The Facts on Prostate Cancer

Prostate cancer is the cancer most often diagnosed in Canadian men. In 1999 in Canada, 16,600 men were diagnosed with the disease.

Causes

Cancer tumours grow from cells that have undergone genetic mutations. These changes cause cells to multiply at very fast rates. They eventually form a mass that keeps growing, called a tumour.

In some people, the genetic mutation is inherited. About 10 % of prostate cancers occur in people who have particular genetic mutations. However, 90% of cancer-causing genetic changes occur after birth.

Some genes don’t directly cause cancer, but may make cells more vulnerable to carcinogens (cancer-causing agents) coming from outside the cell. People of African descent have double the prostate cancer rates of Caucasians, probably due to this factor.

Various factors can increase or reduce the chance of mutations, and therefore cancer. The following factors are believed to increase the risk of prostate cancer:

age – more than 80% of prostate cancers are found in men over 65
family history – having a father or brother with prostate cancer doubles your risk
race – people of African descent are more likely to get prostate cancer
geography – prostate cancer is rarer in Asia, Africa, and South America
weight, physical inactivity – overweight and inactive men have higher rates of prostate cancer

Diet may be a crucial factor in prostate cancer. The fact that Africans are far less affected by prostate cancer than Americans of African descent suggests that diet and lifestyle are partly to blame. Research has shown a link between high-fat diets and prostate cancer. Some experts contend that lack of fruit and vegetables is the problem, and that people with high-fat diets get more cancer because they tend to eat fewer vegetables. As well as fat, high levels of dietary calcium, as in dairy products, have been linked to prostate cancer.

Some foods may protect against prostate cancer. Tomatoes, grapefruit, and watermelon all contain lycopene, a chemical that’s clearly linked to a lower risk of prostate cancer. Many studies have also found a protective effect in vitamin E.

Symptoms and Complications

Usually prostate tumours are small and cause no symptoms. That’s why most of them are only discovered during blood screening tests or surgery for benign prostatic hyperplasia, which often does cause noticeable symptoms.

Large advanced tumours can press on other organs such as the bladder, causing incontinence or making urination difficult or painful. They may also interfere with the nerves responsible for erection of the penis, causing impotence. Advanced tumours can also press on the spine or pelvis, causing pain. Pain or burning when urinating or pain when ejaculating may also occur. Blood may appear in the urine or semen. Pain or stiffness in the lower back, hips, or upper thighs may also occur.

If cells from a tumour are shed into the bloodstream, they can settle in distant parts of the body, and start dividing to form new tumours. This process of migration is called metastasis, and the new tumours are called metastases. You may suffer pain in distant parts of the body if the cancer has metastasized.

As well as travelling by blood, loose cancerous cells can be carried through the lymphatic system, a network of tubes that carry lymph, a clear liquid containing waste products and immune cells. From there it can spread to various lymph nodes and other organs. The lymphatic system is the main carrier of metastases in prostate cancer. Secondary tumours can grow in the lungs, brain, bones, lymph nodes, or almost anywhere else.

Making the Diagnosis

There is a screening test for prostate cancer called the prostate-specific antigen (PSA) test. PSA is made by prostate cells and all men have PSA levels that can be detected in the blood. Men with prostate cancer often have more PSA.

Another test a doctor can do is a digital rectal exam (DRE), which involves feeling the prostate with a gloved finger. If cancer is suspected, a needle biopsy might be done next, which involves removing cells from the prostate with a syringe. The doctor will also want a biopsy sample of the lymph nodes to check if the disease has spread.

If cancer is found, a specialist, usually a urologist, will then determine the size, stage, and grade of the tumour. These will help sort out which therapy may be used to treat the cancer.

Treatment and Prevention

Prostate tumours grow slowly and are non-aggressive compared to most other types of cancer. They also tend to appear late in life. Especially in older men, small tumours are often left in place, and are followed by “watchful waiting.” The doctor will check regularly to be sure the cancer isn’t growing faster than expected.

Cancer that has spread far beyond the prostate requires a range of anti-tumour and pain-killing treatments.

Cancer that is still localized in the prostate is usually treated with surgery. The standard operation is radical prostatectomy, the complete removal of the prostate gland. An incision is made either in the lower abdomen or between the anus and scrotum, and the prostate gland is removed. This is the method most likely to cure prostate cancer.

Removal of the prostate can have major side effects, including impotence and incontinence. The ability to have an erection after surgery depends on whether the nerves next to the prostate have been damaged. Sometimes the nerves are affected by cancer and must be removed. Sometimes the doctor tries to leave them in place but impotence occurs anyway. The doctor should be consulted about the likelihood of a “nerve-sparing” procedure in any specific case.

Sometimes the cancerous tissue is killed with a cold probe (cryosurgery) that freezes it. This technique can also cause impotence. It’s fairly new, so we don’t know if long-term results are as good as for radical prostatectomy.

