This
is part 1 of a 5 part Information Guide. Introduction :
Index
PREPARING
FOR THE JOURNEY
WHERE IS IT?
To help you orientate yourself
in this Strange Place, you might want the answer to these two questions:
"Where
is my prostate gland?"
"What
does it do?"
That's not as silly
as it sounds. Most men don't know where the prostate gland is, even though only
men have them. This is not really surprising. It is one of the best-protected
glands in the human body. It is not very big - about the size of a walnut. It
rarely causes any trouble until after the age of fifty. So why would you know
where it is?
A normal prostate gland has a volume of about 25cc - a weight
of 25gm. It is contained within the bony structure of the pelvis and is very close
to the bladder and rectum. The duct that empties the bladder (the urethra) passes
through the prostate. Prostate disease and treatment disease of the prostate gland
can cause problems with urination.
The
main function of the prostate is to provide the fluid that carries the sperm on
ejaculation. The nerves that control erections are along the sides and at the
base of the gland. Damage to the nerves during treatment can cause erectile dysfunction
or impotence. This means that having an erection can be difficult or impossible
after treatment. New techniques have reduced the incidence of ED (erectile dysfunction),
but most men will have some problems after treatment. The degree of ED (erectile
dysfunction) varies and may be temporary or permanent. This will depend on the
situation of the tumor, the treatment option chosen and the skill of the person
carrying out the treatment. Other factors are the man's health, age and prior
sexual activity.
HOW
DO I GET TO THE STRANGE PLACE?
So,
how do you get to the Strange Place? What's the procedure? Let's start
with some background information to answer frequently asked questions:
How
will I know if I have prostate cancer - what are the symptoms?
Most
prostate cancer diagnosed today is termed asymptomatic - there are no symptoms.
In most cases, diagnosis occurs after a PSA blood test during a routine examination.
Men
who have urinary or ejaculation problems or erection difficulties should always
seek medical advice. Examples of these problems are frequent or painful urination,
difficulty in starting urination, blood in the urine, problems with erections
and ejaculation (such as pain or discolored ejaculate) and pain in the bones.
These
symptoms are usually caused by diseases less dangerous than prostate cancer, such
as infection of the bladder or prostate (prostatitis). They can be caused by prostate
cancer and should be investigated.
Older
men tend to have some urination problems - often frequency and urgency issues.
The most common cause is BPH (Benign Prostatic Hyperplasia) or enlargement of
the prostate. As the prostate grows it narrows the urethra - the channel that
passes through it carrying urine from the bladder. This means that the bladder
empties more slowly or does not empty completely.
BPH
is not a malignant disease and symptoms often start when men reach their 50s.
It can be dealt with by means of medical procedures or with a variety of drugs.
The most common medical procedures are TURP (Transurethral Resection of the Prostate),
TUNA (Transurethral Needle Ablation), TUMT (Transurethral Microwave Thermotherapy).
An herbal
treatment known as Saw Palmetto has been reported as being helpful in relieving
some of the symptoms of BPH, as have pumpkin seeds. There are many other 'natural'
medications which have little proof of their effectiveness.
If
there are no symptoms, how will I know for certain that I have prostate cancer?
The only way prostate cancer can be diagnosed with any certainty is by a biopsy
of the gland. Before that happens there are usually some preliminary steps. These
are described below. In reading them you will start to learn some of the language
and customs that might be new to you.
What causes prostate cancer?
No
one can answer this question. One school of thought links inflammation of the
gland to a potential for tumor to form and grow. There is general agreement that
a healthy lifestyle - good eating habits, correct weight, exercise, stress reduction
- will lead to a lower probability of prostate cancer and may well inhibit the
growth of any tumors. A healthy lifestyle would also help in the recovery process
after any treatment.
Can prostate cancer be spread
to my partner from our sexual activity?
There is no evidence that cancers
can be spread in this way.
BASIC LANGUAGE HINTS
Before
moving onto the diagnostic procedures, there are some basic language issues to
be learned.
Firstly
and most importantly, many words have acquired specific meanings in this Strange
Place - meanings that differ from those you may have attached to the words in
the past.
|
The
best example, perhaps, is the use of the words "positive" and "negative." In your
usual "pre-cancer" place, broadly speaking positive = good and negative = bad.
These positions are somewhat reversed in Strange Place talk. A positive result
to a test is not what you want.
A
positive result means that there are definite signs of the disease. On the other
hand a negative result does not mean you are disease free. There are merely no
positive signs. So in this Strange Place, positive = bad and negative = not positive,
not good.
Another
important word to understand is "cure". There is no agreement on the meaning of
"cure", even for the same therapies carried out by different practitioners. A
study published in 2008 found over 200 definitions of "failure". So there are
as many classifications of "cure". Some claim to have cured the disease immediately
after the completion of the therapy chosen. These claims are not justified for
any therapies, including surgery. The main goal should rather be "remission" -
a freedom of any signs of the disease - rather than "cure". The claim of remission
can only follow observation for signs of any recurrence of the disease over a
period of many years.
Even
the word "cancer" can be misleading. To quote Dr. Christopher Logothetis, a leading
specialist in advanced prostate cancer : "One of the problems with prostate
cancer is definition. They [the pathologists] label it as a cancer, and
they force us all to behave in a way that introduces us to a cascade of events
that sends us to very morbid therapy."
This
view is shared by well known and respected pathologist Dr. Jon Oppenheimer who
believes that there should be a clear distinction between what we call the aggressive
forms of the disease and what we call those that are less likely to prove fatal.
|
There are
other words and phrases you will need to understand. Many are three-letter acronyms,
such as PSA, DRE and HDR: some are two- and four- letter acronyms such as RP,
SI and EBRT. All of these will seem tremendously confusing at first, but will
hopefully become clearer as you learn the language. For easy reference there
is a short glossary of common terms and expressions.
GO
NOW to Part 2 - Getting Started - The Forest of Fear
