Prostate Cancer

The prostate gland is located underneath the bladder and in front of the rectum. Because of this location, this walnut-sized organ has to be examined by insertion of a lubricated gloved finger into the rectum. The prostate gland wraps around the urethra, which is the passageway for urine flowing from the bladder. The seminal vesicles and the ejaculatory ducts are attached to the prostate, and they empty their contents into the prostatic urethra. The prostate gland also produces hormones and enzymes. The hormones assist with the growth of the prostate gland, while prostatic enzymes help ensure the motility of sperm, which improve the chances of reproduction.
As men age, the prostate gland becomes susceptible to three common conditions: benign enlargement, infection, and cancer.
Benign enlargement of the prostate gland is usually referred to as benign prostate hyperplasia (BPH). This non-cancerous condition can cause symptoms related to this enlargement. Urinary frequency (voiding more than seven times per day), urgency (the sensation of the immediate requirement to void), urge incontinence (the inability to prevent the leakage of urine during urgency), and nocturia (awakening more than two times per night for urination in an individual less than 65 years of age) are usually the early symptoms of BPH. As this disease process progresses, men may experience a decreased force of urinary stream (slow stream), straining to void, urinary hesitancy, and the sensation of incomplete bladder emptying. Progressive symptoms can lead to the total inability to urinate, a condition called urinary retention. Treatment of BPH is usually with medications that will help relax the prostate or reduce the size of the gland. Symptoms that are unresponsive to medication can be treated with surgical intervention. The gold standard is transurethral resection of the prostate. Other minimally invasive procedures include microwave therapy, needle ablation, laser therapy, and vaporization of the prostate.
Infection of the prostate gland can lead to a condition called prostatitis. This infection can lead to inflammation of the prostate, which may become symptomatic. These symptoms can include painful urination, blood in the urine, fever, chills, and pain in the perineum, lower abdomen, and back. It can also decrease sexual performance. Treatment is usually with long-term antibiotics; typically a six-week course is required. Chronic infections may recur and require an even longer course of antibiotics. Prostatic massage, non-steroidal anti-inflammatory medications, and Sitz baths can help reduce the discomfort associated with this condition.
The third common prostate condition is cancer of the prostate gland. Prostate cancer is the uncontrolled growth of cells within the prostate gland. Prostate cancer is the most commonly diagnosed malignancy and is the second leading cause of death among American men. This year, approximately 198,100 men will be diagnosed with prostate cancer and 31,500 will die of this potentially curable disease. This means that an American male is diagnosed with prostate cancer every three minutes and death from this disease occurs every sixteen minutes.
In Louisiana, approximately 3,500 men are expected to be diagnosed with prostate cancer and 600 were predicted to die of this disease in 2001. Unlike many other states, Louisiana has not observed a significant decrease in the death rate from prostate cancer. In fact, the likelihood of developing prostate cancer has slightly risen.
The exact cause of prostate cancer is not known. However, there are primary risk factors that increase the chances of developing this disease. The first primary risk factor is age. Beginning in the fourth decade of life, advancing age positively correlates with developing prostate cancer. More than 80% of cases are diagnosed in men over 65 years of age. Race is the second primary risk factor. The highest risk in the world is among men of Sub-Saharan African descent. Asians have the lowest risk in the world. In America, African-American men have up to a 60% higher risk of prostate cancer than their Caucasian counterparts. Even more disturbing is the fact that the death rate among African-American men is twice that of their closest ethnic counterpart. The third primary risk factor is family history. Prostate cancer tends to run in families. The risk increases with the number of first-degree relatives affected. First-degree means a father, brother, or grandfather. Fathers and brothers have twice the risk of men with no affected relatives, and if there are three affected relatives the risk goes up eleven-fold.
Other risks include dietary components, lifestyle and environmental factors. Diets supplemented with vitamins A, D, E, and selenium may lower the chances of developing prostate cancer. These vitamins are contained within seafood, meats, vegetable oils, vegetables, egg yolks, and fruits. Lycopenes, which are present in tomatoes, may also lower the risk of prostate cancer. On the other hand, diets high in saturated fats may raise the risk of developing this disease. Exposure to sunlight may play a protective role against prostate cancer. Reasons to account for these dietary and environmental observations are presently being studied.
