PSA Blood Test

Today I attended our local GP's surgery for another blood test. Specifically, this blood test was to:

• Determine whether my PSA reading [previously 84.8] had begun to drop. Thus showing that the hormonal therapy I have been undergoing for a little over 4 weeks now, has in fact had the desire affect; and
  
  
• Determine whether my cholesterol readings had improved as a result of my [now] 'extremely healthy' diet.
  
  
  

I am told that it is quite normal for the PSA to rise after a trans-rectal biopsy. I also have to bear in mind, that I only started hormone therapy 4 weeks ago. [Orally for the first two weeks, followed by an LHRH implant and continuing the oral regime until two weeks after the implant procedure].

Having said that; it sure would be a 'shot in the arm' [pardon the pun] to receive a lower PSA reading! I am due to receive the results in a few days.

Prostate Cancer and Diet - Part 4

WHOLE GRAINS

Whole Grains Guide

You've probably heard a lot about how good for you whole grains can be. But do you really know what whole grains are – or why they're so beneficial? A grain is considered whole when all three parts – bran, germ and endosperm – are present.

Most people know that fruits and vegetables contain beneficial phytochemicals and antioxidants, but many do not realize that whole grains are often an even better source of these key nutrients.

In fact, whole grains are a good source of B vitamins, Vitamin E, magnesium, iron and fiber, as well as other valuable antioxidants not found in some fruits and vegetables. Most of the antioxidants and vitamins are found in the germ and the bran of a grain.

Common Types of Whole Grains:

• wild rice
• brown rice
• whole wheat
• oatmeal
• whole oats
• barley
• whole rye
• bulgar
• popcorn

Less Common Types of Whole Grains:

• amaranth
• millet
• quinoa
• sorghum
• triticale

Recommendations on Whole Grains

Whole grains have been shown to reduce the risk of heart disease by decreasing cholesterol levels, blood pressure, and blood coagulation. Whole grains have also been found to reduce the risks of many types of cancer. They may also help regulate blood glucose in people living with diabetes. Other studies have also shown that people who consume more whole grains consistently weigh less than those who consumed less whole grain products.

In January 2005, the US government published the new Dietary Guidelines for Americans 2005. One of the new guidelines recommends that all adults eat half their grains as whole grains – that's at least 3 servings of whole grains a day.


Increase whole grain intake: An easy way to increase whole grain intake is to replace some of your refined-grain products with whole grain products.

• have a slice of whole grain bread to replace your white bread
• have a serving of whole grain breakfast cereal in the morning
• substitute half the white flour with whole wheat flour
• add brown rice, wild rice or barley in your vegetable soup
• snack on popcorn instead of chips on movie nights

Check labels carefully! Foods labelled with the words "multi-grain," "stone-ground," "100% wheat," "cracked wheat," "seven-grain," or "bran" are usually not whole-grain products. Colour is also not an indication of a whole grain. Brown does not necessary mean whole wheat or whole grain! Some brown bread has brown colouring added to achieve the brown colour!

When determining if a packaged food product contains whole grain or not, look for the word "whole" in the ingredient list. Also look for the Whole Grain Stamp (see above examples). A "good source" stamp contains at least 1/2 serving of whole grains while an "excellent source" contains at least 1 serving of whole grains.


DAIRY

Dairy and Calcium linked to Prostate Cancer

Study found high intake of dairy and calcium is linked to higher risk of prostate cancer

Researchers from the Tufts University published (December 2005) an article in the Journal of National Cancer Institute found that adult men who consume large amounts of milk or other dairy products may have a slightly higher risk of developing prostate cancer when compared to men who consume less dairy products. They reviewed 12 studies published between 1966 and 2005 and investigated dairy and calcium intake and prostate cancer incidence.

The results showed that men who ate the most dairy products had an 11% higher risk of developing prostate cancer when compared with men who ate lesser amounts of dairy products. Men with the highest intake of calcium were 39% more likely to develop prostate cancer than men with the lowest calcium consumption.

Editor's Note - How much Dairy?

Earlier in January 2005, some questions were already raised when the government announced the Dietary Guidelines for Americans 2005 to recommend Americans increase their intake of dairy products to 3 servings a day.

We understand that dairy products contain calcium and potassium which have been proven to reduce the risks of heart disease, blood pressure and osteoporosis. Some studies also suggested that dairy products may have a role in weight control and even prevent colon cancer.

Although it is too early to conclude that high intake of dairy products and calcium is associated with an increased risk of prostate cancer, it is difficult to ignore the results of the above study. At this point, we know that 3 daily servings of dairy products is safe for most children, teenagers and adult women. Until more research is done, the author of this study questioned if the recommendation to increase dairy intake to 3 servings a day is appropriate for adult men.

Further Reading:

• Prostate Cancer Diet
• Healthy Eating Guidelines

Prostate Cancer and Diet - Part 3

BEVERAGES

Health Benefits of Tea

(HealthCastle.com) Tea is the most commonly consumed beverage in the world after water. Whether it is black, green or red (oolong) tea, they all contain polyphenols which give tea its antioxidant properties. Antioxidants may help protect our body from free radical damage. Indeed, tea ranks as high as or higher than many fruits and vegetables in the ORAC score, a score which measures antioxidant potential of plant-based foods.

Benefits of Tea

Numerous studies have demonstrated the anti-cancer properties of polyphenols. Some studies indeed suggested that tea's polyphenols may reduce risk of gastric, esophageal and skin cancers if one consumes 4 to 6 cups daily. Other laboratory studies have found that polyphenols help prevent blood clotting and lower cholesterol levels. A recent study published in December 2005 showed that just 2 cups of tea may lower the risk of ovarian cancer by 46 percent in women.

Tea: Black, green or red?

The more processing tea leaves undergo, the darker they will turn. Green tea is the least processed tea. They are simply steamed quickly. Black and red teas are partially dried, crushed and fermented. As we have mentioned before, regardless of the processing method, all teas contain polyphenols.

Tea: Caffeine content

According to the American Dietetic Association, a cup of tea contains an average of 40mg of caffeine, compared to 85mg as found in a cup of freshly brewed coffee.

What about Herbal Tea?

Black, green and red teas derive their leaves from a warm-weather evergreen tree known as Camellia sinensis. The leaves from this tree contains polyphenols. Herbal tea is not derived from this leaf and so does not have this particular health-promoting properties. Indeed, most herbal teas in the market are NOT tea at all. They are only infusions made with herbs, flowers, roots, spices or other parts of some plants. The proper term for this type of beverage is "tisane". Therefore, read the labels properly. Although tisane does not contain as much polyphenols, it does promote other various health qualities such as relaxation and calming effects.

What about Decaf Tea?

