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Prostate Cancer Treatments Are Risky

Most doctors or physicians are still in basic agreement on the merit of the standard strategies for coping with stage 3 prostate cancer and stage 4 prostate cancer disease. In contrast, many experts not agree over the best approach for stage 1 prostate cancer and stage 2 prostate cancer disease and over the advisability of mass screening for early prostate cancers.

The conflict partly stems from the fact that the prostate cancer treatments are very risky. Published rates of complication may vary, but both radiation and surgery can lead to considerable impotence and to incontinence, bowel injury, and to death. There are study that older prostate cancer patients are more prone to complication than are younger prostate cancer patients.

Complication rates for surgery can go way down, however if the operation is done by a team that has great expertise in performing the nerve sparing technique from Johns Hopkins University School of Medicine. Surgeons who use this procedure avoid cutting into 2 bundles of nerves and blood vessels that are needed for penile erection and that touch the surface of the prostate gland. The procedure which is now applied in many medical centers also reduces bleeding and can facilitate reconnection of the urethra to the bladder after its severance during surgery.

Proponents of screening and prompt cancer treatment options of small tumors understand that there are serious risks involved in undergoing aggressive cancer treatment aimed at a cure. They, like opponents of such treatment options, are also disturbed by the lack of methods for definitively  distinguishing patients who have indolent tumors from those whose tumors are likely to progress to a higher stage. But they believe that the patients who have the best chance of avoiding the horrors of metastatic disease should be given the opportunity to try to do so. Those patients are ones who are asymptomatic and who have small tumors that are confined to the prostate gland. To find these people, they reason, one must do screening tests.

Because of the cancer risks and costs, even advocates of aggressive therapy for early prostate cancer are divided over which age groups to include for screening and best cancer treatment. Some would rule out patients older than 70 years, on the theory that they are likely to die of other causes before their tumors progress enough to cause serious trouble. Others are more flexible and would actively seek and treat patients who are well into their 70’s, if the men were in good health.

Most advocates of invasive therapy for early prostate cancer stage disease and some who are skeptical of its benefits would favor treating patients who are in their 40 to 50 plus, including those with well differentiated, microscopic malignancies. First, some data suggest that prostate cancer is more virulent in younger men. Second, even if a slow growing tumor developed in these people chances are good that they would live long enough to see the tumor progress and metastasize.

One of the prostate cancer patients at the Dana Farber Cancer Institute at Harvard Medical School would agree with treatment enthusiasts. The patient was diagnosed with prostate cancer at the age of 70+ after his PSA score was slightly elevated in 2 successive test. A biopsy of the prostate show the indicator that a single cluster of cancerous cells was present. After many additional tests including biopsy of the patient’s lymph nodes, the patient was deemed to be free of metastatis. Wanting to be rid of the cancer, he underwent a radical prostatectomy from which he had a basically uneventful recovery. Although he was moderately active before surgery and his potency had not yet returned when last saw him, he remained delighted with his own decision.

Another one could argue that this patient should never have been treated. Opponents of early therapy are worried by an almost sixfold increase in the number of prostatectomies that were performed between 1984 to 1990, many in men older than 70 years. They point out that there is still no proof that aggressive therapy for early prostate cancer disease prevents the development of metastatic tumors and saves lives. That being the case, they fear that such cancer treatment which is aimed at avoiding a possibility that may never materialize is condemning too many men to years of impotence, incontinence and other disabilities.

They contend as well that even if a cure was achieved, the side effects of this treatment would often outweigh the benefits of any extra survival time gained. If treatment is undesirable, it follows that screening asymptomatic men for evidence of prostate cancer is unnecessary and wasteful.

Included in the concern of skeptics are men such as another patient of the Dana Farber Cancer Institute at Harvard Medical School. He was 51 year old, active businessman who underwent a nerve sparing radical prostatectomy after noninvasive and surgical tests showed he harbored microscopic cancer thru his prostate gland(stage 2A prostate cancer disease). After the operation he eagerly awaited the return of erectile function, knowing that about 70% of initially potent men in his age group who underwent the same procedure regained such function within a year.

