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Use of Castration as Treatment Men stricken with the disease often face castration to stop tumours growing and spreading throughout the body. But the drug, which has just completed clinical trials, has been found to be just as effective in keeping the cancer at bay. Prostate cancer kills more than 10, 000 men in Britain each year. Media tycoon Rupert Murdoch and actor Roger Moore are among the public figures who have battled the illness. The new treatment is a member of the anti androgen family of drugs, called Casodex, which has been developed by AstraZeneca.
It has been shown to reduce the impact on sufferers' everyday lives, including the effect on sex drive and ability to carry out activities such as walking, dressing, bathing and playing sport. John Anderson, consultant urologist at Sheffield's Royal Hallamshire Hospital and one of the doctors taking part in the study, said: "It's the male sex hormone, testosterone, which makes the cancer grow. "A form of medical castration was developed which lowers testosterone levels to such a degree it has an effect throughout the body and on the libido. The idea of this new drug is instead of lowering the testosterone it blocks it at the receptor site in the prostate. The net result is that this drug is equally effective to other forms of castration but has advantages in terms of quality of life for the patients. " (Bergstrom & Widwark 305).
The patient's opinions about quality of life and treatment risks also play an ever-increasing role in the decision-making process. In this Internet age, the patient often comes to the consultation with information and his own point of view about treatment. The physician's job is to provide the man with prostate cancer the best information available about diagnosis and treatment options. We will discuss risk factors for prostate cancer, tumor grading and staging, and the most recent data on treatments including observation, radical prostatectomy, radiation therapies, cryo ablation, hormonal manipulation, and chemotherapy. (Walsh & Partin 183). Risk factors Age. Cancer of the prostate is the most commonly diagnosed malignancy in American men.
Each year in the United States some 180, 000 new cases of prostate cancer are diagnosed, and 40, 000 men die of the disease. After age 50, the incidence of prostate cancer and its mortality rate increase at a near exponential rate. Eighty percent of men diagnosed with prostate cancer are older than age 65. (Richie 26). Race. Compared with white men, black men of all ages have a higher incidence of prostate cancer, are routinely diagnosed with later-stage disease, and survive at a lower rate corrected for stage.
Young black men have twice the incidence of prostate cancer of young white men. The reason for this difference has not been satisfactorily explained, although access to medical care may play a role. Young black men have a 15 % higher testosterone level than young white men, but high levels of testosterone are not a consistent finding in cancer of the prostate. (Richie 27). Family history. A genetically inheritable component of prostate cancer has been recognized, especially in cases diagnosed before age 55.
An autosomal dominant gene has been associated with 9 % of cases of prostate cancer and with 45 % of cases in men younger than age 55. The more first-degree relatives with prostate cancer at an early age a man has, the greater his risk of developing the disease. (Richie 28 - 9). Life style. Life style factors such as consumption of a high-fat diet and regular alcohol intake are associated with an increased risk for prostate cancer.
A diet low in fruits and vegetables is also linked with a higher risk of prostate cancer, although this statistical effect may be related to consuming a high-fat diet. (Richie 30). Prostate cancer is more prevalent in northern latitudes. The incidence of prostate cancer in Japan was very low until Japanese men began to assume western dietary habits. The rate of prostate cancer in Japan is now approaching that of the United States. Benign prostatic hyperplasia (BPH) and inflammatory conditions such as prostatitis are not associated with an increased risk of prostate cancer, and no relationship has been established with vasectomy. There is an inverse relationship between vitamin D levels and prostate cancer.
A weak association exists between cadmium exposure and prostate cancer; cadmium is found in cigarette smoke and alkaline batteries. (Richie 32). The most powerful risk factors for prostate cancer -- age, race, and family history -- cannot be modified. Therefore, prevention plays a less important role in patient management than diagnosis and treatment. (Richie 37). The incidence of new cases of prostate cancer increased and may now have peaked because of earlier detection and the use of prostate-specific antigen (PSA) screening. Controversy exists, however, about whether all older men should be screened for prostate cancer. Several long-term trials are underway, but no trial has yet shown an increased disease-specific survival as a result of screening.
