There was a time in history when there was no awareness of the prostate, let alone diagnosis and treatment.   Countless numbers of men throughout the ages have suffered and died as a result of this ignorance.
Through the miracles of modern medicine, today prostate disease is well defined and is no longer necessarily considered a death sentence.  The most effective methods for handling prostate disease are knowledge and prevention. 
In our guide we will help you understand prostate disease, various diagnostic tools and provide recommendations for treatment.


The first step toward understanding how the prostate affects your health is to learn what the prostate is and how it functions.
It is surprising how little many men know about such an important part of their anatomy.
The prostate is an important segment of the male reproductive system.  It is a gland that is located in the lower abdominal cavity, just below the bladder, in front of the rectum and behind the pubic bone. It partially surrounds the urethra.  The urethra is the channel that carries urine to the penis from the bladder and it runs right through the prostate.
A healthy prostate is about the size of a walnut, weighs approximately 1 ounce and is shaped similar to a donut. 
There are “seminal vesicles” that are attached to the prostate.  They produce a protein that mixes with prostatic fluid which forms semen.  How this works is that tubes from the testicles carry sperm up to the prostate where sperm is mixed with the seminal vesicle and prostatic fluids.
This fluid is ejaculated during orgasm through ejaculatory ducts that connect to the urethra.   In addition, the prostate helps to control the flow of urine.
Nearly every man will experience some type of prostate problem during his lifetime.  Men who are over forty-five may experience an enlargement of the prostate.  While this is not a problem in itself, it is uncomfortable and can be a forerunner to other more serious maladies which we will discuss further.
The prostate actually continues to grow throughout life, but grows very slowly after the age of twenty-five.   Enlargement of the prostate is part of the normal aging process due to hormonal changes and usually does not become a serious problem until a man reaches sixty years of age.


Enlargement of the prostate is called benign prostate hypertrophy, or BPH.  While this growth is usually considered a nuisance, if a man experiences problems with burning, or difficult urination at any time, the prudent course of action is consulting a urologist.
Other symptoms may be:
·    A feeling of having to push out urine
·    A sensation that the bladder is not emptying
·    Increased urinating, especially at night
·    Intermittent starting and stopping of the urinary stream

After a diagnosis of BPH, many men will just continue to live with the symptoms and subsequent discomfort.  It is not a life threatening condition, and there are treatments.  In some cases surgery might be considered if the enlargement is significant.
Ignoring BPH can be extremely dangerous and lead to other disease such as kidney infections or damage as the urine can back up into the kidneys because of the blockage of an enlarged prostate.  There can also be an occurrence of bladder infections.
There is a huge difference between BPH and prostate cancer.  BPH is a normal part of aging.  Prostate cancer is a condition where prostate cells grow exponentially and out of control.  These cells create tumors that may spread to any part of the body.
Numerous health organizations report that 1 in 6 men will experience prostate cancer.  However, if the condition is diagnosed early, approximately 99.3% of them will survive.   The key is early detection. 


Prostate cancer can occur in any man, but there are certain “risk groups.”  Younger African American men appear to have twice the risk and fatalities of Caucasians.   Sadly, many are diagnosed before they reach the age of 50.
Another risk group is men who have a family history of prostate cancer, placing them in the same group who may contract the disease before the age of 50.
The only method to determine whether you are at risk for prostate cancer is diagnostic testing.   The earlier you are screened the higher your chances of survival.  Let’s explore some of the diagnostic options.

Digital Rectal Exam (DRE)
Testing begins with a digital rectal exam (DRE).  This examination has been the benchmark for discovering cancer as well as BPH.  Your doctor can determine the condition and size of the prostate by inserting a gloved finger into the rectum.

Prostate Specific Antigen (PSA)
In the mid-1980s’ the FDA approved the use of monitoring blood levels for prostate specific antigen (PSA).  At that time, this was considered a major breakthrough in the diagnosis and treatment for prostate cancer.

Here’s why.  PSA readings specifically target prostate cells.  A healthy prostate gland produces a constant level, usually 4 nanograms per milliliter which is considered as a PSA reading of “4” or less.

Cancer cells produce growing amounts that escalate.  They correlate with the severity of cancer.   A PSA level greater than 4 will give the doctor some cause for investigation.  If the level reaches 10 he will have cause to consider the presence of prostate cancer.  An amount over 50 may indicate that the cancer has spread to other parts of the body. 

A PSA test usually measures the total amount that is attached to blood proteins.  However, later research gained an FDA approval for a test called the Tandem R test.  This test also gives a measure of the total PSA and reads another component called free PSA.  Free PSA floats unbound in blood.