But, one and half years later, his ability as a man had not returned. Greatly concerned, he tried so many treatment that dilate the blood vessels but they didn’t work well for him. In spite of counseling, he has had bouts of severe depression and has lost enthusiasm for maintaining his vigorous business interests.

Prostate Cancer Treatment

Nowadays, Standard protocols for Prostate cancer treatment in American recommend that most prostate cancer patients with Stage 1 or 2 prostate cancer disease (except maybe for older individuals with stage 1A prostate cancer disease) be treated promptly with 1 of 2 potentially curative therapi

es. These kind of cancer treatment options, which are thought to be about effective, involve removing the prostate gland ( a radical prostatectomy) or irradiating the gland to kill the cancerous cells within it. Radiation cancer treatment to this gland is often preferred for men who are too frail to withstand surgery.

Doctors or Physicians are further taught that prostate gland radiation is the treatment of choice for stage 3 prostate cancer disease, because with surgery cannot fully eradicate tumors that have pushed their way past the borders of the prostate gland. Textbooks also note that neither surgery nor radiation is likely to cure metastatic, stage 4 prostate cancer disease. Individuals with such advanced prostate cancer are therefore better served by systemic therapy aimed at slowing the progression of metastatic deposits and at easing pain and other symptoms.

For the past 50 years doctors or physicians have attempted to inhibit progression of advanced cancer by initiating hormonal therapies. This approach is based on the discovery of Charles Huggins from University of Chicago who are Nobel Prize Winning, that male androgens can markedly accelerate the growth of prostate cancer and withdrawal of such androgens can retard its cell growth.

Androgen levels in the body can be reduced by removing the testes which is a bilateral orchiectomy where 95% of testosterone (the primary male hormone is produce). They can also be lowered by several medicine such as estrogen, that interfere with the actions or synthesis of androgens. Sadly, almost all metastatic tumors become resistant to this kind of hormonal therapy at some point and the progress rapidly. Normally prostate cancer patients die within 2 to 5 years after metastates are discovered.

Stages of the Prostate Cancer Disease

One of the method to determine the Prostate cancer stages is using the microscopic analysis. When this Microscopic analysis confirms the presence of a malignancy, Doctors or Physicians try to determine its stage of progression. They are doing so because current recommendations for treatment are based on the level of progression. Classification methods vary, but a common one divides prostate cancers into 4 Stages.

Stages 1, 2 and 3 of the prostate cancer include forms of cancer that have not metastasized – they haven’t produced new tumor colonies in other cells. Stage 4 prostate cancer consists of tumors that have already metastasized. Generally prostate cancer spreads first to the lymph nodes which are instantly downstream from the prostate gland, after that it would seem in the bones and also other organs.

The first 3 prostate cancer stages are identified from one another through the size of the tumors. Stage 1 prostate cancer cells are microscopic – they are the type which have usually been revealed by transurethral resection. This kind of cancers can be divided into 2 subclasses. Stage 1A tumors are confined to one small area of the prostate and are consists of relatively well differentiated tissue, despite some obvious abnormalities in the malignant cells such as enlarged nuclei, they also like healthy gland cells are of uniform size and closely packed. Stage 2A cancers are much more diffuse, consist of moderately to poorly differentiated cells, as well as display both characteristics. Several tumor sites in the prostate gland or poor differentiation implies that the cancer is likely to respond aggressively.

Stage 2 prostate cancer cells are usually palpable or big enough to be felt as a nodule during a rectal exam, but also rarely cause discomfort. Stage 3 tumors have spread through most or almost all of the gland, making it rock hard, and also have typically pushed past the borders of the prostate into surrounding structures. Cancer Patients bearing Stage 3 malignancies in many cases are diagnosed after urinary symptoms cause them to seek medical help.

In order to “stage” tumors, Doctors or physicians initial combine the information gleaned from the rectal exam, the ultrasound as well as the bipsy with information provided by other noninvasive tests. For example, they will do a computed tomographic scan of the abdomen and the pelvis, searching for evidence of cancer in the lymph nodes. Experience shows us that cancer in these nodes often signals the presence of cancer elsewhere in the body. Doctors or Physicians may also perform a specialized kind of scan to look for metastatic deposits in the bones. With these clinical findings in hand they assign the tumor to a tentative stage.

