Prostate cancer is the leading cause of cancer in men. The risk of developing prostate cancer is highest in blacks, lower in whites and lowest in American Indians and Asians. Most men with prostate cancer are over the age of 65. Having a close relative with prostate cancer increases one’ s risk of developing prostate cancer. Although obesity does not increase prostate cancer risk, obese men who develop prostate cancer are more likely to die from it.
Testing for prostate cancer antigen (PSA) in tandem with palpation of the prostate allows physicians to identify men who are at high risk for prostate cancer. Some men with an elevated PSA or an abnormal prostate exam have prostate cancer that has already become incurable by the time it is found. Other men who undergo screening for prostate cancer have cancer cells that are incapable of spreading to other parts of the body. In either case, screening for prostate cancer would not be beneficial. For this reason experts recommend that men consult with a physician before pursuing screening tests for prostate cancer.
A variety of substances including green tea extract, pomegranate, soy and citrus pectin may be effective in preventing prostate cancer. Vitamin E supplements increase the risk of developing prostate cancer while neither selenium, calcium nor lycophene ingestion has any effect on prostate cancer incidence. Medications that decrease the size of the prostate such as finasteride and dutasteride reduce the incidence of prostate cancer in populations of men who are being screened for prostate cancer. Unfortunately, these drugs exert no effect on the death rate from prostate cancer.
The discovery in the 1940s that having a low male hormone level can kill prostate cancer cells led to a Nobel Prize award in the 1960’s. When prostate cancer cells grow despite a dearth of male hormone in the body an alternative treatment strategy must be used. The search for drugs that increase survival time in men with widespread prostate cancer recently has been productive.
Prostate cancer patients who have a minimal amount of cancer spread may benefit from a novel vaccine treatment. In men with widespread prostate cancer that is resistant to hormone treatment, the first line of defense is usually chemotherapy. Two chemotherapy drugs, docetaxel and cabazetaxel, prolong the lives of such patients.
If prostate cancer patients do not respond to chemotherapy then they may benefit from abiraterone, a pill that prevents prostate cancer cells from producing their own supply of male hormone. Last month the Food and Drug Administration approved enzalutamide for use in patients with prostate cancer who have previously received chemotherapy. Enzalutamide kills prostate cancer cells by blocking male hormone receptors that are present in prostate cancer cells.
Prostate cancer patients use medications such as zoledronic acid and denosumab in order to decrease the risk of bone fracture when prostate cancer cells have spread to bone. Radioactive medications such as samarium and strontium reduce the growth of cancer cells in bone. Conventional radiation therapy can control temporarily the growth of prostate cancer metastases.
Progress has been made in recent years in defining the biology of prostate cancer. This information has led to development of drugs that can prolong the survival of prostate cancer patients. Clinical trials are under way to determine if these new drugs can also prevent potentially lethal prostate cancer cells from appearing in the first place. The future of prostate cancer control has never been more promising.
Dr. Barton Paschal is a graduate of Emory University School of Medicine and completed fellowship in cancer medicine at Wake Forest University. He is certified by the American Board of Internal Medicine in the subspecialty of medical oncology. Dr. Paschal is a member of the staff of Haywood Cancer Center at 600 Hospital Drive, Suite 10 in Clyde and Macon Cancer Center in Franklin. Call (828)456-5214 or (828)369-4257.