We do not know whether decaf teas have the same polyphenols, and thus the same health benefits. It is not yet known if removing caffeine also removes polyphenols in the decaffeinating process.

Alcohol and Cancer

What is the link between alcohol and cancer risk?

According to the expert report from the American Institute for Cancer Research, Food, Nutrition and the Prevention of Cancer: a Global Perspective, there is convincing evidence that alcohol increase the risk of cancer of the mouth, pharynx, larynx and esophagus. The risk of upper respiratory tract cancer is greatly increased if drinkers also smoke. Alcohol also increase the risk of liver cancer and probably increases the risk for colon, rectal and breast cancer.

How does drinking alcohol increase cancer risk?

When you drink alcohol, the sensitive tissues of your upper-respiratory tract are directly exposed to alcohol in beverages, causing damage to cells and possibly initiating cancer. Cancer of the liver is probably preceded by alcoholic liver cirrhosis which develops after years of drinking. There is less known about how drinking alcohol affects the development of other cancers.

What can I do to lower my cancer risk?

One thing you can do is choose not to drink alcohol, or choose to drink them only in moderation. That's no more than 2 drinks per day for men and 1 for women.

1 drink =

1 bottle or can of beer (12 oz)
1 small glass of wine (5 oz)
1 shot of 80 proof liquor (1.5 oz)

Why is the recommended limit different for women and men?

Alcohol affects women and men differently. A woman's body has more fat and less muscle than a man's. Alcohol can be diluted into water-holding muscle tissue, but not into fat tissue. Therefore alcohol cannot be diluted as quickly in her body as in his. Also, a woman cannot metabolize alcohol as quickly as a man. Therefore, alcohol stays in her bloodstream longer.

Does drinking present special risks for women?

The risk for developing breast cancer, the second most common cancer in women in the States, rises with increased alcohol consumption. Women at a high risk for breast cancer should consider not drinking. Women develop alcohol-related health problems, such as cirrhosis of the liver, faster then men who drink the same amount. Finally, alcohol can severely injure a pregnant woman's unborn child.

Is it true that drinking alcohol can lower my risk for heart disease?

There is evidence that drinking modest amounts of alcohol is associated with a lower risk for coronary heart disease in men, and perhaps women. For more details, read Red Wine - Health Benefits? However, drinking higher amounts of alcohol raises the risk of cancer along with risks for high blood pressure, stroke, heart disease, birth defects, inflammation of the pancreas, damage to the brain and heart, malnutrition, osteoporosis, accidents, violence and suicide. There are better ways to decrease your heart disease risk, including exercising, reaching and maintaining a healthy weight, lowering saturated fats and trans fats in your diet, controlling blood pressure and not smoking.

Prostate Cancer and Diet - Part 2

VITAMINS

Vitamin D and Cancer

Study affirmed Vitamin D may reduce the risk of breast, colon and ovarian cancer

On December 28, 2005, researchers from the University of California released their most recent findings on the possible role that Vitamin D may play in cancer prevention. Researchers reviewed 63 observational studies published between 1966 and 2004 and investigated vitamin D status in relation to cancer risk. They found that oral intake of 1000 IU vitamin D can reduce the risk of colon, breast and ovarian cancers by as much as 50 percent. The results of this study will be published in the American Journal of Public Health in February 2006.


Editor's Note - Vitamin D and Cancer

Currently, Vitamin D recommendations for people of 1 - 50 years of age is 200 IU daily; 400 IU for adults of 51 - 69 years of age. After age 70, 600 IU of vitamin D are recommended each day. This finding of the role of Vitamin D in cancer prevention is exciting, but not conclusive yet. This study did not take into consideration the amount and length of sun exposure or address the decreased ability of the elderly population to convert Vitamin D.

It is difficult to obtain 1000 IU of Vitamin D daily from food sources alone. One glass of milk contains 100 IU of Vitamin D. Other food source includes fatty fish and egg yolks. The author of this study recommended taking 1000 IU of active form Vitamin D, i.e. D3 supplement daily. He also suggested that our skin can produce 2,000 to 5,000 IU of vitamin D when we spend 10 to 15 minutes in the sun on a sunny day without sunscreen if 40% of the body is exposed. However exposure to the sun without sunscreen is not recommended in light of skin cancer issues.

The tolerable upper intake level (UL) for Vitamin D is 2000 IU for people age 1 and above - in other words it is safe to consume up to 2000 IU of vitamin D daily. If you would like to adopt a healthy eating pattern to reduce cancer risk, try eating a lower fat diet rich in antioxidants and fiber with plenty of fruits & vegetables as well as whole grains.


GARLIC

Benefits of Garlic in Cancer

Health benefits of garlic are often reported. The most commonly known benefits of garlic are its potential role in heart disease and cancer. Read Benefits of Garlic in Heart Disease.

Benefits of Garlic: Cancer Prevention

Indeed, the first scientific report to study garlic and cancer was performed in the 1950s. Scientists injected allicin, an active ingredient from garlic, into mice suffering from cancer. Mice receiving the injection survived more than 6 months whereas those which did not receive the injection only survived 2 months.

Many studies showed that the organic ingredient of garlic, allyl sulfur, another active ingredient in garlic, are effective in inhibiting or preventing cancer development. Many observational studies in human being also investigated the association of using garlic and allyl sulfur and cancer. Out of the 37 studies, 28 studies showed evidence that garlic can prevent cancer. The evidence is particularly strong in prevention of prostate and stomach cancers. This particular study looking at the risk of stomach cancer was especially interesting. This study was conducted in China.

Researchers found that smokers with high garlic intake have a relatively lower stomach cancer risk than smokers with low garlic intake. A large-scale epidemiological Iowa Women's Health Study looked at the garlic consumption in 41,000 middle-aged women. Results showed that women who regularly consumed garlic had 35% lower risk of developing colon cancer. It is thought that the allyl sulfur compounds in garlic prevent cancer by slowing or preventing the growth of the cancer tumour cells.


FRUIT AND VEGTABLES

Cancer Fighting Vegetables

The fact is, many types of vegetables can prevent cancer and provide the protection against cancer. Research has identified many active ingredients found in vegetables and their roles in protecting different types of cancer.

Vegetables with the Highest Anti-cancer Activity

• garlic
• cabbage
• soy
• ginger
• umbelliferous vegetables such as carrots, celery, cilantro, parsley and parsnip


Vegetables with the Modest Anti-cancer Activity

• onions
• flax seed
• citrus
• cruciferous vegetables such as broccoli, Brussels sprouts and cauliflower
• solanaceous vegetables such as tomato and peppers

The fact is, many types of vegetables can prevent cancer and provide the protection against cancer. Research has identified many active ingredients found in vegetables and their roles in protecting different types of cancer.