PSA and DRE. The American Cancer Society recommends a yearly digital rectal exam (DRE) and PSA determination starting at age 50 (or at age 45 if there is a strong family history or the patient is African-American). Prostate cancer is commonly detected based upon the serum PSA value, without a suspicious DRE. PSA testing is also more likely to detect organ-confined disease than DRE. Screenings based entirely upon DRE can miss more than two-thirds of clinically localized prostate cancer.
However, DRE is an important component of screening because not all men with prostate cancer have an elevated PSA. Biopsy is indicated for all DRE-palpable abnormalities. (Bergstrom & Widwark 306 - 9). PSA is a serine protease enzyme produced exclusively by prostatic tissue. PSA is prostate-specific but not prostate cancer-specific. PSA values need to be interpreted with respect to patient age, rate of change, and associated conditions. For example, prostatitis or a urinary tract infection can markedly elevate the PSA value and render PSA useless as a screening test.
Recent ejaculation (within 24 hours) can mildly elevate PSA values but not so much as to cause misinterpretation of test results. Although it has been commonly thought that DRE would increase PSA levels, any elevations have been found to be very minor and not statistically significant. (Bergstrom & Widwark 310 - 11). PSA values. An elevated PSA level or an accelerated change in value suggests the possibility of underlying malignancy. For most men, a PSA value [less than] 4 ng / m L is accepted as normal, although levels [greater than] 2. 5 ng / m L warrant investigation in men younger than age 50. As a man ages, the "normal" PSA value increases up to 20 % due to the effects of BPH.
When the PSA is between 4 and 10 ng / m L, the free PSA/total PSA ratio is helpful in deciding which patients should be referred to a urologist for biopsy. This ratio is not affected by patient age. In men with BPH, the ratio is usually [greater than] 25 %. Ratios [less than] 15 % are cause for concern and indicate the need for biopsy; values between 15 and 25 % are inconclusive. (Bergstrom & Widwark 311). Adenocarcinoma is the most prevalent type of prostate cancer. Pathologic grading is done according to the Gleason grading system, which assesses the microscopic pattern of the cells of the prostate.
Grade one represents a glandular pattern close to normal (most differentiated), and each higher grade represents an increasing loss of glandular architecture up to grade 5 (least differentiated). Any tissue with a grade of 4 or 5 must be interpreted as an indicator of aggressive disease. (Greenlee 7 - 28). Prostate cancer is staged according to the TNM (tumor, node, metastases) system. Various assessments are used in obtaining a clinical stage.
The DRE may be a clear indicator of locally extensive disease. The Gleason score and PSA are the most important indicators of disease spread. Sophisticated nomo grams using Gleason score and PSA have been developed to help predict nodal and bony metastases, the most common sites of disease progression. As the result of the widespread use of PSA screening, 70 to 86 % prostate cancers are now organ-confined when diagnosed. For men with organ-confined tumors, treatment options include observation only, surgery, radiation therapy, and cryo ablation. Observation.
Prostate cancer is a slow-growing malignancy with a doubling time of 3 to 4 years. Therefore, providing no treatment (so-called watchful waiting) is a viable option if a patient's life expectancy is less than 10 years and the tumor is low-grade. It is extremely difficult, however, to provide a reasonable determination of how much life remains for many older men. (Greenlee 29 - 30). Radical prostatectomy. The most favorable long-term, disease-specific survival rates are associated with surgical removal of the prostate. Radical prostatectomy is considered the preferred therapy for men younger than age 65, but patient choice has become a determining factor as other methods of local cancer control have been improved.
Surgical removal of the prostate is performed by either a perineal or retro pubic approach. The retro pubic approach allows for lymph node sampling, whereas the perineal approach does not. Risks associated with surgery include erectile dysfunction and urinary incontinence. Although surgical refinements have allowed for the sparing of nerves needed for erectile function, impotence occurs in 30 to 70 % of cases. (Walsh & Partin 184).
Radiation therapy. Radiation can be administered via external beam sources or by implantation of...
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Research essay sample on Young Black Men Prostate Cancer