Have these two tests to compare helps to rule out prostate cancer in men whose PSA is just mildly elevated due to other causes.  A 1995 study in the Journal of the American Medical Association shows that a free PSA test reduces unnecessary prostate biopsies by 20% in certain patients whose PSA is between 4 and 10.

As newer sophisticated methods are made available, it is creating a controversy among the healthcare community regarding “when” men should be screened, how often and whether to screen men under 50 with no symptoms. 

Some are saying that mass screening is expensive while others point out reductions in mortality rates when early screening diagnoses prostate cancer.  The jury is still somewhat “out” on that debate, but it never hurts to err on the side of caution.  It is your body, after all!

It should be noted that both The American Urological Association and The American Cancer Society recommend annual PSA test for all men over 50 and for those at high risk over 40.

Take the case of Joe.  A healthy, 36 year old, robust father of two was required to take a routine physical exam for his work-related insurance.  During this exam, his doctor noted that his prostate was enlarged.  Unfortunately, the resulting tests proved that he did indeed have prostate cancer.  Further investigation revealed that he was “at risk” based on family history.

Why take chances?  Get yourself screened so you have a benchmark, then having annual screening.  Remember, prostate cancer is slow growing so the odds are in your favor when detected early.

Urine Test
A standard urine test can also help to diagnose prostate problems by screening for blood or infection.  The chemical tests will also check for liver, diabetes or kidney disease.

Hyperplasia INTRAVENOUSPYELOGRAM (IVP)
This test is actually an X-ray.  Dye is injected into one of the major veins.  While the dye is circulating, pictures of vital organs are taken.  This test will record the progress of the dye through the kidneys, bladder and ureter tubes (the tubes that drain the kidneys).  This test is more or less optional since most men who have enlargement of the prostate usually have no abnormalities of the ureter tubes or kidneys in a normal urinalysis.

Bladder Ultrasound
This is a simple procedure that can be conducted right in the doctors’ office.  It is non-invasive and determines if there is urine left in the bladder after urination.  If a large amount of urine remains, it could be an indicator of enlarged prostate that is not allowing the bladder to be completely emptied.

Prostate Ultrasound
This is a test to estimate the size of the prostate by using state of the art software that helps guide the physician.  The prostate ultrasound is also important if a biopsy is called for which we will discuss later.
Uroflow
This is a simple test that entails the patient urinating into a container and measuring how strong the stream of urine is.

Radionuclide Bone Scan
A test that can be used if staging (see below) indicates that cancer has spread into the lymph nodes.  If the tumor has spread to the lymph nodes, bone commonly follows.  However, if PSA levels are under 10ng and there is no indication of bone pain, physicians find that the presence is so unlikely that this procedure is skipped.

Cystoscopy
This test allows the physician to visually examine the bladder and prostate.  This is done by inserting an instrument through the urethra.

Computed Axial Tomography (CAT)
This is another test that could identify cancer in remote areas of the body.  Without probable cause, like the Radionuclide Bone Scan above, it is probably unnecessary just as the
Magnetic Resonance Imaging (MRI)
This test may be unnecessary, especially if the prostate cancer is localized.

Pelvic Lymph Node Dissection
Considered to be the “final check” to determine if cancer has spread, this procedure can be completed through normal open surgery but more often is conducted using a fiber optic probe that is inserted through a small incision in your abdomen.
All of these diagnostic tests are tools to determine whether there is a possibility of cancer present in the prostate and if so, just how invasive it may be.

However, there is only one way certain method to determine the presence of cancer cells and that is by examining the tissue itself.

Based on the findings of the tests we have discussed, if a physician determines that there may be cancer cells he will recommend a biopsy.

A biopsy is conducted by a urologist and the procedure is normally done right in his office.  Here is where the ultrasound we discussed previously comes into play.  Using a transrectal ultrasound (TRUS), the doctor will image the prostate by using sound waves by inserting an instrument into your rectum.  This allows the doctor to “image” the prostate.  He will use biopsy needles that are hollow into any area of the prostate that looks or feels suspicious.  Small bits of tissue are extracted through the needle.  You may feel a stinging sensation. 

Depending on the reasons for the biopsy, the doctor may take samples randomly.  For instance, if the biopsy is conducted due to elevated PSA instead of a suspected abnormality in the prostate gland, as many as a half dozen or more samples may be taken.  This is considered a “pattern biopsy” and is done to help determine the size and invasiveness of any cancer.  Even though you may have multiple samples, a biopsy can still miss some cancers.

Once the biopsy is complete, the tissue samples are taken to a pathologist to determine the presence of cancer cells.

Normal prostate cells are usually uniform in size and are neatly patterned when viewed under a microscope.  They appear similar to one another in an orderly manner.
Abnormal cells change their appearance and are not well defined.  They will usually appear as misshapen and irregular.