Vegetables with the Highest Anti-cancer Activity

• garlic
• cabbage
• soy
• ginger
• umbelliferous vegetables such as carrots, celery, cilantro, parsley and parsnip


Vegetables with the Modest Anti-cancer Activity

• onions
• flax seed
• citrus
• cruciferous vegetables such as broccoli, Brussels sprouts and cauliflower
• solanaceous vegetables such as tomato and peppers

For further information please visit: Health Castle.com

Prostate Cancer and Diet - Part 1

Overview

Diet has long been thought to be associated with the development of prostate cancer that is common in Western countries and rare in Japan and Asia. In a study published in October 2004 by the Urological Sciences Research Foundation found that when Japanese men migrate to the United States and adopt a Western lifestyle, the protection begins to disappear within one generation. The researchers suggested that the western diet containing high animal saturated fats and low soy content may be the contributors to the higher incidences of prostate cancer.

For further information please visit: Health Castle.com


SOY

Soy and Prostate Cancer: decades of promising data

Many people often associate the benefits of soy with breast cancer. Indeed, data on soy and prostate cancer has been most promising; many studies support the role of soy in the prevention and possible treatment of prostate cancer. During the late 80s, researchers found that Japanese men in Hawaii who ate tofu at least 5 times per week had 65% less chance of developing prostate cancer than those who ate tofu only once a week or less.

In 1998, researchers found that men who drank soy milk at least once a day had a 70% less chance of developing prostate cancer than those who never drank soy milk at all. Soy has also been found to be potentially beneficial in treating prostate cancer and slowing its progression in many animal and in vitro studies. Lately, more human studies point to similar results. In a small study published in Urology in September 2004, Australian researchers found that men consuming a soy-enriched diet had a statistically significant drop of 12.7% in prostate-specific antigen (PSA) levels, compared to the control group whose PSA levels rose 40%.


TOMATO

Lycopene in Tomatoes and Prostate Cancer

Lycopene, a powerful antioxidant, is found abundant in tomatoes and tomato products. Studies found that lycopene may help reduce some cancer and heart disease. The most compelling evidence so far is the role of lycopene in prostate cancer prevention. In a study of over 40,000 health professionals, Harvard investigators found that men who ate more than 10 servings tomato-based foods daily (like cooked tomatoes and tomato sauce,) had a 35 percent lower risk of developing prostate cancer than those who ate the least amount of these foods. The benefits of lycopene were more pronounced with advanced stages of prostate cancer.

In another study of prostate cancer, researchers looked at blood levels of lycopene and found that the risk of developing prostate cancer, especially aggressive cancer, decreased with increasing blood lycopene levels. Men taking 50mg of lycopene daily had significantly higher level of lycopene. In this study, researchers found that high level of lycopene in the blood was associated with low PSA (prostate specific antigen) levels. High PSA levels in blood are often a sign of prostate cancer.

Enjoy the benefits of lycopene by eating more tomatoes and processed tomato products. Indeed, research showed that lycopene is better absorbed by the body when tomatoes are processed. It is due to the fact that lycopene is bound to tomato's cell structure; processing releases lycopene from the cell structure.


MINERALS

Selenium and Prostate Cancer

Because it boosts the body's antioxidant capacity, selenium is thought to have some ability to control cell damage that may lead to cancer. Selenium may even act in other ways to stop early cancer cells in their development. A recent study also suggested that selenium may enhance immune function, at least in those healthy adults with relatively low blood selenium. So far based on the evidence of animal and epidemiological studies, the role of selenium and cancer is probably the most significant for prostate cancer.

Selenium and Prostate Cancer

Quite a few promising studies published in 2004 showed the potential benefits of selenium in prevention of prostate cancer. One particular epidemiological study published in May 2004 in the Journal of National Cancer Institute revealed that men with high blood levels of selenium were about half as likely to develop advanced prostate cancer as the men with lower blood selenium. This study had a good sample size (>1000 healthy male) and a long study period of over 13 years. The duration is significant because prostate cancer is a slow growing disease.

A well designed randomized double-blind controlled study would be able to determine selenium's benefits. Currently the SELECT trial (the Selenium and Vitamin E Cancer Prevention Trial) is in progress. This study hopes to enroll 32,000 men aged 55 or older and will be follow them for 12 years.

Selenium and other cancers

Several other studies recently suggested that lower blood selenium may be associated with increased risk of colon cancer. Another study published in August 2004 also revealed that selenium may prevent gastric cancer, especially in men.


COQ10

Benefits of Coenzyme Q10 (CoQ10) for Cancer Treatment

Coenzyme Q10 (CoQ10) has been quite popular in the past years. Possible benefits of CoQ10 supplements include the prevention and treatment of cancer and heart disease. CoQ10 supplements are usually available in either powder capsules or oil-based softgel capsules.

What is CoQ10?

Coenzyme Q10 is considered a non-essential nutrient as it can be synthesized by our bodies. It is used by our bodies to produce energy. It also acts as an antioxidant protecting us from free radical damage. Its antioxidant effects are similar to those of vitamin E. Some studies also suggested that Coenzyme Q10 stimulates the immune system.

Possible Benefits of CoQ10 in Cancer Treatment

Two studies showed that cancer patients have lower levels of Coenzyme Q10. In addition, a small human trial in Denmark involving 32 breast cancer patients investigated the efficacy of CoQ10 as an adjunct therapy (adjunct = supplements + conventional cancer treatment). The results showed that all patients in the trial reported that they used fewer painkillers and did not lose weight during cancer treatment. In addition, 6 patients showed signs of remission i.e. tumor regression. Please note that this Denmark trial was, however, not well-designed. It was not a double-blinded study and neither control or placebo group was included. Therefore, it is rather difficult to draw a definite conclusion from this trial on the benefits of CoQ10 in cancer treatment.

Furthermore, some anecdotal reports also recorded that adjunctive CoQ10 supplementation has increased the survival of patients with cancers of the pancreas, lung, colon, rectum, and prostate cancer.

Cancer - exercise to help you cope

The following article is excerpted from the Better Health Channel - Healthier Living Online and is offered here, in the hope readers may become better informed. I would encourage all our readers to visit the author's website.

Cancer and cancer treatments can make a person feel too tired to exercise. However, studies show that regular, moderate physical activity can help a person who has cancer to cope with the disease and the side effects of treatment. Your doctor can help you devise an appropriate exercise program. Do not exercise without your doctor’s knowledge and support because inappropriate exercise may be harmful.


Causes of fatigue

Cancer and cancer treatments such as chemotherapy can cause persistent fatigue (tiredness). Some of the reasons include:

* All types of cancer interfere with the body’s normal functioning. For example, cancer may disrupt the hormone balance.

* Cancers that involve the bone marrow can impair the body’s ability to make red blood cells. This results in anaemia, which is a known cause of fatigue.