Early detection is the key to surviving this potentially curable disease. Two simple tests are recommended, a digital rectal examination and a serum prostate specific antigen (PSA) level. During the digital rectal examination, a lubricated examining finger is gently inserted into the rectum to feel for the prostate gland. This examination is associated with minimal discomfort and takes only a few seconds. Prostate specific antigen is a protein found in the blood that is usually elevated in men with prostate cancer. Many urologists believe that a normal PSA is between 0 to 2.5 nanograms per milliliter. Values higher than 2.5 nanograms per milliliter are abnormal and may need further medical workup. The important thing to remember is these two very simple tests can save your life. African-American men and men with a family history of prostate cancer should begin yearly screening at the age of 40 years, whereas all other men should begin yearly screening at 50 years of age.
The three most common reasons for an elevated PSA are BPH, prostatitis, and prostate cancer. Individuals with an elevated PSA or abnormal DRE should undergo further testing to rule out prostate cancer. This should consist of transrectal ultrasonography and biopsy of the prostate gland. This procedure is usually performed in the physician's office under a local anesthetic. It is usually associated with mild discomfort and few post-procedure complications. It takes approximately 20 minutes to perform. The ultrasound probe is inserted into the rectum to identify the prostate gland. Six or more (usually 12) biopsies are obtained from multiple sites throughout the gland. These samples are then examined under the microscope for the presence of prostate cancer.
The treatment of prostate cancer depends on multiple factors, which are age, concurrent medical conditions, stage and aggressiveness of cancer. Stage refers to whether the cancer is confined to the prostate gland (Stages A and B or T1-2) or has spread outside the capsule of the prostate to local or distant sites (Stage C and D or T3-4). Treatment options consist of:
Radical prostatectomy: surgical removal of the prostate gland. Recommended for early stage disease (RESD).
Interstitial brachytherapy: surgical placement into the prostate gland of small seeds that give off radiation over several months. RESD.
High dose radiotherapy: the administration of high doses of radiation through needles or plastic cylinders temporarily implanted into the prostate. These needles are removed after 3-4 doses are administered (usually 24 hours after insertion). RESD.
External beam radiation: radiation is administered to the prostate gland (and/or entire pelvis) daily for 6-8 weeks. RESD and locally advanced prostate cancer.
Cryotherapy: probes inserted into the prostate gland are used for a double freeze and thaw cycle. RESD and prostate cancer refractory to radiation.
Hormonal therapy: agents used to either decrease the production of testosterone (the male sex hormone and growth factor for prostate cancer) or prevent its action. These agents can be given as the primary form of treatment or to supplement any of the above treatments.
Chemotherapy: agents that slow the growth of prostate cancer.
Watchful Waiting: treatment is withheld until symptoms arise.
In conclusion, individuals with symptoms of BPH or prostatitis should see their physician (preferably a urologist) for treatment, as well as to determine whether prostate cancer is present. Prostate cancer is a curable disease if detected in the early stages. Treatment is individualized, and the risks and benefits of each option should be understood before one is selected.

Changing Behaviors to Help Self-Manage Diabetes

Diabetes is a condition that must be dealt with 24 hours a day, seven days a week, 365 days a year. There isn't a vacation from taking care of a person's diabetes. There is no, "I'll take care of my diabetes tomorrow or next week." The person who has diabetes must make numerous decisions every day as to what is healthy or the best way to self-manage or take care of themselves and their diabetes daily. A person who has diabetes must see a health care provider (doctor, nurse practitioner, physician assistant, etc.) on a regular basis and probably more often than most people. However, most people with diabetes are the real caretakers of themselves and their diabetes. That is real self-management.
Diabetes is also a condition that has the possibility of causing numerous complications such as cardiovascular (heart and circulation), kidney, neurological (nerve), and eye problems. Additionally, conditions such as hypertension (high blood pressure) and various forms of hyperlipidemia (high cholesterol, high fats in the blood) commonly occur with diabetes. So, when we look at all of these conditions together, we can see that what is done to protect hearts will also help self-manage diabetes. For most people this means changing behaviors (the way we do things) and habits.
Change is hard for most people. We become very comfortable in what we do, such as eating ice cream every day, or in what we don't do, such as exercising. We like what we do. Even when we really want to change a behavior, there is usually hard work, determination, and some degree of discomfort. So in order to make a change in our behaviors, or way of living, something is usually given up. It might be something enjoyed or just a habit that has served well in the past but is no longer useful. You may be giving up time or energy that has been used for other things. Some people grieve or feel sad about giving up an old habit. Changing how to do things, like eating healthy foods, means breaking a habit or finding something new to enjoy. OLD HABITS ARE STUBBORN - JUST LIKE A MULE!
