PROSTATE DISEASE

What is a prostate?  The prostate organ produces most of a man’s semen or ejaculate fluid.  It pumps fluid out of the penis during arousal and protects him from getting urinary tract infections. 

How common are prostate problems? Prostate cancer is the most common cancer among Canadian men.   Last year an estimated 24,700 males were diagnosed with prostate cancer and 4,3000 died from it.   Enlargement of the prostate is extremely common, effecting half of men over the age of 50. This condition, called benign prostatic hyperplasia (BPH), causes symptoms such as urinary urgency, frequency and inadequacy as well as difficult erections and/or painful ejaculation.  Prostate cancer is the leading cause of cancer death in men.  Luckily, in many cases, it is slow growing.  This means that more men are likely to die with it than of it.

Ambiguities in Screening. The current Gold Standard for screening men for prostate cancer is a blood prostate-specific antigen (PSA).  Two recent studies seem to suggest that PSA screening is not as useful as we had hoped and many times leads to unnecessary radiation, chemotherapy and invasive surgeries.   PSA levels can be falsely elevated by sexual activity, riding a bicycle, prostate size, medications and other unknown factors. A US survey of 77,000 men found that only 20% more cancers were detected in a group of men aggressively screened (six PSA blood tests and four prostate exams yearly) versus those receiving at least one PSA screening in the seven years.  Having the aggressive screening did not decrease the risk of dying from prostate cancer in the first seven years, and only marginally afterwards.   A seven-country European trail looked at 162,000 men aged 55-69.  It found no benefit of screening in the first seven years of follow-up, but hinted PSA screening may prove slightly beneficial with the passage of more time.  Dr. Christine Berg, the report's senior author and head of the US National Cancer Institute group running the US study said PSA testing causes unnecessary suffering.  She refers to many men living with incontinence and impotence caused by unnecessary removal of the prostate. (Toronto Star, March 19, 2009, A17)  Dr. George Pasut, VP of prevention and screening for Cancer Care Ontario, says that these two studies reinforce their current guidelines to physicians.  These guidelines caution against over-prescribing the PSA test and caution physicians to fully inform their patients about the risks of various invasive procedures.   

What are the side effects of conventional treatments?  This question is difficult to answer because of the huge variety of prostate problems compounded with multiple possible treatments.  For BPH side effects of medications range from low blood pressure, dizziness and heart palpitations to impotence and decreased sex drive.  The gold standard surgery for BPH is called TURP (transurethral resection of the prostate).  It has a 25% failure rate and brings serious complication such as urinary incontinence (2-4% men), retrograde ejaculation (70-75% of men) and impotence (5-10% men).  Medical expert Dr. Glenn Bubley admits that when it comes to treating prostate cancer, not enough evidence exists to clearly establish which procedures might be most effective, whether it is a surgical removal (radical prostatectomy), radiation, chemotherapy or drugs.  Depending on the man, impotence may be one of the most common and disconcerting side effects of certain procedures. While this type of detail is beyond the scope of this article, be aware, says Dr. Bubley, that each specialist (for example, a radiologist) is likely to tell you their method is the best, while this is not necessarily the case.  Ask lots of questions, see several different specialists, and decide what is best for you.

How may prostate disease relate to lifestyle? A number of epidemiological factors, clinical observations and small studies indicate multiple lifestyle factors that contribute to both BPH and prostate cancer.  Most striking is that a man is 36 times more likely to develop prostate cancer in North America than in China.  When men from China migrate to America their incidence of prostate cancer rises.  Epidemiological evidence suggests that having red meat and dairy products as the main source of protein in North America, versus soy and fish sources in China, may explain this difference.  We also eat fewer whole grains, fruits and vegetables.  The main beverage in China, green tea, with its proven anti-cancer properties, is in stark contrast to the milk, coffee and pop drinking culture of North Americans. 

Obesity may contribute to prostate problems since fat cells convert testosterone into estrogen, and high estrogen levels have been shown, in dogs, to induce BPH.  Furthermore, the hormone testosterone also factors in.  Eunuchs, men who have no testes and therefore very low levels of testosterone, are said to never get prostate cancer.  Deficiencies in a number of nutrients such as Zinc can cause excessive amounts of dihydrotestosterone (DHT), a form of testosterone, to accumulate in the prostate of some aging men.  This can cause enlargement of the prostate and be a risk factor for prostate cancer.