* Some treatments may destroy non-cancerous cells such as red blood cells.

The benefits of exercise

Physical activity can boost the energy levels of a person who has cancer. Moderate regular exercise can:

* Prompt the body to make more red blood cells, which increases the oxygen-carrying capacity of the blood

* Strengthen the cardiovascular system and improve blood supply to every cell of the body

* Increase muscle tone and strength

* Improve stamina, which makes daily activities less tiring to perform

* Reduce nausea and vomiting associated with chemotherapy

* Increase appetite

* Encourage deeper and more refreshing sleep

* Reduce the pain of cancer – exercise stimulates the brain to release endorphins, which are opiate-like pain-killing chemicals

* Stabilise mood – depression and anxiety are known to cause fatigue

* Reduce the need for drugs used in the treatment of depression and anxiety – some of these drugs may cause fatigue.

The cancer-fighting benefits of exercise

Some studies show that regular exercise can:

* Encourage the body to produce more white blood cells

* Boost functioning of the immune system

* Reduce the time spent in hospital in some cases

* Increase survival rates in some cases.

Other health benefits

For the person who has cancer, regular exercise can:

* Increase the amount of platelets and reduce the risk of bleeding

* Prevent or help to treat constipation

* Help to manage other medical conditions such as shortness of breath or heart problems

* Reduce the risk of infection such as upper respiratory tract infections (URTIs)

* Allow the person to feel more in control

* Boost self-confidence

* Give the person enough energy to participate more fully in daily activities

* Improve quality of life

Appropriate forms of exercise

It is important to be guided by your doctor. The exercise program you choose in consultation with your doctor depends on your lifestyle, treatment program (including the type of surgery you may have had) and your doctor’s opinion on which forms of exercise are safe or best for you. Almost any type of exercise may be appropriate, including:

* Walking, jogging, running

* Dancing

* Tai Chi

* Cycling

* Weight training

* Team sports

* Gardening

* Yoga

* Swimming

General exercise guidelines

Be guided by your doctor, but general suggestions include:

* If you were physically active before your diagnosis and treatment, continue the same program. You may need to reduce the intensity, duration and frequency of the exercise.

* Aim for five to 20 minutes of exercise per session.

* Aim for moderate intensity. Don’t push your heart rate too high.

* Regularity is the key. Short periods of physical activity on most days of the week are far more beneficial than the occasional gruelling work-out.

* Do not force yourself to exercise when you feel exhausted. Instead, take a short stroll around the garden or do some stretches.

* Avoid exercise for the first 24 hours after chemotherapy.

* Do not exercise if you are ill: for example, if you have a fever. Consult with your doctor.

* Avoid high-impact activities (such as running or any sport that involves jumping) if you have bone cancer.

* Some cancer medications may affect your balance. Be advised by your doctor.

* If you are bedridden, perform regular stretches to help keep up your stamina. Even small amounts of exercise can be beneficial.

* Your doctor may recommend that you avoid exercise altogether. This is because exercise may be harmful in some cases. It is important to follow your doctor’s advice.

Where to get help

* Your doctor

* Oncologist

* Hospital physiotherapist

* Hospital occupational therapist

Prostate Cancer - A Glossary

Updated: Now includes an extensive 'online' glossary and also an online acronym and abbreviations decipher.

Researching Prostate Cancer, as a lay person, proved to be rather difficult at first. I really had no point of reference or basis for understanding (or remembering) either the medical terms or the anatomical names!

So, my solution, was to find a glossary of terms that would assist me on my endeavour until such times that the terms etc, became familiar to me by virtue of common usage. It is with this in mind, I offer the following as an aid to other lay persons who find themselves on the same journey.

Ablation - Removal or separation of something.

Adrenal glands - Small glands lying on top of the kidneys which produce a small amount of male hormone.

Androgens - Male hormones. The most active male hormone, testosterone, is produced by the testicles. Other male hormones are produced by the adrenal glands.

Anti-androgens - Drugs which block the effects of male hormones.

Asymptomatic - Not having symptoms, symptom-free.

Benign - Non-cancerous (not cancer).

Benign prostate enlargement - Non-cancerous enlargement of the prostate.

BPH - Benign Prostatic Hyperplasia. A condition causing non-cancerous enlargement of the prostate.

Biopsy of the prostate - Removal of small pieces of tissue, in this case, from the prostate gland. Tissue samples are taken from different areas of the prostate, and then examined under the microscope to see if they are cancerous.

Brachytherapy - A type of prostate radiotherapy - involves the insertion of radioactive seeds or rods directly into the prostate.

CAT (CT) scan - CAT stands for Computerised Axial Tomography. A series of x-ray pictures are taken in a circle around the body and are processed by a computer.

Chemotherapy - Usually refers to the killing of cancer cells with cytotoxic chemicals (cytotoxic means toxic to cells.)

Cystitis - Inflammation of the bladder, often caused by infection.

Cystoscope - A tiny tube with a lighted end which slides along the urethra and is used to examine the bladder.

Digital Rectal Examination (DRE) - An examination of the prostate through the rectum wall. The doctor inserts a finger in the rectum and feels the shape of the prostate. Irregularities may be caused by cancer.

Dry ejaculation - Also called reverse or retrograde ejaculation. After surgery on the prostate, a man may achieve orgasm, but produce no ejaculate. This is because of either the removal of a muscular valve which prevents the ejaculate from going backwards into the bladder (in the case of surgery called a TURP), or because the glands which produce much of the fluid in the ejaculate are also removed (in the case of a radical prostatectomy).

Ejaculate - Fluid produced at ejaculation which contains sperm and secretions from glands such as the prostate, seminal vesicles and testicles.

Gleason score - A way of grading cancer cells. Low grade cancers (Gleason score 2,3,4) are slower growing than high grade (Gleason scores 8,9,10) cancers.

Grade - A way of describing how abnormal the cancer cells look, and consequently how aggressive or fast-growing the cancer is likely to be. The most commonly used grading system is the Gleason score, which ranges from 2-10.

Hot flush - A sudden rush of heat to the face, neck, sometimes chest and back. It can be associated with hormonal therapy for prostate cancer.

Hormone resistance - Prostate cancer cells are dependent on testosterone or male hormone for growth. Withdrawal of male hormone by surgery or by means of drugs is therefore a means of controlling its growth. However cancer cells may develop which do not need testosterone for growth. The cancer is then said to be ‘hormone resistant’.

Hyperthermia - Higher than normal temperature. In the case of prostate cancer, a way of destroying tissue by heating.

Impotence - Inability to achieve an erection.

Indolent - Means ‘lazy’, usually referring to the type of cancer cells which grow only slowly.

