fighting Cancer: A Survival guide

Dr Waleed Abdul-Wahab, is a Bahraini doctor working at the Franziskus Krankenhaus-Charite University, Berlin, in the capacity of a consultant urologist. In 2010, the university will celebrate 300 years in the field of health services and its urology unit celebrates 100 years next year.

This institution is not only the major healthcare provider and tertiary referral centre for Berlin and the surrounding regions, but is also a centre of medical excellence and cutting-edge pioneering research. The Charite Medical University boasts 13 Nobel Laureates to date.

It is true that medicine is an extremely complex field that is continuously evolving even as I write this column.

However, this does not mean it cannot be simplified for the purpose of giving non-medical readers a basic comprehension of what should be the quintessential issue of their lives: their health.

After all, it does not take a scientist to know that good health is positively related to life while poor health ends it.

Therefore, it is our aim to reach out to the largest possible number of people and arm them with awareness of diseases that threaten their lives as well as the lives of their loved ones.

Cancer is by far, one of the most common causes of death in the developed world - a disease which strikes down one in four of the population.

The irony is that many lives could have been saved if those affected had sought help earlier on in the disease process. However, people tend to overlook essential tell-tale signs and fail to seek a professional opinion at the right time.

It is here, where we are striving hard to make a difference with GulfWeekly's One in Four community campaign. We want to drive home the message that public awareness does make a difference in the fight against cancer, so please, BE AWARE!

This month we will talk about Prostate Cancer. Even though, this disease only occurs in males, I am sure our female readers have husbands, fathers, and brothers whose health is also of their concern. Always remember that when cancer strikes, it does not only affect the patient, it has an effect on the entire family.

What is the prostate?

The prostate is a gland which is only found in men. It is approximately the size of a walnut. It secretes a fluid which constitutes around 90 per cent of the seminal fluid or male ejaculate.

This fluid provides sperm cells with essential nutrients as well as vital protection during their journey to reach and fertilise the female egg.

Where is the prostate located?

The prostate sits right below the bladder. As we know, urine exits the bladder via a tube called the urethra. The urethra runs through the prostate on its way out of the body.

What is the importance of the prostate's location?

Since the urethra runs through it, a myriad of irritating and obstructive urinary symptoms occur when the prostate enlarges in conditions such as Benign Prostatic Hyperplasia (BPH) as well as prostate infections.

The resulting symptoms include a weak, intermittent stream associated with hesitancy and dribbling or even worse a total inability to pass urine.

Now that is a painful condition! This happens because the enlarged prostate squeezes the tube that carries urine out of the body. These symptoms are not always associated with prostate cancer but never-the-less requires consultation with an urologist.

What is cancer?

For the benefit of those who are reading our medical series for the first time, cancer is a disease when specific cells within the human body rebel against the system and start to multiply out of control until they spread and ultimately cause death.

Is prostate cancer common?

Yes it is. Prostate Cancer happens to be the second commonest cancer detected in men after skin cancer. In fact, some studies have revealed that one in every six men will develop this disease during their lifetime.

However, there is no cause for panic because despite this high number only one man in 35 will actually die of this disease - but please do not get too comfortable with these figures because this still means that prostate cancer is the second commonest cause of cancer-related deaths in males after lung cancer.

Luckily though, prostate cancer-related deaths are going down thanks to cancers being detected at earlier stages and the correct treatment strategies being implemented at the right time.

What are the symptoms?

Unfortunately, this is not a cancer that is known to have specific early signs & symptoms (fig 1). Bone pain can sometimes be the initial symptom but that usually means the disease has already spread (metastasized).

Therefore, in this specific cancer, we must stress on the risk factors in the aim of identifying those most likely to develop prostate cancer and investigating them before they develop any symptoms.

What are the causes of prostate cancer?

Unfortunately, we still do not know what causes prostate cancer.

However, we are aware of certain risk factors that are linked with the disease but even this is not so clear because some people that have risk factors never develop the disease while others who don't have any risk factors do develop the disease. This only adds to the controversy and complexity of prostate cancer, even for doctors.

What are the risk factors?

Almost all the risk factors related to prostate cancer are ones that cannot be avoided. However, as I mentioned above, there is no definite correlation between having a risk factor or factors and definitely developing the disease. The commonest risk factors are as follows:

Age

Family history of prostate cancer

Ethnic origin

Geographical distribution

Diet

Obesity

How is age related to prostate cancer?