As they deteriorate, a tumor can appear.  Tumors can be benign (non-cancerous) or malignant (cancerous).

If the pathologist determines the presence of prostate cancer, he will “grade” each of the tissue samples.  This will determine how advanced beyond normal the cancerous tissue has developed.  This grading system gives the physician a good idea as to how the tumor is behaving.  Tumors with a low grade are most likely to be slow-growing.  Tumors with a high grade are more apt to spread aggressively or may have already spread outside of the prostate.  If the latter is true, it is said to be “metastasized.”
The actual grading system most widely used by pathologists is the Gleason Grading System, developed in 1977 by Pathologist Donald Gleason.  You will find the Gleason Scores in numerous places on and off the internet as it is a standard method, but we have provided them for you here.

Gleason Scores
The Gleason grading system assigns a grade to each of the two largest areas of cancer in the tissue samples. Grades range from 1 to 5, with 1 being the least aggressive and 5 the most aggressive. Grade 3 tumors, for example, seldom have metastases, but metastases are common with grade 4 or grade 5.

The two grades are then added together to produce a Gleason score. A score of 2 to 4 is considered low grade; 5 through 7, intermediate grade; and 8 through 10, high grade. A tumor with a low Gleason score typically grows slowly enough that it may not pose a significant threat to the patient in his lifetime.

Once the grade is established, your physician will need to have additional information before determining a course of treatment.  He will need to “stage” your tumor which is dependent upon the size and how far it has spread.

There are two systems used for “staging” the tumor.  One of them is TNM and the other is ABCD Rating.  They both evaluate the size of the tumor and the spread in reference to nearby lymph nodes and if the cancer has spread beyond those parameters. 
The staging system determines whether the tumor is “Localized,” “Regional” or Metastatic.  Within each of these categories are divided into categories that are more precise.

Localized
Using the TNM method, you have Stage I (could also be referred to as T1.)  These are tumors that cannot be felt.  Using the ABCD method the staging is considered “A.”
TNM Stage II or B or T2 are tumors that you can feel but are still confined to the prostate gland.

Regional
In Stage III or C or T3 tumors have broken through the prostate capsule.  They may have invaded the seminal vesicles.
T4 indicates that tumors are growing into muscles and organs that are nearby.

Metastatic
Stage IV, D or N+ or M+.  This staging refers to tumors that have invaded either the pelvic lymph nodes (N+) or into other distant areas of the body (M+).

  If you receive a diagnosis of cancer and different treatment options from your doctor, it would be prudent to get a second opinion.  This is a normal practice and one which can help you make intelligent decisions about the most important step you may take in your life.

Getting that second opinion may confirm the diagnosis but help you to adjust the staging and your treatment options.  A second opinion may also lead you to a special clinical trial of new cancer treatments that your current physician is not aware of.
Try and locate a prostate cancer support group in your area.  Speaking to other men who have experienced prostate disease can do wonders in learning how to deal with your diagnosis and treatment options.


Again, it can’t be stressed enough, early detection is imperative in combating prostate cancer.  The challenge is that in the early stages there are no symptoms of prostate cancer.  By the time symptoms appear in the form of urinary complications, the cancer has spread beyond the prostate.

Treatment options vary depending upon several factors such as age, overall health of the patient and whether there is evidence of bladder infection or kidney damage resulting from an enlarged prostate.

Faced with the enormity if your disease, when you add treatment options into the mix it can be overwhelming to say the least.  This is why we recommend that second opinion.  We will take a look at some of those options here.  Just remember, that the best option for you will be the one that you and your doctor determine is the best route for your situation.  When it comes to treating prostate cancer there’s no such thing as “one size fits all.” 

There are some questions that you will need to address before selecting any of the options your physician may recommend.  Let’s take a look at some of those now.  These shouldn’t be taken lightly, as you will be making decisions that will absolutely affect the rest of your life.

·    Other than the prostate cancer, are you in good over all health?
·    Is the cancer confined to the prostate?
·    How fast is it growing?
·    How old are you?
·    Is it important for you to be able to maintain control of your bladder or bowel?
·    Would you find it unsettling to live with cancer that is untreated and have to look at strict monitoring of the disease?
·    Are you healthy enough for surgery?


In this situation you are looking at Stage I or II based on the Gleason Score.  In this particular scenario, you are looking at three different choices of treatment for treatment that can result in long term survival. 

One is called Watchful Waiting; one is Surgery; and finally Radiation.  Let’s explore each of these options further.

Watchful Waiting
Watchful Waiting is the term coined by the medical community to describe an approach for managing cancer that has not yet moved beyond the prostate gland.  This approach is also known as “observation” or “surveillance.”