Incontinence - Inability to hold urine or control urine loss.

Lymph nodes - Small glands which filter tissue fluid before it returns to the blood stream. This means that they often capture cancer cells which have escaped from the main tumour and have started to spread to other parts of the body.

LHRH - Luteinising Hormone Releasing Hormone. It is produced by the hypothalamus in the brain and stimulates the pituitary (another part of the brain) to produce LH (Luteinising Hormone). This, in turn causes cells in the testicles to produce testosterone, the male hormone.

LHRH agonists - Drugs which interfere with the production of LH (see above) by the pituitary.

Libido - Sex drive.

Margin-positive - See surgical margins.

Metastasis - A piece of cancer which has broken off from the main cancer and become established in a different part of the body. Prostate cancer metastases often occur in lymph glands, bone or in the lungs.

MRI - Magnetic Resonance Imaging. A way of imaging the inside of the body without using X-rays.

Nodules - Small lumps.

Oncologist - A doctor who specialises in treating cancer.

Orchidectomy - (Also Orchiectomy) A type of operation which removes the testicles, but usually leaves the scrotal sac or scrotum.

Pelvis/pelvic - The area of the body below the waist and surrounded by the hip and pubic bones.

Pituitary - Part of the brain which produces hormones which stimulate the testicles to produce testosterone (male hormone) and other hormones.

Prostatitis - Inflammation of the prostate. It can be caused by bacteria.

Prostatectomy - Operation to remove all or part of the prostate.

PSA - Prostate Specific Antigen. It can be used as a test for prostate cancer or to monitor its recurrence.

Radical prostatectomy - An operation which removes the prostate and the seminal vesicles. This may be done through a cut in the abdomen or the perineum (the area of skin between the rectum & scrotum).

Rectum - The last part of the bowel, leading to the anus, and through which stool passes.

Retrograde - Also called reverse ejaculation. This may occur after surgery for benign enlargement of the prostate. The ejaculate travels back into the bladder instead of exiting out through the penis. This means a man is infertile, but he can still achieve orgasm.

Scrotum - A pouch of skin which contains the testicles and some other parts of the male repro-ductive system. It hangs outside the body and below the penis.

Seminal vesicles - Glands which lie very close to the prostate and produce secretions which form part of the ejaculate.

Staging - A way of describing how far the cancer has spread.

Stricture - Scar tissue which obstructs fluid flow; in the case of a urethral stricture, urine flow is obstructed.

Surgical margins - After a radical prostatectomy, the edges of the tissue which has been removed are examined to see if cancer cells are present. If they are not (negative surgical margins) the chance is higher that all of the cancer has been removed.

Testicles - Glands which produce sperm and the male hormone, testosterone. They are found in the scrotum.

Testosterone - The major male hormone. It is produced by the testicles.

TRUS - Trans-Rectal Ultra-Sound. A means of imaging the prostate in order to locate cancer. The ultrasound probe is placed in the rectum.

TURP - Trans-Urethral Resection of the Prostate. An instrument is inserted, under anaesthetic, along the urethra (urine tube) and removes prostate tissue which may be blocking the flow of urine. It is a common operation for benign enlargement of the prostate, but only occasionally used to treat prostate cancer.

Urethra - Tube which carries urine and ejaculate along the length of the penis and to the outside.

Online Glossary: Acronyms and Abbreviations: Courtesy of: Prostate Cancer research Institute

More about Hormone Therapy

The following article is excerpted from the Prostate Health Improvement Program (PHIP) Rising and is offered here, in the hope readers may become better informed. I would encourage all our readers to visit the author's website.


When is hormone treatment used?

This is not a simple question to answer, for many factors need to be considered prior to choosing this treatment option. In general, hormonal therapy is used when there is evidence that the cancer is no longer confined to the prostate (and sometimes to shrink the gland prior to removal or radiotherapy).

Commonly hormone treatment is used for men in whom radical treatments have not succeeded in curing the disease, ie following radical surgery or radiotherapy. Often our best indicator of recurrent prostate cancer growth is from a rising PSA level (PSA is a blood test which, after surgery or radiotherapy, indicates the amount of cancer activity still remaining in the body - see information sheets 2 and 4). The exact timing of hormone treatment in response to a rising PSA level is variable and based to some extent on the speed of tumour growth and the sites of the tumour.

Hormone treatment is also the principal therapy for metastatic prostate cancer when the prostate cancer cells have escaped from the prostate to grow in other sites of the body. In this case, the treatment may be started soon after this diagnosis is made, although on occasions a delay in starting does not pose serious risk to the patient.

Hormone therapy may also be used to shrink the tumour prior to or in conjunction with other treatments. There is some evidence that it may be beneficial when used with radiotherapy, however, its use in conjunction with surgery is controversial (if proposed, this should be discussed with a specialist). Once the prostate treatment has been completed, the hormone treatment is usually stopped and the response observed, by following the PSA levels.


What does hormone treatment involve?

Essentially, there are two ways of reducing male hormones:

* By surgery where the testicles are removed (orchidectomy)

* By medication, either in the form of regular injections or tablets. Both are effective. (Refer to Table 1 and Figure 1).

Since the testicles provide over 95% of the male hormones it is obvious that their removal will reduce the levels. This occurs very quickly after the operation, which is performed sometimes as day surgery but more commonly with an overnight stay in hospital. An advantage of this form of hormone treatment is that the inconvenience and cost of regular medications is avoided.

Medications are available as an alternative to orchidectomy. The injectable drugs act on the brain to reduce the production of male hormones in the testicles and currently last from 1- 3 months per injection. This means that regular monthly or 3-monthly injections are required to control the cancer cell growth, and should these be stopped, the prostate cells will begin to grow.

Tablets are available to control the cancer cells also, although they are not frequently recommended by themselves as a first choice method of cancer control. In the past, both injectables and tablets were frequently used in combination to control prostate cancer cell growth (called total androgen ablation). However, we are currently not certain of the additional effectiveness of taking a tablet whilst on an injectable drug or in combination with orchidectomy (removal of the testicles). Sometimes hormone therapy may be given in cycles ie started and stopped repeatedly.

This type of treatment is called intermittent hormonal therapy. Typically, hormone treatment is continued for several months until PSA has reached a low level, and then discontinued. Once the PSA level in blood rises to a particular level again (and this can take many months), hormone therapy is started again. The benefits of this approach are a reduction in side effects (see the next section), and potentially prolonging the effectiveness of hormone therapy (although we are not yet sure that this is the case).


What are the current medications available in Australia?

A list of current medications available in Australia is shown in Table 1.

What are the side effects of hormone treatment?