Radiation may be used to kill the cancerous tissue. This also carries a large risk of impotence and incontinence, though newer machines are better at focusing the harmful rays on cancer tissue only. Sometimes radioactive pellets are placed into the prostate gland.

Hormonal therapy involves reducing the levels of the male hormones like testosterone (called androgens). Prostate cancer cells rely on androgens to grow. This treatment can also cause the prostate to shrink. It won’t cure the cancer, but it may be useful before surgery, especially cryosurgery. Both hormones and radiation are common treatments in patients whose cancer has spread or come back after surgery. Normal cancer chemotherapy is not commonly used for prostate cancer, except to relieve symptoms from metastases.

The doctor will discuss treatment options based on the size, type, and location of the cancer.

If you’re worried about developing prostate cancer and have more than one of the risk factors listed in the causes section, you should ask your doctor about PSA testing and digital rectal exams.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis is a long term condition that causes swelling, pain, stiffness and sometimes damage to the joints. The disease is cyclic, meaning that there are times when the symptoms are bad and there are times when there are few symptoms.

Not everyone is affected the same way by rheumatoid arthritis. For some people, the arthritis is mild and stays the same for years. For other people, the condition gets worse as time goes by.

There are 3 categories of rheumatoid arthritis:

Mild or early rheumatoid arthritis – symptoms are mild and flare ups are far apart
Moderate rheumatoid arthritis – Flare-ups are worse and happen more often. Some people may have trouble doing certain things, like buttoning a shirt.
Active rheumatoid arthritis – the symptoms are bad and cause disability. The symptoms are present almost all the time.

Causes of Rheumatoid Arthritis

We don’t really know what causes rheumatoid arthritis. Scientists think that it is caused by the body attacking itself, but they don’t know why it happens. The first time signs of arthritis are noticed, the person is often under physical or emotional stress. It is 2-3 times more common in women. Rheumatoid arthritis can attack at any age. It is most common between the ages of 25 – 50.

Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis can show up suddenly and affect only a few or many joints. The first symptoms include:

• Swelling
• Redness
• Pain in the joints

The symptoms usually start in the fingers, in the joints closest to the hand. Rheumatoid arthritis usually affects both sides of the body at the same time.

Later, the symptoms get worse and begin to affect the wrists, elbows, shoulders, feet, knees and hips. It can be hard to get around for some people. Rheumatoid arthritis affects the whole body. Symptoms that many people have are:

• Feeling tired
• Stiff joints in the morning
• Weight loss
• Fever

Diagnosis

Your doctor must do a physical exam before you can be sure that you have rheumatoid arthritis. The doctor may look at the joints to see if they look swollen, or if you have trouble moving them. Your doctor might do other tests, too, such as x-rays or blood tests.

Treatment:

There is no cure for rheumatoid arthritis right now. Luckily, there are things that you can do to help with the pain. Some people use drugs for the pain and swelling. Some people use exercises and special tools. Many people use both.

Mild or early rheumatoid arthritis:

Heat and cold may be used to relieve pain and swelling.
Special exercises can help to relieve some pain.
ASA, or other drugs, might be used to fight swelling and pain.

Moderate rheumatoid arthritis:

Your physiotherapist or occupational therapist might suggest special supports and other tools that can help you with everyday tasks.
Your doctor might prescribe drugs for arthritis.

Active rheumatoid arthritis:

A number of drugs can be used. These include anti-inflammatory drugs, gold preparations and pain medication. They do not cure the arthritis, but can relieve some of the symptoms.

Lifestyle Management:

You can help cope with arthritis by making some changes to your lifestyle.

Exercise:

Exercise helps to keep your muscles healthy and strong. It helps keep your joints flexible. Exercise also helps you to control your weight. For some people, losing weight will help to reduce pain. Range of motion exercises help to keep your joints moving smoothly. Your physiotherapist or occupational therapist can help you pick exercise that is right for you. Your doctor may be able to help you as well. It is always best to make sure with one of these health professionals that the exercise you do is the best kind for you.

Rest:

Getting enough rest is just as important as exercise. When you are having symptoms, try to get more rest. When you are not having symptoms, try to exercise.

Care of joints:

You can help control the pain in your joints by using heat. The heat can be from a warm bath, a whirlpool, or heating pads. You can try sleeping with gloves on at night to keep heat in your hands.

A splint around a swollen joint can help control pain and swelling by letting it rest. Long handled shoe horns and zipper pullers can cut wear and tear stress on the joints. There are other products that can help with things you do every day, such as getting on and off chairs, beds and toilet seats.

Controlling stress:

Relaxation, distraction, visualization, and exercise all help to reduce stress in your life.

This information has been prepared for your general knowledge by health care professionals. Any decisions concerning your current therapy or condition should be discussed with your doctor or pharmacist.