Because cancer in this stage advances very slowly there is the possibility that it will not cause any lifetime problems.  This is especially true of older men.  Men who opt for this approach do not participate in any active treatment without cause.  They visit their physicians for monitoring but unless a problem arises they have no other treatment.
If there are no indications of infection, kidney or bladder damage this can be a reasonable approach.  Other obvious advantages to this approach are sparing the man pain and potential side effects related to surgery or radiation.
 
The down side of this approach is the risk of decreasing control of the disease before it spreads.  Another minus factor is postponing treatment until a man is more at risk from the side effects and the difficulty of dealing with the treatment itself.  Some men also find that dealing with the stress of having cancer and doing “nothing” about it can cause panic and anxiety.

Watchful Waiting is more viable for older men who have tumors that are very small and growing very slowly as mentioned above in the low-grade Gleason Score. 
Some men who opt for this approach have been known to live for years with no outward signs of disease and in several studies for as long as 10 or 15 years, there is no significant difference in life expectancy than those men who were treated with surgery or radiation.

Surgery
There is no doubt about it.  Surgery is an invasive procedure.  There is evidence that surgery for prostate cancer is rampant in the United States with an increase of 60% between 1984 and 1990.  Contrast this with the Watchful Waiting approach used in Europe for the same stage prostate cancer.  Recent studies, however, do show a decrease in the number of men having radical prostatectomy procedures.  
While the medical community would like to see more incidence of the Watchful Waiting approach, patients find the approach too stressful.

Let’s discuss the actual surgical procedure.  It is called a radical prostatectomy and is the complete removal of the prostate as well as tissue nearby.  The procedure can be further described by the incision used to accomplish the procedure.  These incisions are:

·    Retropubic prostatectomy.  The prostate is reached via an incision in the lower abdomen;

·    Perineal prostatectomy.  The prostate is reached via an incision in the perineum which is the space between the scrotum and the anus.

Radical prostatectomy consists of removing the entire prostate gland, the seminal vesicles, both of the ampullae (the enlarged lower sections of the two vas deferens which are the tubes that carry sperm from the testicles to the actual prostate gland) and the other surrounding tissue.  The portion of the urethra that travels through the prostate is cut away as well as the bladder neck and some of the sphincter muscle that controls urine flow.

Dissection of the pelvic lymph node is routine with a retropubic prostatectomy but with a perineal prostatectomy the dissection requires a separate incision.

A radical prostatectomy is a serious, complicated, demanding procedure.  The surgery itself will take anywhere from 2 to 4 hours.  The patient will remain in the hospital for approximately 3 days.  He will require a catheter (tube to drain urine) for about 10 days to 2 weeks.  There is a small percentage (5 to 10%) of surgical related problems like bleeding or infection.  The risk of death from the surgery is very minimal and much less for younger men as opposed to older men who may be frail.

Post surgical, long term problems associated with prostatectomy range from sexual impotence, stool incontinence and urinary incontinence.   It is highly unlikely that a man will father children after the procedure.  The reason is that without the prostate, very little ejaculate is produced.

It is common for the majority of men to experience incontinence after surgery and have occasional dribbling when coughing or exerting themselves.  A few will lose all urinary permanently.   Some men are candidates for an artificial urinary sphincter which is implanted surgically or narrowing the bladder opening with injections of collagen.
Stool or fecal incontinence (loss of normal muscle control of the bowels) may affect some men after their prostatectomy.  This is caused by muscle damage during rectal surgery and stool incontinence is also caused because of a reduction of the elasticity of the rectum.  What this does is shorten the time period between the sensation of the stool and the need to have a bowel movement.   The rectum can be scarred and stiffened by surgery or radiation.

Historically, a prostatectomy always resulted in sexual impotence.  Advances in surgical procedures called “nerve-sparing surgery” may reduce the risk of impotence.  The nerve sparing technique avoids cutting the two bundles of nerves and vessels that run along the surface of the prostate gland that are needed for an erection.
Unfortunately, this procedure is not viable for everyone, if the cancer is too large or if it is located too close to the nerves.    Under these circumstances, even with this technique many men (especially older men) will become impotent.

The fact is that most men will lose a degree of sexual function and if a man has a problem with erections before treatment, the nerve-sparing surgery is not indicated.
The chances of impotence run the gamut from 20 to 90% depending on age, stage of the disease and the type of surgery.

Radiation Therapy
Radiation therapy consists of using very high energy x-rays.  They are delivered by an external beam from a machine or actually implanted in the prostate to kill cancer cells.

External Beam Radiation Therapy
This treatment can also be used to treat men whose cancer tumors have advanced into the pelvis and can’t be removed with surgery if they have no indication of lymph node invasion.   Radiation therapy can also reduce tumors and relieve pain for men who have advanced disease.