Many of the side effects of hormone treatment are related to the lack of normal levels of male hormone within your body and occur whether you choose surgery or medications. These are summarised in table 2 below. Typically, most men suffer from poor or absent erections (impotence) and there is also a lack of interest in sexual activity (reduced libido). Your voice will not change; however, some men notice an alteration of their body hair, such that it is a different texture and may grow again on previously quite bald areas. Tiredness is a common complaint, and is related to the main male fuel being suppressed.

Hot flushes are very common in the early stages of treatment but may decline spontaneously after several months of treatment. There are medications available to reduce the intensity of this sometimes disabling symptom if required. Over many months or years there may be a decline in muscle strength and some tenderness or enlargement in the breast area.

Before commencing on hormonal therapy, it is helpful to discuss the possibility of side effects with your wife or partner. Good communication is important in dealing successfully with these changes and maintaining your close relationship.

A word about hormonal therapy

The very nature of this treatment, the removal of male hormone or its effects means that a man will experience changes in the way he feels, his attitudes, and of course his sex life. While this can be distressing, and it means communication with your partner is particularly important, it does not change who you are. It does not change your identity as a man and your ability to direct your own life. Some men feel a need for a change in focus in their lives at this stage, however, and they may take up activities which are more meaningful to them. According to these men, the years that follow can be rewarding and productive.


Hormone resistance: what if the treatment stops working?

The ability of hormone treatment to control your cancer is quite variable. Some men (approximately one in five) have recurrent growth within a year from starting hormone treatment whereas others have no sign of recurrent disease after 10 years of treatment. The average time to PSA evidence of regrowth (hormone resistance) is 2.5 years. The delivery of hormone therapy in bursts (ie intermittent rather than continuous) as a way of delaying the onset of resistance is possible with medications, but not after the removal of the testicles with an operation. Whilst this approach has some theoretical advantages, its benefits have not yet been established, and continuous hormonal therapy is still regarded by most doctors as the best option.

When resistance to hormonal therapy occurs (usually indicated by rising PSA in the blood), treatment is frequently tailored to an individual’s symptoms. Symptoms typically occur many months to years after evidence of cancer regrowth and are related either to growth of the cancer in the pelvic region (blood in the urine, reduced ability to pass urine) or growth at distant sites such as the bones (pain in the pelvis, back, etc).


Treatment Options for Hormone-resistant Cancer:

Options available for this stage of the disease are:

(1) Radiotherapy, to alleviate pain and control cancer growth at sites away from the prostate. Radiation is usually delivered by ‘external beam’ (meaning from outside the body) in this setting although agents which are injected are sometimes used.

(2) Additional hormone treatments, typically tablets. Not many men have a lasting favourable effect from “second-line” hormonal therapy; however, a downward trend to the PSA can occur for some months. Stopping one tablet and using a different one is also sometimes helpful.

(3) Steroids such as prednisolone to control pain and reduce tumour growth.

(4) Non-specific pain relief medications, including arthritis-type tablets and morphine.

Injection of LHRH Implant

Attended the Urologist's Surgery in St Leonards to receive an injection of a luteinising hormone-releasing hormone (LHRH)- specifically a 'Goserelin acetate implant' (the generic name) or Zoladex (the product name).

For a video demonstration of the proper technique for administering Zoladex please click here.

What is hormonal therapy?

Hormonal therapy treats prostate cancer by decreasing the supply or blocking the action of male hormones (androgens) such as testosterone that encourage prostate cancer growth. Hormonal therapy can slow the growth of the cancer and reduce the size of the tumour(s).

The following are the main types of hormonal therapy which may be used in prostate cancer:

Orchidectomy or surgical castration

Orchidectomy is the surgical removal of the testes, which are the organs that produce 95% of the body’s testosterone. Since the testes are the major source of testosterone in the body, this procedure is classified as hormonal therapy rather than surgical treatment. The aim is to deprive the prostate cancer cells of testosterone, thereby causing the cancer to shrink and/or to prevent further growth of the tumour. The testicles are removed through a small incision in the scrotum.

Figure 1: Orchidectomy

Most men who undergo surgical castration will experience a loss of sexual desire and impotence. In addition, hot flushes frequently occur. Surgery is permanent and the effects cannot be reversed.

Medical castration

Medical castration is achieved by using luteinizing hormone-releasing hormone agonists (LHRHa’s) (e.g. goserelin - ‘Zoladex’, leuprolide). They work by ‘switching off’ the production of male hormones from the testicles by reducing the levels of a hormone called luteinizing hormone. This hormone, is produced by the pituitary gland (a pea-sized gland located at the base of the brain which regulates and controls the release of hormones which directly or indirectly affect most basic bodily functions).

LHRH implants work just as well as orchidectomy in advanced diseasebut do not involve surgery. They are also used in combination withradiotherapy as adjuvant therapy for earlier disease.They are given by injection either under the skin (subcutaneous) or into the muscle (intra-muscular). The injections are generally given every month or every 3 months.

Most men who undergo medical castration will experience a loss of sexual desire and impotence. In addition, hot flushes frequently occur. However, medical castration is potentially reversible. If treatment is stopped, testosterone is produced once again.

LHRH Agonists

The 'original' 3.6mg formulation of Zoladex has been available since 1989 as a monthly implant. The new formation, 10.8 mg goserelin acetate implant given every three months, offers greater convenience to subjects choosing treatment with a luteinizing-hormone-releasing hormone (LHRH) analogue.

The 'original' 3.6mg formulation of Zoladex was shown to be as effective as orchiectomy (surgical castration) in controlling the spread of prostate cancer, thus offering men a choice between medical treatment and surgery.

This 12-13 week formulation of Zoladex is, a white to cream coloured, cylindrical implant with a 1.5 mm diameter that contains 10.8 mg of goserelin. Given by subcutaneous injection, into the anterior abdominal wall, the biodegradable implant slowly dissolves, delivering therapeutic levels of the drug continuously over a period of 12 weeks. This means an injection will be required every 12 to 13 weeks.

Ongoing Treatment

The success of this treatment (in my case Goserelin 10.8mg every 3 months) will be monitored by regular blood tests which look specifically at the Prostate Specific Antigen (PSA) readings. A lower PSA indicates that the treatment is working.

Subsequent to this treatment and dependent upon how my body reacts to the LHRH, radiotherapy will then be considered.

As with most things, there is a down side to this treatment. Men receiving Hormone therapy may have side effects from the withdrawal of testosterone. This could include: increased tiredness, erection problems, reduced sex drive, weight gain, hot flushes, breast tenderness, depression, and loss of bone strength (osteoporosis).

These side effects can significantly affect the way a man functions, however there are treatments that can minimise the impact of the side effects.

In order to monitor the progress of the Hormone Treatment, I have been scheduled to have two further blood tests (December and February) with the expectation that my PSA readings will go down. At present my PSA is 84.8. Normal readings for someone my age would be between 0 and 3.5 - still a way to go!

