Prostate cancer

Published January 17, 2021, 12:40 AM

by Dr. Jose Pujalte Jr.


Dr. Jose Pujalte, Jr.

“Tell them I’ve had a wonderful life.” – Ludwig Wittgenstein (1889-1951), Austrian-British philosopher on his deathbed, with prostate cancer

Below a man’s urinary bladder and in front of his rectum lies a gland the size, the anatomist Henry Gray described, as that of a castaña.  But, it can be thought of more as a pilonga that is fittingly, a dried chestnut.  It is the prostate.  As in most parts of the anatomy it is unnoticed and unappreciated until one day it starts giving problems.

The prostate belongs to the male reproductive system.  Part of it envelops the urethra or the common tube exiting in the penis (where urine and semen pass).  A known function of the prostate is secreting the fluid that forms part of the ejaculate. This fluid makes the vaginal environment less acidic and less hostile to sperm.

Risk Factors. The prostate is not immune to cancer. In fact, researchers theorize that in a high fat diet, the excessive fat increases the production of the hormone testosterone which in turn revs up the cancer cells. It runs in families so if a brother or father has prostate cancer, the chances of getting it increases. Age is a risk factor. The risk increases as the male gets older.

The horror of prostate cancer is compounded by consequences of treatment such as bladder problems and impotence (erectile dysfunction to the faint-hearted). However, the good news is that if the cancer is detected early, treatment success is high and side-effect may be temporary.

Signs & Symptoms.  Here’s the downside: signs and symptoms when already detectable may mean that the cancer has gone beyond the prostate. Nevertheless, watch out for:

  • Pain during urination.
  • A dull ache in lower pelvis.
  • Urgency to urinate.
  • Difficulty starting urination.
  • Hematuria (blood in the urine).
  • Weak urine flow and dribbling.
  • Loss of weight and appetite.
  • Painful ejaculation.
  • Frequent urination at night.
  • The feeling the bladder isn’t empty.

Diagnosis. It’s true that these difficulties may point to other (non-cancer) conditions. Examples are BPH (benign prostatic hypertrophy) or enlargement of the prostate and infection which may also be present with pain and abnormal urination. Nevertheless, it would be wise to visit a urologist. A digital rectal exam (please, you cannot insist on the nurse) means that doctor’s gloved and lubricated index finger is used to feel the prostate. A high PSA (prostate specific antigen) is seen in prostate cancer, inflammation, infection, or enlargement. Other exams may include a urinalysis and a transrectal ultrasound. If indeed cancer is suspected, more sensitive tests are in order. Most definitive is a biopsy or tissue sample of either the prostate itself or lymph nodes. From the grading of the cancer, its aggressiveness is confirmed and appropriate treatment can follow.

Treatment. Urologists and cancer specialists have joined forces in treating prostate cancer. Predictably, treatment approaches are numerous and combined. These included radiation therapy, in which high-powered xray beams zap cancer cells. In hormone therapy, LHRH or luteinizing hormone-releasing hormone agonists mount a chemical blockade to stop testosterone from keeping the cancer cells from growing. The surgeon’s contribution is radical prostatectomy (removal of the prostate, involved lymph nodes). Cryotherapy, in which the prostate is frozen using a rectal microwave probe, is another option. The procedure attempts to destroy cancer cells by freezing.  In brachytherapy, radioactive “seeds” are embedded in the prostate – landmines as it were in the territory of the prostate.

There is ample documentation that men die with their prostate cancer rather than of it. But the sooner prostate cancer is detected, the less suffering can be expected. Was it Wittgenstein’s eccentricity that led him to ignore the agony of prostate cancer? Still, his most famous utterance “Whereof one cannot speak, thereof one must be silent,” is somehow consistent to a life enduring a condition he could not imagine or picture.

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