Prostate Cancer - Something NOT to be Ignored
Article published in Engineers Australia Nov 2005
It is a sad fact that prostate cancer kills around 2,500 Australian men every year, second only to lung cancer in terms of cancer mortality. Many of these deaths could have been avoided if men regularly visit their doctors for a blood test and examination to detect the early signs of cancer.
The prostate is a small doughnut shaped gland located below the bladder surrounding the urethra or the tube going from the bladder to the penis. Since it is an internal gland, it is generally ignored unless it enlarges and squeezes the urethra. If that occurs men can experience the symptoms of prostate enlargement being the need to wake frequently at night to urinate, a sudden or urgent need to urinate, difficulty in starting, stopping or passing urine or discomfort when urinating. Prostate enlargement can also affect sexual function causing painful ejaculation, blood in the urine or semen, a decrease in libido (sex urge) or reduced ability to get an erection. Having these symptoms does not necessarily mean that you have prostate cancer but you should visit your doctor to check things out.
Just because you don’t have any symptoms does not mean that you should avoid regular check ups. Dr Phillip Katerlaris, a urologist, director of the Prostate Cancer Foundation of Australia and Director of Prostate Cancer Research at the Institue of Magnetic Resonance Research advises that all men over 50 should have a PSA test (which looks for suspicious proteins in the blood) as well as a digital rectal examination (DRE). If there is any family history of prostate cancer, the risk of contacting the disease is significantly increased so you should commence regular PSA and DRE tests from age 40.
Although there is no specific cause of prostate cancer, Katerlaris believes that the best way to reduce risk is through maintaining a healthy weight, regular exercise and a high fibre low fat diet. “There is a lot of research and controversy over other dietary supplements such as lycopenes [from tomatoes], soy products, vitamin E and selenium which are the subject of ongoing trials. My own feeling is that risk prevention is not about bottling a particular molecule, rather that it is more the composite beneficial effect of a high fibre, low fat diet that contains plenty of fresh fruit and vegetables.”
Whilst not ruling out natural supplements such as Saw Palmetto, Katerlaris believes that there is insufficient scientific evidence to conclusively prove any benefit.
Diagnosis of prostate cancer is indicated by the change in PSA markers over time, but like with any medical test, it is not infallible. The latest diagnostic test to confirm prostate cancer is endorectal magnetic resonance imaging of the prostate which can also determine whether the cancer cells have burst through the prostate and spread throughout the body. More traditional approaches involve conducting a biopsy (taking a small sample of prostate tissue) to determine if it contains cancer cells.
There are various management options available if one is diagnosed with prostate cancer ranging from watchful waiting (do nothing), external beam radio therapy (radiation), brachytherapy (seeding the prostate with radioactive iodine isotopes or inserting radioactive iridium wires into the prostate to kill off the cancer cells).
For younger men or men with an obstructive or virulent form of the disease, the most common treatment is a radical prostatectomy or removal of the prostate. There is some disagreement between surgeons as to the best method of doing this with some opting for removing the prostate via the peroneum (between the testicles and anus) and others preferring a laparoscopic (or keyhole surgery) approach.
One of the latest techniques is robot assisted laparoscopy which involves making 6 small (5 – 10mm) incisions into the belly which are used to insert a laparoscope and miniaturised robot surgical tools.
Professor Tony Costello at the Epworth Hospital in Melbourne is one of the highly skilled surgeons who utilised this technique. According to Costello the use of robotics means that there is minimal invasion, no incision and no blood loss. The $3 million da Vinci® prostatectomy robot is controlled by the surgeon’s hands as he operates in a virtual 10x magnified 3D view of the surgical region. With his head in what could pass for a game console the surgeon’s hand movements are digitised, scaled down and smoothed giving the surgeon unprecedented vision and control over accuracy of the surgical tools. Costello believes that “this is the best bit of surgical technology since the scalpel blade because it allows the patient to go home in one day and virtually eliminates the risk of the patient losing continence.” Using minimal incisions, the surgical site is almost bloodless allowing the surgeon to exactly see the nerves and key blood vessels vital for continence and maintaining an erection. Depending upon the spread of the cancer, the patient has a 50% chance of being able to maintain an erection after robot assisted surgery.
More information
www.prostate.org.au
www.cancervic.org.au
www.aihw.gov.au/publications/index.cfm/title/10083
www.prostatecancer.com.au
www.tonycostello.com.au
www.epworth.org.au
Prostate cancer surgery carried out by robot at the Epworth Hospital in Melbourne, Australia.