Latest Statistic

The latest statistics associated with the Prostate Cancer Institute suggests that there is a much greater awareness of prostate cancer in the community. As we move closer to the baby boomer era, there will certainly be a rise in the number of prostate cancer sufferers.

The Cancer Institute of NSW stated that prostate cancer made up 14% of new cancer cases detected in NSW in 2003 – a total of 4637. By 2011, the incidence of new cases is expected to be 5942, with prostate cancer the most common form of all cancers.

The attached graph displays the number of new patients with prostate cancer with the green section showing new patients under the age of 60 years.

For the latest statistics on prostate cancer, please visit the Cancer Institute NSW's website here", with a link to:

http://www.statistics.cancerinstitute.org.au/

More on Staging

After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.

The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
  
  
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  
  
• Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.
  
  
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  
  
• Seminal vesicle biopsy: The removal of fluid from the seminal vesicles (glands that produce semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
  
  
  

The stage of the cancer is based on the results of the staging and diagnostic tests, including the original tumor biopsy. The biopsy is used to determine the Gleason score. The Gleason score ranges from 2-10 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread. The lower the number, the less likely the tumor is to spread.


The following stages are used for prostate cancer:

As prostate cancer progresses from Stage I to Stage IV, the cancer cells grow within the prostate, through the outer layer of the prostate into nearby tissue, and then to lymph nodes or other parts of the body.


Stage I

In stage I, cancer is found in the prostate only. It cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. The Gleason score is low. Stage I prostate cancer may also be called stage A1 prostate cancer.


Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.


Stage III

In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles. The Gleason score can range from 2-10. Stage III prostate cancer may also be called stage C prostate cancer.


Stage IV

In stage IV, cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones. The Gleason score can range from 2-10. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.

Is Cancer Confined to the Prostate Gland?

The following article is excerpted from PSA Rising - Prostate Cancer Survivor (News, Info & Support) in the hope readers may become more informed. I would encourage all our readers to visit the author's website.

These tables may help you and your doctor to predict the chance of organ confined prostate cancer.

Find the table headed with your PSA level. Next, read down the left column to your Gleason score. Then read across to the column headed by your clinical stage (e.g T2a).

Where the row for your Gleason meets the column for your clinical stage is a number. This number, e.g. 66, is a percentage - 66%. Your number gives you a rough idea of how many chances out of a hundred a patient with your PSA level, Gleason score and Clinical Stage has of organ confined disease.


The higher this number, the better. Remember you're NOT an "average" number!

PSA 0.0 - 4.0 ng/mL

Clinical Stage___ T1a ---- T1b ---- T1c ---- T2a ---- T2b ---- T2c ---- T3a

Gleason Score ----% Probability (that cancer is organ-confined)

-- 2-4 ---------------------90 ------80 -------89 -------81 -------72 -------77

-- 5 ------------------------82 ------66 -------81 -------68 -------57 -------62 -------40

-- 6 ------------------------78 ------61 -------78 -------64 -------52 -------57 -------35

-- 7 ----------------------------------43 -------63 -------47 -------34 -------38 -------19

-- 8-10 ------------------------------31 -------52 -------36 -------24 -------27

_______________________________________________________________

PSA 4.1 - 10.0 ng/mL

Clinical Stage___ T1a ---- T1b ---- T1c ---- T2a ---- T2b ---- T2c ---- T3a

Gleason score --------------------------% Probability

--2-4 ---------------------84 ---- --70 -------83 -------71 -------61 ------66 --------43

--5 ------------------------72 -------53 -------71 --------55 ------43 ------49 --------27

--6 ------------------------67 -------47 -------67 -------51 -------38 ------43 --------23

--7 ------------------------49 -------29 -------49 -------33 -------22 ------25 --------11

--8-10 --------------------35 ------18 --------37 -------23 -------14 ------15 ---------6

_______________________________________________________________

PSA 10.1 - 20.0 ng/mL

Clinical Stage___ T1a ---- T1b ---- T1c ---- T2a ---- T2b ---- T2c ---- T3a

Gleason score ---------------------------% Probability

--2-4 ----------------------76 ------58 ------75 -------60 -------48 --------53

--5 -------------------------61 ------40 ------60 -------43 -------32 --------36 ------18

--6------------------------------------33 -------55 -------38 -------26 --------31 ------14

--7 -------------------------33 ------17 ------35 -------22 -------13 ---------15 -------6

--8-10 --------------------------------9 -------23 -------14 ------- 7 ----------8 --------3

________________________________________________________________

PSA above 20.0 ng/mL

Clinical Stage___ T1a ---- T1b ---- T1c ---- T2a ---- T2b ---- T2c ---- T3a

Gleason score ---------------------------% Probability

--2-4 -------------------------------38 --------58 -------41 ------29

--5 ----------------------------------23 --------40 -------26 ------17 --------19 ------8

--6 ----------------------------------17 --------35 -------22 ------13 --------15 ------6

--7 ----------------------------------------------18 --------10 -------5 ----------6 ------2

--8-10 -------------------------------3 --------10 --------5 --------3 ----------3 ------1
________________________________________________________________

Making Decisions at Time of Diagnosis

The following article is excerpted from PSA Rising - Prostate Cancer Survivor (News, Info & Support) in the hope readers may become more informed. I would encourage all our readers to visit the author's website.

Slow down and take a breath before making any decisions about treatment. Prostate cancer can develop into a deadly disease. But for most men at time of diagnosis today, prostate cancer is not usually in need of immediate, emergency treatment. Most likely, you'll have time -- days, weeks and in some cases months -- to gather information and to decide among several treatment options.

Even so, a recent study found that men with stage T2 prostate cancer who had to wait nine weeks or more before receiving treatment by radiotherapy had a higher rate of recurrence unless they received a higher dose of radiation.

Your first task, with your doctors' help, is to get information about your Gleason grade and stage of prostate cancer and your PSA velocity.

Your second task is learn about which treatments offer you best outcomes in long-term survival and side effects.

Medical information about prostate cancer may be new to you. Your body is on the line, and new information may be hard to absorb. This may be the most complex decision you've ever made. Do what you can to make it easier on yourself.


A few practical steps will help you to get organized and on track:

* Bring someone with you to your appointments.

* Bring a notepad and tape recorder to the appointments.

* At home, set up a calendar, a phone number book and a file box (or file drawer) and a loose-leaf ring binder.

* Use the file for your new medical records, medical bills and health insurance papers, and for print-outs from reliable sources like medical journals.

* Use the binder to list your own questions and to jot down your doctors' replies. If you prefer to use a small notebook in the doctor's office, tape your notes into the binder when you get home.