External beam radiation therapy treatments are usually conducted 5 days a week for up to 6 or 7 weeks.  The treatments are painless with each session lasting just a few minutes.  Sometimes, if the tumor is extremely large, hormonal therapy may begin during the radiation therapy and can continue for several years.

Hormonal therapy prevents cancer cells from receiving the hormones that feed their growth.  In prostate cancer, male hormones are blocked with hormonal drugs or by surgically removing the testicles.

The prime target of the external beam radiation is the prostate gland itself as well as irradiating the seminal vesicles as they are a common area of cancer spread.  It was once believed that irradiating the lymph nodes in the pelvis was necessary, but the long term benefits have proven that this only applies to certain situations.
Since a radiation beam is passed through normal tissue to reach the prostate, there is the risk of killing healthy cells.   Diarrhea is a side affect when radiation is applied to the rectum but diarrhea, in addition to fatigue caused by the radiation, will usually disappear when treatment is completed.

One of the long term affects of radiation is proctitus.  This presents as inflammation of the rectum, bleeding, bowel problems such as diarrhea and cystitis which is an inflammation of the bladder.  This usually leads to problems with urination.  Radiation therapy also results in impotency for 40 to 50% of men treated.

Some of these side effects may be minimized by using higher energy radiation beams that can be more precise in targeting the affected area.  Coupled with computer technology, treatments are tailored to exactly match the anatomy of the man being treated.  This type of state of the art equipment is not always readily available.

Internal Radiation Therapy
Internal Radiation Therapy is a procedure that delivers a very high dose of radiation to tissue in the immediately affected area and minimizes the damage to healthy tissue like the rectum and the bladder.

This is accomplished by inserting dozens of tiny seeds that are radioactive directly into the prostate gland.  The therapy depends on ultrasound or CT that guides placement of very thin needles through the skin of the perineum.  The needles deliver the tiny seeds (made up of radioactive palladium or iodine) directly into the prostate using a pre-determined, customized pattern created by extremely sophisticated computer programming.  This high tech process allows the needles and seeds to directly conform to the size and shape of each prostate.

This procedure is normally completed in just an hour or two.  It is done under a local anesthesia and the patient goes home the same day.
Radiation is emitted from the seeds for up to several weeks.  Once insertion is complete, the seeds remain in place causing no harm whatsoever. 
Some physicians use a different approach.  They will use a more powerful radioactive seed and implement over several days.  These are temporary implants.  This procedure requires hospitalization and may be combined with low doses of external beam radiation.

Long term results are not yet in on this procedure primarily due to the fact that internal radiation therapy is still a recent process and is limited to just a few patients.  However, after 5 years more than 90% of patients treated still remain cancer free.
The procedure is not recommended for large, advanced tumors or for men who were previously treated with transurethral resection of the prostate (TURP) or Benign Prostatic Hyperplasia (BPH).  These men are at a higher risk for urinary problems.  When a man has small, well-differentiated tumors it is an option that has fewer side effects as well as being less invasive.  It is less costly than external radiation or surgery and requires a shorter hospital stay.

Discomfort experienced post-implant is usually controlled by oral painkillers and a man can expect a few weeks of incontinence.  Long term problems like prostatitis (inflammation of the prostate gland) are infrequent and usually not severe in nature.  Only 15% of men under the age of 70 experience sexual impotence and 30 to 35% of men over the age of 70.


In this situation the localized therapies just won’t be enough to stop the growth.  This is Stage III and radiation therapy will most likely help by keeping the tumor in check.   Radiation combined with hormonal therapy will help to slow the growth. 
Hormonal therapy

We briefly touched on this subject in the previous chapter, but now let us explore this therapy.

With hormonal therapy, the goal is to cut off all production of male hormones, such as testosterone, resulting in castration.  Castration can be surgical or medical but the end result is the same and for good reason.

Prostate cancer cells can actually “feed” on male hormones causing them to grow.  Blocking the hormones with an antiandrogen (drugs that block male hormones from circulating in the blood) will slow the growth of the cancer cells.  This process is the equivalent of a medical castration.

There are numerous approaches to the use of hormonal therapy.  Different drugs have been combined to test the results.  An example of one such combination is known as maximum androgen blockade.  This is a total hormonal therapy usually combined with either surgical or medical castration.  An antiandrogen pill is ingested each day for months or years. 

Evidence as to the efficacy of this approach has proven that there is no significant difference in the effectiveness of this process as opposed to standard hormonal therapy.  However, surgical and hormonal therapies in combination do seem to relieve symptoms.

When considering surgical castration versus medical castration, it’s important to keep one fact in mind.  Medical castration can be reversed simply by ending use of the drug.  Oddly enough, in some cases ceasing the hormonal treatment has temporarily interrupted the growth of the cancer.