Knowing WHY you want to make a change is just as important as knowing WHAT to change. Remember, the final goal is to lessen and hopefully prevent complications. Try to think of what you would like your life to be like in 5, 10, or 15 years. What you do today affects your future. I would much rather be an old grandma, wearing a purple hat and enjoying my grandchildren, than for my grandchildren to have to take care of me!
Whether You Are Changing Your Diet, Exercise, Smoking, Footcare, Medication, or Some Other Behavior, There Are Some Hints That Can Help You Do So More Easily:
1. Get informed. The more information you have about your habit and the changes you want to make, the more successful you will be.Example - If you want to change your meal plan or the foods you eat, talk to your health care provider, talk to a dietician, read a book, look on the Internet, go to lectures. Get as much good information as you can. Get information you understand and ask questions. Be sure to get your information from good sources and not just the person ahead of you in the grocery line.2. Only work on one or two changes at a time. If you try to do everything at once, you can stretch yourself too far.Example - Even if you do need to lose weight, increase your exercise, stop smoking, and take your medicine regularly, pick the area you are most ready to handle. Then work your way down the list once the first habit or behavior is under control. So, maybe you think that by setting an alarm you could get up in time to take your medicine before going to work. Do that until you are absolutely not missing any medicine. Then go to the next habit - maybe walking. Do this until all behaviors are changed or managed.3. Start small. Plan to make little steps toward your goal.Example - Start with baby steps. You can't make it on the Olympic team your first day of exercising. For some couch potatoes, getting up and moving is a good start. Remember, if you are overweight, the weight didn't just appear overnight; it isn't going away overnight either.4. Get help. If you work with a buddy who is also trying to change, the two of you can support each other.Example - Get a walking partner. Walk with your children. Join or start a support group. Share recipes and ideas. If you can't see your feet, find a foot checking partner.5. Add something new. It is always easier to add a new habit than to take something away. So, try to change your behavior by adding instead of subtracting, especially at first.Example - Instead of thinking, "I can never eat ice cream for dessert," make a plan to eat fresh fruit for dessert at least two times each week. Instead of thinking, "I can't stay here in bed sleeping," make a plan to walk 15-30 minutes three times each week.6. Keep a record. The first step to changing your habits is knowing yourself well. Keep a list of what you are doing on your behavior, now before you really get down to changing it. That way you will know when things start to change.Example - If you are trying to lose weight, write down your weekly weights. You might even want to make a chart or graph. If you are trying to stop smoking, write down how many cigarettes you smoke each day, or write down the time you smoke each cigarette in the pack.7. Reward yourself. Since you are doing something hard, you deserve a reward. Decide ahead of time how you will "pat yourself on the back" while you are changing your habit - don't expect others to reward you. Be your own reward system.Example - Choose something you enjoy or something you would like to have. If you are trying to lose weight, give yourself a non-food treat each day or each week to reward yourself (a nap, the movies, a bubble bath, fishing). Every person does better when rewarded - it doesn't matter what the task or job is.8. Tell others. If you are trying to make a big change, get your family and friends on your side. Tell them what you are trying to do so that they can be your cheerleaders.Example - No man is an island. Let your family know you are trying to cut down on ice cream, so they don't offer it to you. Let friends and family be your support system. Involve others in the deal.9. Be positive. Getting angry at yourself for not changing faster doesn't help. Remind yourself that you can do it - even though it might be really hard.Example - Instead of telling yourself, "I'll never get to my goal," tell yourself, "I'm working hard at it, and I'm healthier for it!" Be kind to yourself.10. A slip is not the same as a fall. You will have time where you don't quite meet your goals. Stick to the plan anyway. Even tiny steps toward your goal are better than no steps at all. Example - If you don't exercise on an exercise day, don't give up. Think of the times you have exercised. Just regroup - get started moving again. A little exercise is better than no exercise.
So, remember, although changing behaviors can be hard, it can be done. Others have done it, so you can also - with a commitment to change and some work. In order to do that, just get started. I know you can do it.
For more information on changing behaviors, contact: Your local hospital's diabetes program
A behavioral psychologist or other professionals - often available through hospitals behavioral medicine departments or diabetes programs. Local colleges or universities may also be sources.
As always, the American Diabetes Organization is an excellent source of information regarding any aspect of living with diabetes. You may contact your local chapter or go to http://www.diabetes.org
The above information was adapted with permission from How to Make a Change by Michele Larzelere. It is an unpublished educational handout used in the Daughters of Charity Health Center Disease State Management program.