* If you wish, jot down or clip and paste in info from sources like books, pamphlets and computer print outs. Family, friends and support group members may be able to help you gather and sift information.

* Select the most important points that may affect you. These are points you want to discuss with your doctors.

* Nothing is too dumb (or too clever) to ask.

* If you need privacy to talk to your doctor about impact of various treatments on sexual desire, lovemaking and erections, or bladder and bowel control, say so.

* Expect any doctor you would care to allow to treat you to be interested in your overall health and well being and to see you as an individual with cancer not as a statistic or person of a certain age.

* Don't underestimate the value of statistics and "cancer numerology." Graphs and studies tell a story about human beings.

*Seek a second opinion about your biopsy.

*Seek second opinions and, if needed, third opinions or more about your treatment options.

*If you're considering either surgery or radiotherapy (external beam or brachytherapy), find a practitioner who has done the procedure many times. Usually, this means going to a major hospital recognized as a national cancer center. Prostate cancer has no single best treatment. But evidence has shown that some practitioners are "artists" and quantity of experience also counts. Quality of equipment used (especially for external beam radiation) is key. Urologists (surgeons) and radiologists who are leaders in their field and who have treated the most patients do a better job.

* Take some time to consider the information you have been given before you make a final decision.

In many situations in life we don't make optimal choices, "we choose the first reasonable option, a strategy known as satisficing." Satisficing is OK if there's no big penalty for choosing wrong.

In life and death situations, many people do not carefully gather all available information and come to a rational decision. A study of fire commanders found that they "took the first reasonable plan that came to mind and did a quick mental test for problems. If they didn't find any, they had their plan of action."

Some of the best cancer doctors are trained to be able to "take the first reasonable plan," do the quick mental test for problems and, if none jump out, to sell that plan of action to the patient.

But these people already know most of the available information.

Reflection

After you've gathered and studied a full range of good information, it's fine to sleep on it and let the decision come naturally.

A Dutch study has found that people can think unconsciously and -- surprisingly -- that for complex decisions unconscious thought is actually superior.

Lead researcher Dr Ap Dijksterhuis told the BBC: "The take-home message is that when you have to make a decision, the first step should be to get all the information necessary for the decision.

"Once you have the information, you have to decide, and this is best done with conscious thought for simple decisions, but left to unconscious thought - to 'sleep on it' - when the decision is complex."

It's your body and your life. You want to stay healthy, productive and active for as long as you can. More than one type of treatment might work equally well for you. For some men, no immediate treatment may be the best decision. But don't lose sight of the fact that you probably have just one good chance of a cure. It's worth bucking the urge to "satisfice" too soon. Keep reading and asking questions. Do the best that you can to make the right choice for yourself. Don't sell yourself short. Then, when you wake up with the decision "made" by your gut, or your unconscious mind, you can accept that and go forward without looking back.

The following video may prove useful in trying to understand the range of options available for treating Prostate Cancer today.

Diagnosis and Treatment of Prostate Cancer

Staging Prostate Cancer

Updated to include a video of an MRI scan. Click on 'MRI' link in Regional Lymph Nodes (N).

The following article is excerpted from PSA Rising - Prostate Cancer Survivor (News, Info & Support) in the hope readers may become more informed. I would encourage all our readers to visit the author's website.


What is Staging?

If prostate cancer has been found by any method, the next step is to see how much of the prostate it takes up and whether it has spread outside the prostate to nearby tissue, lymph nodes, organs and/or bones.

This is called staging the cancer. Your prostate cancer stage is key to your treatment options. Primarily, staging is based on your digital rectal exam (DRE).


Two different systems of staging have been used for prostate cancer.

Today the older ABCD system has largely been replaced by the TNM (Tumor, Nodes, Metastases) system. In addition, two levels of staging are used, clinical and pathologic.

Clinical staging is based on digital exam and any further non-invasive tests necessary to find the extent of the cancer. It affects primary treatment decisions.

Pathologic stage refers to examination of the prostate and any other tissue removed during surgery. Only patients who undergo surgery receive the second level of staging.


The TNM system of staging

Primary tumor (T)

TX: Tumor cannot be assessed.

T1: Doctor is unable to feel the tumor or see it with imaging such as transrectal ultrasound.

T1a: Cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed.

T1b: Cancer is found after TURP and is present in more than 5% of the tissue removed.

T1c: Cancer is found by needle biopsy done because of an elevated PSA.

T2: Doctor can feel the tumor when a digital rectal exam (DRE) is performed but the tumor still appears to be confined to the prostate.

T2a: Cancer is found in one half or less of only one side (left or right) of the prostate.

T2b: Cancer is found in more than half of only one side (left or right) of the prostate.

T2c: Cancer is found in both sides of the prostate.

T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles.

T3a: Cancer extends outside the prostate but not to the seminal vesicles.

T3b: Cancer has spread to the seminal vesicles.

T4: Cancer has spread to tissues next to the prostate (other than the seminal vesicles), such as the sphincter, rectum and/or wall of the pelvis.

T4a: Invades bladder neck, external sphincter, or rectum.

T4b: Invades muscles and/or pelvic wall.


Regional Lymph Nodes (N)

To see if the cancer has spread to the lymph nodes or bones, the doctor may order a CT scan or an MRI of the pelvis and a bone scan.

Sentinel lymph nodes in the pelvis that look suspicious on CT scan or MRI can be examined by fine needle aspiration biopsy method. This is done commonly in breast cancer staging.

NX: Nodes cannot be assessed

N0: No regional node metastasis

N1: Single node metastasis, 2 centimeters (cm) or less at largest point

N2: Single node metastasis, 2 cm to 5 cm at largest point, or multiple nodes, no larger than 5 cm at largest point

N3: Metastasis larger than 5 cm in any node


Distant Metastasis (M)

MX: Metastasis cannot be assessed

M0: No distant metastasis

M1: Distant metastasis

M1a: Distant lymph node(s) involved

M1b: Bone(s) involved

M1c: Other site(s) involved (e.g. liver, lung)


Note on stages that "cannot be assessed."

Patients in whom abnormal digital rectal examinations (DREs) do not match up with their prostate biopsy findings are "clinically unstageable."

To find out what unstageable prostate cancer involves, Wisconsin researchers looked at post-op pathology reports of some 100 patients who were unstageable.

"For these patients pathological staging revealed pT2a cancers in 26%, pT2b in 53%, pT3a in 19%, pT3b and pT0 in 1% of patients." The authors conclude: "Thus, the prevalence of unstageable prostate cancer is low but significant and it can be accurately classified into clinical stage T1c. "Clinical and pathological characteristics of unstageable prostate cancer: analysis of the CaPSURE database. Langenstroer P et al. Medical College of Wisconsin. J Urol. 2005 Jul;174(1):118-20.