While hormonal therapy in the case of metastatic cancer seems to work, sadly, the reprise is only temporary.  Remission will normally last for 2 or three years.  At some point, those cancer cells that do not need testosterone to grow will begin the growth cycle again.  If this takes place a second array of hormonal drugs (progesterone or hydrocortisone to name two) may be considered.

Clinical Trials
Investigating the possibility of participating in clinical trials is always an option for treatment.  Clinical trials are usually new drugs, combination of drugs or mechanical in nature.

Cryosurgery
This process is used to kill prostate cancer cells by freezing them.  Similar to the tiny radioactive seeds delivered through thin needles that we discussed previously, rather than seeds liquid nitrogen is passed through thin probes that are passed through needles that have been passed through the perineum directly into the prostate.  The liquid nitrogen will form a ball of ice from the cancer cells and as the frozen cells thaw out they break up.  This procedure will take a couple of hours under anesthesia which can be either local or a spinal and a 1 or 2 day hospital stay.
There is a downside to this treatment.  Even though a “warming catheter” is inserted into the penis to protect the urethra, the overlying nerve bundles usually freeze as well rendering the man impotent.

Chemotherapy
While chemotherapy is an aggressive approach, according to the medical community it is not necessarily effective as a choice to fight the slow growing prostate cancer cells.
This does not mean that it should be ruled out entirely.  New anti-cancer drugs are always being studied and released.  There are a few currently under study that are being included surgical or radiation therapy in men at Stage III prostate cancer.
Another study includes them in the regimen along with hormonal therapy.  This is specifically being used for men with advanced cancer that is not responsive to hormonal therapy by itself.

Early Hormonal Therapy
Just as the name signifies, this is the practice of starting hormonal therapy immediately upon the diagnosis of prostate cancer.  The goal is to slow the growth of cancer cells that have grown beyond the prostate and into surrounding tissue and even the lymph nodes.  Sometimes early hormonal therapy helps in shrinking the tumor.

Conformal Radiation Therapy
Conformal radiation therapy (3D-CRT) is a three dimensional computer software program.  It allows radiation beams to conform and shape to fit the prostate thereby accurately targeting only the prostate gland thereby minimizing damage to the surrounding healthy tissue.
No matter what avenue of treatment you select for managing prostate cancer, do your very best to maintain a positive attitude.  Yes, the horizon may look a bit gloomy, but with modern medicine advancements are being made every day. 
Your best defense is a strong offense.  Get screened as soon as possible for early detection then have regular follow-ups especially if you are in an at risk group.


Chances for survival from prostate cancer are dependent on many different factors.  Obviously, early diagnosis is the best case scenario.  Nip it when it is still in State I or Stage II with a Gleason Score of less than seven and you are looking at optimum results using any of the three treatment options we’ve discussed: Watchful Waiting, Surgery or

 Radiation Therapy. 
For a man who is over 70 there is a strong possibility that he might die of other natural causes rather than prostate cancer.  The fact is that many men with localized Stage I or II prostate cancer ARE much more likely to die of something other than the cancer itself.
If a man with localized prostate cancer decides to take the Watchful Waiting treatment option, there is a 19% chance of metastases developing in his next 10 years

For men with Stage III prostate cancer, the prognosis is 50-50 that the cancer will progress in the next 10 years and result in death.
Stage IV prostate cancer is called metastatic prostate cancer and the most widely used treatment is hormonal which might stave off the disease for another two to three years.  The likelihood of fatality within 10 years is very high.


It may seem as though we have come full circle, but even if your diagnosis leaves you free of prostate cancer, you may still have Benign Prostate Hypertrophy.  Rather than using hormonal or alpha blockers, many men have opted for a natural approach to avoid some of the unpleasant side effects of the drug therapy.
The two prescription drugs, inasteride (Proscar) and terazosin (Hytrin) make lots of money for drug companies because they are the only two approved by the FDA to prevent prostatic proliferation (the growth of new prostate cells that cause BPH in men over 50).

Before beginning an exploration of natural treatment options, it must be perfectly understood that there is no substitute for your physician.  These options are presented as just that. . .options and you should consult your physician before undertaking any new treatment options whether medical or homeopathic.

First we will look at 7 different therapy options.  These options are Ayurveda, Reflexology, Food Therapy, Imagery, Hydrotherapy, Vitamin and Mineral Therapy and Yoga.  We present you with a brief synopsis of each therapy as it relates to prostate problems.

