I do have prostate cancer, where can I get information about my treatment options?
  6. Be sure to take paper and pen into the meeting so you can take notes and formulate additional questions.

What treatments are available for prostate cancer?

The main conventional treatments for prostate cancer are surgery, radiation and hormone therapy. There are many variations on each approach. There are also a host of possible alternatives and approaches still under investigation to consider. Arriving at a decision as to which therapy to use is a complicated process that is reached through consideration of several factors: analysis of the grade and staging of the tumor; the therapy that has the greatest therapeutic value with the least side-effects for the patient’s specific situation; and the patient’s own preferences and intuitive insights. The process is described in great detail in my book.

How is prostate cancer diagnosed?

At present, the definitive diagnosis of prostate cancer can be only be arrived at by a biopsy. During a biopsy, a urologist (a doctor who specializes in diseases of urinary tract and sex organs in men, and urinary organs in women) removes 10 to 20 prostate tissue samples with a needle inserted through a rectal probe. This is an outpatient procedure, generally done in the doctor’s office with local anesthesia.

The samples are then sent to a pathologist (a doctor who identifies diseases by studying tissues under a microscope), who checks for cancer cells and assigns a “Gleason Score.”

What is Gleason Score?

The Gleason Score is a grading system for prostate cancer developed by Dr. Donald Gleason in 1977 as a method for predicting the behavior of prostate cancer. Grades range from 1 to 5, with 1 being the least aggressive and 5 the most aggressive. Grade 3 tumors, for example, seldom have metastases, but metastases are common with grade 4 or grade 5. The final score is arrived at by adding the grade of the specific tissue sample taken to the grade of the predominant tissue in the area from where the sample was taken.

Tumors with a low Gleason score are less likely to show aggressive behavior and therefore are less likely to have spread outside of the gland to lymph nodes (metastases). As the Gleason score increases, the survival rate decreases.

What can you do to prevent prostate cancer?

Research clearly suggests that lifestyle changes can reduce the risk of prostate cancer. Interestingly, these general preventive measures apply to all cancers and other chronic illnesses as well.

Eat plenty of fresh fruits and vegetables and cut back on meat and cholesterol laden foods. Quit smoking! Some studies have linked rapid growth of prostate tumors with smoking. Exercise on a regular basis, get enough rest, reduce stress, and develop a rich spiritual life.

If you have difficulty implementing lifestyle changes, your primary health care provider may be of assistance.

Does treatment for prostate cancer inevitably cause
sexual dysfunction or impotence?

Most conventional therapeutic approaches to prostate cancer run two major risks: incontinence and impotence. These can be either long-term or short-term, and the outcome is different in every situation. The main variables have to do with the invasiveness of the tumor and the aggressiveness of the therapy needed to deal with the cancer.

Can a man who has had his prostate removed
still have an orgasm?

Yes. However, men who have a prostatectomy no longer produce semen, so they have dry orgasms.

Can a man with prostate cancer transfer cancer cells to a woman through his semen prior to treatment?

No. Cancer is not contagious.

How does prostate cancer kill?

Cancer contained within the prostate itself is not at all life threatening. It is when prostate cancer metastasizes to another organ, like the liver or bones, that it becomes problematical.

What causes prostate cancer?

The cause of prostate cancer is not yet known. There are several risk factors, but prostate cancer may also affect a man with few or no risk factors. Risk factors are discussed in detail in my book.

Does masturbation cause cancer?

No. Several studies have shown that masturbation may actually prevent prostate cancer. The studies say that ejaculating could rid the prostate of cancer-causing chemicals.

Dr. Connie Hernandez
Women’s Health

 

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