Regrettably, the diagnostic tests often can’t end there, because 25% to 50% of tumors that are assigned initially to stage 2A, 2 or 3 turn out, on further testing to be metastatic, stage 4 prostate cancer. The rate for the stage 1A tumors is undoubtedly much lower. Finding of metastatis is very important because metastatic malignancies call for a therapeutic approach totally different from those applied to less advanced tumors. To determine the stage more accurately, doctors or physicians may biopsy or even remove lymph nodes from the pelvis so that nodal cells can be analyzed directly for evidence of cancer. Unfortunately this surgical staging technique can’t detect stray cancerous cells that have escaped into the blood and lodged in the bones and so some patients who are treated as if they had early disease will actually have metastatic cancer.

Prostate Cancer

During 1994 prostate cancer gland was expected to be diagnosed in more than 200000 men in the America and to take the lives of 40000 American males. With that number, make prostate cancer the most frequently diagnosed malignancy (other than disease cause by the skin) in American males and the second leading cause of cancer related deaths (After the popular lung cancer) in that group. In the past, musician Frank Zappa, theater producer Joseph Papp and actors Telly Savalas as well as Bill Bixby They all lost their battles with this Prostate Cancer disease. Even iIt does not kill gently. In their Last months most people who succumb to it endure excruciating pain that is difficult to control by them.

In-fact, prostate cancer which becomes increasingly common with advancing age and is typically diagnosed in men older than 60 years, has historically been the subject of relatively little research. Doctors and Physicians therefore lack the information they need in order to decide on the best prostate cancer therapy for many patients. A patient who finds himself diagnosed with prostate cancer today is thus quite likely to discover that even leading experts disagree on the best course of action in his particular case.

Indeed, doctors and policymakers  are mired in controversy over how the prostate cancer disease should be managed, especially in its early stages and over whether many seemingly curable cases should be treated at all. These and other issues relating to prostate cancer are in urgent need of resolution if deaths and suffering are to be reduced significantly.

First Steps in Diagnosis Prostate Cancer

The ongoing arguments can be best understood if they have some knowledge of how prostate cancer is currently diagnosed and treated. Doctors and Physicians usually detect prostate cancers by finding a lump in the prostate gland, which is a walnut shaped structure that functions  to maintain the viability of their sperm. This kind of lumps may be discovered during a routine checkup or during an examination prompted by a patient’s complaint of sudden urinary discomfort or impotence. To examine the prostate cancer gland, the physician inserts his finger into the rectum and feeling the gland through the rectal wall, searches for abnormalities in contour, size or consistency.

The prostate cancer symptoms that send men to their doctors often arise when a cancerous mass causes the prostate to press on nearby structures. The gland lies underneath the urinary bladder, and it surrounds the urethra – the tube through which urine passes from the bladder to the penis and outside the body. For instance, if the tumor pushes on the bladder or pinches the urethra, it can cause men to have to urinate at night, with unusual frequency, or with great urgency; it can lead to difficulty initiating or maintaining an urine stream.

In some instances prostate cancer is detected in quite a different way as a by product of treatment for a disorder called Benign Prostatic Hyperplasia. This condition, an aging related enlargement of the prostate, affects more than half of men older than 45 and may give rise (albeit gradually) to the same urinary troubles caused by a tumor. If the symptoms of prostate cancer become too distressing, a surgeon may attempt to relieve them by performing transurethral resection of the prostate, a procedure in which parts of the gland are scraped away. Whenever the resection is done, the excised tissue in analyzed under a microscope for evidence of malignancy, which is occasionally found.