Ayurveda
The Ayurvedic approach to all disease is to first make certain that you have received an appropriate diagnosis from a medical professional.
If the prostate diagnosis is benign the "flowing" approach can be used.  Mix the following herbal powders: Punarnava, Gokshura and Shilajit.  Ingest just 1/4 teaspoon a day either dry or added to warm water.  An alternative is to drink any one of horsetail, ginseng or hibiscus tea, consuming as much as you wish each day.  All of these herbs should be available at your health food store or by mail order.

Reflexology
Reflexology is the pratice of directing energy toward specific pressure points in the body.  Reflexology sessions begin with relaxing the total body then shifting the focus of the reflex to those areas of greatest need.  For our purposes that would be the prostate, endocrine, pituitary, parathyroid, thyroid and adrenal glands as well as the pancreas with the reflex in the hands or feet. You can find reflexology charts that give you the reflex points at most health food stores or schedule a session with a professional reflexologist.

Food Therapy
The key to affecting positive change in the prostate by eating specific foods is including any foods high in zinc.  The properties in zinc have been proven beneficial in shrinking an enlarged prostate.  Take a daily supplement of zinc.  In addition to a low-fat diet, particularly avoiding saturated fats, consider adding one or two tablespoons per day of flaxseed oil to your diet as well as pumpkin and sunflower seeds, both know for their high content of zinc.

Imagery
Imagery is closely associated to hypnosis, both practices incorporating positive visualization techniques to effect positive changes.  Here is one exercise proven beneficial for our purposes here: 
Close your eyes; breathe out three times and imagine entering your body through any opening you choose.  Find your prostate and examine it from every angle.  Next, envision putting a thin golden net around the gland.  This net has a drawstring that you can tighten.  Cinch the drawstring so that the net is wrapped snugly around the prostate.  As you do this, picture the prostate shrinking to its normal size.  Then imagine using your other hand to massage your prostate.  Sense that urine can now flow evenly and smoothly.
The recommendation for this exercise is to practice it twice a day, three to five minutes per session for six cycles of 21 days on and 7 days off.

Hydrotherapy
A hot sitz bath comes highly recommended for the treatment of an inflammed prostate.  Sit down in a tub filled with comfortably hot water to a depth of your navel.  Soak for twenty to forty-five minutes and follow with a cold bath or shower.  This treatment should be done once a day for thirty days or until the symptoms are gone.

Vitamin and Mineral Therapy
The ideal vitamin and mineral treatment for prostate problems incorporates herbal medicine.  The following regimen is recommended to help control symptoms:
•    400 international units of Vitamin E per day
•    30 milligrams of zinc twice a day
•    1 milligram of copper twice a day
•    One tablespoon of flaxseed oil a day
•    160 milligrams of saw palmetto twice a day

Flaxseed oil and saw palmetto are easily obtainable in any health food store.

Yoga
Certain Yoga poses can increase blood flow to the groin, thereby relieving certain prostate problems.  You can find books on Yoga that include these poses, as well as many others, at any herbal or homeopathic store.  The two poses that will benefit prostate problems are the "knee squeeze" and the "seated sun" along with the "stomach lock."  To do the "stomach lock," lie on your back and take a deep breath.  Breathe out until all air is expelled from your lungs, then pull in hard on your buttocks, groin and stomach muscles.  Hold this pose for a count of three then release the muscles.  It is recommended that this session is repeated two or three times a day, three times a session to help prevent prostate trouble.

You should not use this yoga pose if you suffer from high blood pressure, hiatal hernia, ulcers or heart disease.

More Natural Treatments

Pumpkin Seeds
Not enough can be said about the healing power of pumpkin seeds!  It seems hard to believe, doesn’t it?  Why do these little seeds have such a profound effect on prostate problems? 

Did you know that pumpkin seeds contain fatty oil that is a natural diuretic?   The medical community scoffs at the idea that increased urine flow may have anything to do with an increase in urine flow.  However, in addition to being a natural diuretic, these seeds contain as much as eight milligrams of zinc equivalent to a half cup per serving!  
Some doctors recommend taking 60 milligrams of zinc each day as part of the regimen to combat BPH!  However, make certain you are in contact with your regular physician because this amount is way more than the daily value.

The point is studies have proven that zinc reduces the size of an enlarged prostate. 
Those little pumpkin seeds are high in the amino acids: alanine, glycine and glutamic acid.

According to recent study men who were taking the supplements of these amino acids with a dose of 200 milligrams each day, BPH symptoms showed significant relief.

Saw Palmetto
Did you know that after Proscar was approved by the FDA, that agency banned all nonprescription drugs for BPH?  According to Varro Tyler, Ph.D., dean and professor emeritus of pharmacognosy (natural product pharmacy) at Purdue University in West Lafayette, Indiana, the ban was initiated for two reasons.  First, the FDA purported that there was no credible evidence to show that any over the counter (OTC) products were effective in the treatment of BPH.  Second, the agency also expressed a viewpoint that those who used OTCs might put off getting proper treatment while their disease worsened. 