The older men get the more likely they are to develop prostate cancer. It is estimated that it can be found in 30 per cent of men aged above 50 and this figure jumps to 70 per cent in men aged over 80.

But please do not be alarmed because most of these people will live a full life and die of other diseases without even knowing they ever had prostate cancer.

The only problem, however, is that we can never tell for sure which people will develop the fatal form of this disease and who will not. In any case, this is a risk factor nobody can do anything about. We all have to get older whether we like it or not.

What foods are likely to lead to prostate cancer?

At last, a risk factor we can do something about. It is believed that diets rich in animal fats such as red meats and high-fat dairy products predispose men to higher chances of developing it.

Are there any diets that prevent prostate cancer?

Scientists have identified foods that they believe lessen the risk of prostate cancer such as soy products and lycopenes.

The latter is typically found in tomatoes and watermelons and gives them their red colour. As a matter of fact, the tomato rich diet of the Mediterranean peoples is believed to have reduced the incidence of this disease among their men.

What are the steps for detecting/screening cancer?

A blood test for measuring Prostate Specific Antigen (PSA) is helpful since when it is elevated it suggests the presence of cancer.

However, as its name suggests, this test is specific for the prostate but it is not specific for cancer and therefore you may also get false readings which may cause panic among patients.

Other less serious causes that can cause an elevated result such as prostate infections and increased prostate size (BPH). Your doctor will take these issues into consideration.

A digital rectal examination (DRE) is also carried out by your doctor where he will assess the prostate for any suspicious nodules that may be cancerous.

This is performed by the doctor inserting their finger into the rectum and feeling the surface of the prostate. OUCH! Actually, this does not hurt as much as it sounds.

A trans-rectal ultrasound is becoming a useful tool because it gives us a picture of the prostate using harmless, ultrasonic sound waves. Areas of suspicion will show up on the screen. This tool has greatly enhanced the efficacy of taking prostate biopsies.

Based on the findings of these examinations, a further test known as the Prostate Biopsy may also be required (fig 2). This gives us factual evidence on the microscopic level whether or not there is prostate cancer and how vicious is its nature. It is the result of this test that will be detrimental in deciding whether further treatment is required as well as what type of treatment may be most suitable.

Who should do go to the urologists and when?

It is generally recommended that when men reach the age of 50 years they should do the PSA blood test and DRE on an annual basis. However, men who have high risk may be advised to start as early as 45 years. In fact, when there are multiple first degree relatives with this disease, some specialists even advise to start this screening even as early as 40 years.

Who should decide whether or not I should do prostate cancer screening?

Your doctor would probably be the best judge of whether or not you fulfil the criteria for screening or not. Even if you do fit the criteria, by assessing your character traits he may well advise you not to do any further investigation.

Again, the man on the spot probably knows what's best because it is so difficult to generalise in this highly debatable disease. Sometimes when things are uncertain, doctors may offer a very close follow-up to their borderline patients known as "watchful waiting".

Are there any treatments?

Yes, as a matter of fact there are numerous treatments available that aim at removing or destroying the cancerous growth in order to cure the disease, provided that it has not spread.

Therefore, it is essential that the disease is identified in its early stages and this is an argument favouring screening. Today there are many treatment options and they all have their advantages and disadvantages.

What are the different treatments for prostate cancer?

I think prostate cancer more than any other cancer has the widest selection of treatment options.

They range from surgical removal of the prostate which can be done in a number of ways; either the classical open methods or through small openings through the abdomen and performance of the operation with a camera (Laparoscopic).

In some research centres, they have specialised robots called Da Vinci to help remove the prostate (fig 3).

The prostate can also be destroyed by powerful x-ray beams. This is known as Radiotherapy.

In addition, there is also the possibility of implanting radioactive seeds into the prostate to have a similar effect and this is called Brachytherapy.

Cryotherapy is another treatment option where a special device is used to freeze the prostate.

HiFu, however, is the latest technique in prostate cancer treatment.

As a matter of fact, our hospital, is one of the few centres around the world to offer this to our patients.

The concept here is to heat the prostate with high intensity sound waves until the cancer cells are destroyed.

The beauty of this is that it can be used with people who are not fit to undergo an operation since only minimal anesthesia is required (fig 4).

The results have so far been superior to those of radiation therapy.

Can we contact you with specific questions related to this topic?

I would be delighted to offer any help I can so please send in any questions to drelansari@hotmail.com