Schizophrenia is a disorder of the message system in the brain – it’s like getting the wires crossed on a switchboard. Someone with schizophrenia loses the ability to act properly or to think clearly; his or her mind is “split from reality” (hence schizo, split, and phrenia, mind, from ancient Greek). The term schizophrenia does not refer to multiple personality disorder.

Schizophrenia affects about 1% of people throughout the world. It sometimes starts during childhood, but most often shows up in the late teens or 20s.

It can develop gradually, over the course of weeks or months, or it can seem to come on very suddenly. The signs of schizophrenia are easy to misunderstand, and can sometimes be frightening to other people. While this disorder never goes away, it can often be managed with proper medical care and family support.

Causes

We don’t yet know what causes schizophrenia. There are many theories, but it’s most likely a result of genetic factors. We do understand that it causes complex changes in the brain’s chemistry and structure. However, it’s not clear whether schizophrenia is a single disorder or a number of “syndromes” with different causes.

Symptoms and Complications

Because schizophrenia presents a variety of symptoms, the illness is classified according to which symptoms are most prevalent in a particular individual.

Paranoid schizophrenia describes those who have psychotic episodes, often triggered by stress or substance abuse. They can become delusional, believing that other people or circumstances are controlling their lives, or are bent on destroying them. Hallucinations can affect any of the senses – sight, sound, smell, taste, or touch – making it hard to tell what’s real and what’s not. People with schizophrenia often hear malicious “voices” which are angry or critical of them. This combination of delusions and hallucinations create a state of paranoia.

Disorganized schizophrenia or thought disorder happens when an affected person isn’t thinking clearly. Thoughts may become disorganized and it becomes difficult to focus on one topic during a conversation. Speech can become impossible to understand. Bizarre behaviour – such as silliness, agitation, strange conduct, and inappropriate appearance – can occur at any time.

With catatonic schizophrenia, mobility can either be impaired, excessive, or unusual.

A person with schizophrenia can also have deficit or negative symptoms. These refer to emotional and general apathy, which makes someone appear unresponsive or lazy. “Emotional flattening” – the inability to feel pleasure or anger – goes hand-in-hand with unchanging facial expressions or trouble making eye contact. Life seems to lose its purpose, leading to depression and social withdrawal.

During the acute phase of the disease, symptoms get worse and influence the ability to function normally. Stabilization refers to a period when symptoms are being treated and controlled by drugs. There may not be any obvious symptoms during this phase, but some people still have problems coping with day-to-day situations.

Making the Diagnosis

No diagnostic test exists for schizophrenia. Instead, the disease is identified (usually by a psychiatrist) by the symptoms. This specialist will ask a patient about his or her ability to work, socialize, or function. Family and friends might also be called upon to answer questions about the patient’s behaviour over the last six months or so.

Other possible causes for the symptoms must be ruled out. Psychosis-like behaviour can occur with mood disorders resulting from brain tumours, some metabolic or autoimmune diseases, Huntington’s disease, liver disease, or reactions to particular medications. Substance abuse can also be responsible for certain behaviours that are similar to the symptoms of schizophrenia.

To investigate further, a doctor might perform computed tomography (CT) or magnetic resonance imaging (MRI) scans. These create detailed images of the brain, and can sometimes show abnormalities associated with schizophrenia.

Treatment and Prevention

Schizophrenia can’t be prevented, since we don’t understand what causes it. There’s no cure, but medications can effectively treat the symptoms. It’s very important that the medications are taken correctly and regularly, according to your doctor’s instructions.

Antipsychotic drugs can control delusions and hallucinations. These can greatly lower the chances of further psychotic episodes. The older tried-and-true antipsychotic medications are called “conventional” drugs, and most people respond well to a number of these. Due to the side effects they can cause, however, some people with schizophrenia are treated with a newer generation of drugs, called “novel” antipsychotics. With any therapy, the dose a patient is started on might need to be changed, in order to find a good balance between the treatment and the side effects. Other medications can also be prescribed to help reduce the side effects of antipsychotic drugs.

The more common side effects of antipsychotic drugs can include:

• lethargy
• muscle stiffness
• tremors or involuntary movements of lips, tongue, arms, or legs
• weight gain

In all instances, a doctor will monitor the patient for side effects and will make sure the medication is working. For instance, one particular medication can lead to seizures or bone marrow suppression. People taking this drug must have their white blood cell levels monitored regularly.

People being treated for schizophrenia require more than just medical treatment. They also need to be coached on coping with the stresses of daily life, since these can aggravate symptoms or cause a relapse.

Health care professionals are on hand to help patients take care of themselves. They can advise those living with schizophrenia on how to have better relationships with the people around them, and on how to hold onto a job. These are all skills that must be learned, since the illness has kept many of those affected from participating in activities others take for granted. Rehabilitation and psychotherapy provide assistance that allow patients to live independently.

Along with appropriate medical treatment, having a good support network of friends and family can make a difference in dealing with schizophrenia, and make inroads towards leading a full, productive life.