“What the FDA overlooked,” says Dr. Tyler, “was the considerable evidence in Western Europe that certain phytomedicinals (plant based medicines) are effective in treating BPH and that people using them experience an appreciable increase in their comfort level.  Perhaps the most popular of these is saw palmetto.  The beneficial effects include increased urinary flow, reduced residual urine and decreased frequency of urination.”

Saw palmetto can be found in southeastern states.  It is a small palm tree.  The Seminole Indians ate the seeds as food.  Who knows?  Maybe they found it helped their urinary problems. 

The reason it works is because it contains a compound that turns testosterone into dihydrotestosterone thus preventing the transformation of the testosterone.  It is exactly the same way that Proscar works, but in a different way.
Half a dozen studies have proven saw palmetto as an effective treatment.  In one of them, a clinical trial of more than 2000 German men with BPH received substantial easing of PBH symptoms after a daily does of one to two grams of saw palmetto seeds.

It is interesting to note, Science News reports, “30% of all American men have undiagnosed prostate cancer by age 60-but the incidence is only about 1% among Arctic Intuit men of the same age group.”  It is believed that this is a result of a diet high in fish oil.  This may be something to consider in your own diet.


There is no way to sugar coat it.  If you are diagnosed with any form of prostate disease you will experience some type of erectile dysfunction, even if it is a surgical procedure using the nerve sparing technique.

There is no need to repeat the treatments we’ve already covered, but let’s take a moment to review some of the possibilities that are available to men AFTER being diagnosed with prostate disease who experience erectile dysfunction:

·    There are now numerous erectile dysfunction drugs (EDDs) available.  These drugs promote erections by increasing blood flow to the penis.

·    There is a substance called Prostaglandin E1 that can produce erections.  It is produced naturally and can be injected almost painlessly into the base of the penis before sex.

·    A penile implant or prostheses can restore an ability to achieve an erection.
·    There are vacuum devices that are designed especially to create an erection by placing around the entire penis before sex.
While erectile dysfunction will most likely begin immediately following surgery for prostate removal, if the technique of nerve sparing is used there is a possibility of recovery within a year of the procedure.  If non-nerve sparing is used the recovery of erectile function is highly unlikely.

There are studies that report sparing nerves on both sides of a prostate have regained erectile function in 60 – 70% of men.  Also, erectile dysfunction drugs appear to work for up to 43% of men whose prostate was removed surgically.  This shows a promising trend.

There is some difference when radiation therapy is used.  The man will also experience erectile dysfunction but it usually doesn’t happen until six months after beginning treatment.  However, there is also good news here showing that as many as 50-60% of men regain erections with the use of EDDs.

When hormonal treatment is the route taken, erectile dysfunction will usually occur between two and four weeks after beginning treatment and is linked with decreasing sexual desire.   Unfortunately the studies do not show the same results as the previous two treatments having little or no impact on erectile dysfunction.  The good news, however, is that normal erectile function returns when the hormonal therapy is ended.


Whatever type of prostate disease you experience, it need not be an immediate death sentence.  Every day new strides are being made in the detection and treatment of prostate ailments.
More important than the prostate gland is the other organ that can control your prognosis.  It’s the one that fills the space between your ears.
No matter how dark the day may appear, there is always another chance to experience a brighter day tomorrow.
Avoid too many idle hours.
Develop a positive mental attitude and outlook.  Your mind is powerful medicine when used appropriately.
Fill your days with healthy food, happy people, good friends and family.
Use the natural therapy technique of Imagery and see yourself alive, well, whole and enjoying everything this world has to provide.  You are more than a diseased prostate! 


-"Natural Prescriptions", by Robert M. Giller, M.D. and Kathy Matthews

You can obtain information about clinical trials from:
The National Cancer Institute at:  http://www.cancer.gov/clinicaltrials
Other resources:
National Centers for Disease Control and Prevention's (CDC's) – Online at http://www.cdc.gov/
Contact them offline, too, for more information at:
CDC/DCPC
4770 Buford Hwy, NE
MS K64, Atlanta, GA 30341
Toll-free information line: 1-888-842-6355
FAX: 1-770-488-4760
E-mail cancerinfo@cdc.gov


U. S. Department of Health and Human Services –
The U. S. Food and Drug Administration will give you information about “natural therapies as well as the stringent guidelines that drug companies must follow in order to certify a drug and earn FDA approval.  Contact them at:
http://fda.gov/
Food and Drug Administration
5600 Fishers Lane
Rockville, Maryland 20857
1-888-INFO-FDA (1-888-463-6332)
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