This evening I am going to talk about the only disease that I know about that is sex specific.  You may think that breast cancer is sex specific but in very rare instances men may develop it.  I am talking about prostate cancer.

It is diagnosed in 1 in 10 men.  It is the second most common cancer in man and the second leading cause of death in men.  Three out of every 10 men diagnosed with prostate cancer will die.

For many years there has been a reluctance among many men to discuss this problem, very probably as a result of one of the main sequella of treatment, impotence.

The prostate is a gland located in the pelvic region that surrounds the ureter and produces seminal fluid that carries sperm during an ejaculation.   Once you have had your children it is not an essential gland.

The greatest risk for prostate cancer is your age.  75% of all cases are diagnosed in men over the age of 65.  There is a heredity component.  If you have a brother or father who has had prostate cancer your risk of developing this disease doubles.  This accounts for 9% of all cases of prostate cancer.  For these individuals you should start having yourself screened yearly at the age of 40.  For individuals of Japanese or African origin living in North America you are at 35 to 50 % more risk of developing cancer than are other races.  This may be an indication of an environmental component to contracting this condition.

The risk factors for prostate cancer are many and varied.  They include high fat diets, low exposure to the sun, heavy metal exposure, infectious agents, smoking, high levels of male hormones, and lack of exercise.

The symptoms are frequent urination especially at night, inability to urinate, trouble starting or holding back urination , a weak or interrupted urine flow, frequent pain in the lower back, hips, upper thighs, spine and pelvis, swollen lymph nodes in the groin area, impotence, blood in the urine and painful ejaculation.  These symptoms may come from a variety of other conditions.  As men grow older the prostate may grow larger.  This may be a benign condition called prostate hypoplasia.  It may require medication or surgery to relieve the symptoms.

If you have any of these symptoms, have a brother or father who has had prostate cancer or are over the age of 50 your doctor should be using several screening tests.  The first is a digital rectal exam where a doctor palpates the prostate to determine whether it is hard or lumpy.  The second is a PSA or prostate specific antigen test.  These two test can also be used to try to detect silent prostate cancer, those where there are no symptoms. 

It should be emphasized that these two tests are not infallible.  For every 10 men found to have a higher than normal PSA level.  3 on further tests will be found to have prostate cancer, 7 will be found to not have prostate cancer at the time of screening.  You will please not the term “at the time of screening.”  These men may develop a problem later.

Of those men who have a normal PSA level 2% will actually have prostate cancer that has not been detected by the tests. 

If you have an elevated PSA level a biopsy will be done.  A small incision is made in the abdomen and small pieces of the prostate are removed. I have it on good authority that this procedure entails very little discomfort.

At the present a gene has been located that may be used to in the future determine which men will have prostate cancer that will become lethal and metastatic.

One of the major problems with prostate cancer is it varied reactions.  In some men it may be so slow growing that they will die of other causes.  On the other hand it may be much more aggressive and invasive.  This is why the treatment of prostate cancer is also varied and to a large extent depend on the patients willingness to accept risk and weigh the benefits.

Prostate cancer is treated by watching and waiting medication, irradiatation or surgery.  If you are in you 50's or 60's and healthy you may choose a more aggressive course of treatment and opt for surgery.  Men in their 70's who have other serious health problems and early stage cancer may choose to just wait and watch.  Prostate cancer is grade on the size and rate of growth.  The higher the Gleason score the more aggressive the treatment should be.  If the cancer has already metastasize it is less likely to be curable.  Your choice of treatment may also depend on your acceptance of the side effects. 

A prostectctomy is where the whole gland is removed.  This may result in the severing of the ureter, blood vessels and nerves leading to the penis.  The result may be urinary incontinence, impotence and hot flashes.  Recent new surgical techniques have been developed that spare the nerves and preserve the urinary and erectile function. Hormonal therapy may result in the inability to have an erection, loss of sex drive and hot flashes.  Radiation therapy may cause inflammation of the rectum, inflammation of the bladder and inability to have an erection.  Radiation may be the external beam type, or implanted radioactive seeds or a combination of the two.  A new cyrotherapy where the gland is frozen has had encouraging results.

Impotence may be treated by drugs such as Viagra to increase blood flow to the penis, mechanical devices that draw blood into or hold it in the penis or surgery to repair the blood flow. Meuse may be used externally to achieved the same result.  Stopping smoking and reducing your alcohol consumption will help impotence as well.  Looking to the future there are at present 39 drugs or vaccines which are currently undergoing clinical trials to treat prostate cancer. 

So what can you do to help prevent prostate cancer.  To start with reduce the fat in your diet.  We will eat to much and could stand to do this for our overall health.  Eat more tomatoes.  Tomatoes contain lycopene which has been shown clinically to affect the size and spread of these tumors.  Lycopene can be used for prevention or treatment.  Get more sun.  The less your sun exposure the more likely it is you will have a prostate cancer problem.

Eat salmon, herring or mackerel to get omega 3 fatty acids, EPA and PHA.  Eat your broccoli, peas and baked beans.  A high intake of vegetables may reduce your risk.  Betacarotine usage every other day has been found to lower the incidence of prostate cancer. 

Reduce your smoking.

Become physically active.  If you burn more than 1000 kilocalories  a week by exercising you have 3 times less risk of developing prostate cancer.

Vitamin A may help in the prevention and treatment of prostate cancer.

Selenium supplementation has reduce mortality and incidences of lung, prostate, rectal and colon cancer. 

I hope that this over view of prostate cancer has been useful and may help each of you in the future.

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