A simple blood test constitutes a third means of detecting prostate cancer; and it can signal the presence of cancer in individuals who display no symptoms of prostate cancer abnormalities. This test measures the level of a glycoprotein called Prostate Specific Antigen (PSA), one of many molecules secreted by the prostate gland. In most versions of the test, which became widely available in 1986, levels of the glycoprotein that exceed 4 nanograms in a milliliter of blood suggest cancer might be present; levels greater than 10 are especially suggestive. (A nanogram is a billionth of a gram). Most of the tumors detected by the Prostate Specific Antigen (PSA) test are still microscopic.

An elevated Prostate Specific Antigen (PSA) reading is by no means proof that cancer is present, however. Factors other than cancer such as development of Benign Prostatic Hyperplasia (BPH), inflammation of the prostate (prostatitis), and mechanical pressure on the gland – can cause it’s level to rise. Conversely, in many men who have prostate cancer the PSA (Prostate Specific Antigen) level is normal at the time of diagnosis. Investigators are currently exploring ways to overcome these drawbacks.

Regardless of the test’s shortcomings, its ease and relatively low cost ($40 to $70) have made it a popular tool for detection of cancer in asymptomatic men. It is so popular, in-fact that it probably accounts for the recent, striking increase in the number of men who are diagnosed with prostate cancer every year. The number of cases identified in 1995 was expected to be more than double the 100000 cases that were identified in 1987.

As will be seen, the rise in prostate cancer cases has increased the intensity of the debate over whether patients with small cancers should be sought out and given aggressive treatment shortly after diagnosis in an attempt to effect a cure. Controversy has arisen in part because no one can yet distinguish conclusively among microscopic cancers that will remain latent (causing no symptoms of prostate cancer in the patient’s lifetime) and those that will become clinically significant (growing enough to cause prostate cancer symptoms or become life threatening). Doctors and physicians can make educated guesses about virulence by examining such characteristics of tumors as their size and microscopic appearance. But they can not determine with certainty which early tumors need treatment and which do not.

Improvement in the ability to identify small tumors in men has sparked arguments because it may lead to delivery of risky treatment to huge numbers of men who would have died with, not of, prostate cancer. Autopsy studies of males who died from other causes indicate that about a 1/3 of men older than 50 have at least some cancerous cells in their prostate and that the incidence increases steadily after age 50 (so that 90% of men older than 90 years are affected). Yet most men who acquire prostate cancer do not die from it. (About 3% of American men are expected to die eventually from the disease). Some experts favor minimizing the number of men who receive unneccessary treatment; others worry that lack of screening and treatment will cause thousands who might have been saved each year to suffer a cruel death.

Of course, no one is treated on the basis of a PSA (Prostate Specific Antigen) test or discovery of a lump alone. Detection of a possible cancer is usually only the first step in diagnosis. When either a rectal examination or an elevated PSA (Prostate Specific Antigen) level reveals that a cancer might be present, physicians generally follow up with an ultrasound examination. The ultrasound examination can often pinpoint the location of a tumor and aid in the next step of diagnosis, namely, bipsy of the prostate and study of the suspicious tissue under a microscope.

Arch of Stones

An old arch of stones can seem a very puzzling creation. Each stone looks as if it has been put in place individually, but the whole structure looks as if it can’t be supported until the last capstone is put in place : you can’t have an almost arch. So how could it have been made ?

The problem is an interesting one because it is reminiscent of a curious argument that is much in evidence in the United States under the name of Intelligent Design. Roughly speaking, its advocates pick on some complicated things that exist in the natural world and argue that they must have been designed in that form rather than have evolved by a step-by-step process from simpler forms because there is no previous step from which they could have developed. This is a little subjective, of course we may not be very imaginative in seeing what the previous step was but at root the problem is just like our arch, which is a complicated construct that doesn’t seem to be one step away from a slightly simpler version of an arch with one stone missing.

Our unimaginative thinking in the case of the arch is that we have got trapped into thinking that all structures are build up by adding bits to them. But some structures can be built by subtraction. Suppose we started with a heap of stones and gradually shuffled them and removed stones from the center of the pile until we left an arch behind. Seen in this way we can understand what the almost arch looks like. It has part of the central hole filled in. Real sea arches are made by the gradual erosion of the hole until only the outer arch remains. Likewise, not all complexity in Nature is made by addition.