What are the symptoms of prostate cancer?

Different men have different symptoms for prostate cancer. Some men do not have symptoms at all. Some possible symptoms of prostate cancer are—

• Diffculty in starting urination.
• Weak or interrupted fow of urine.
• Diffculty in emptying the bladder completely.
• Pain or burning during urination.
• Blood in the urine or semen.
• Frequent urination, especially at night.
• Painful ejaculation.
• Pain in the back, hips, or pelvis that doesn’t go away.

If you have any symptoms, you should see your doctor right away. Keep in mind that these symptoms may be caused by other health problems.

How can I prevent prostate cancer?
There is no known way to prevent prostate cancer, but researchers are trying to find ways. Some of the factors under study include—

• Vitamins and herbal supplements.
• Foods high in animal fat.
• Physical activity (or exercise).
• Men’s hormone levels.
• Environmental agents, such as chemicals to kill pests.

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Dr. Tim Byers: I’m going to hit the high points of the discussion of the tobacco and obesity group and then ask a couple of specific questions for some final discussion. The group felt that we’re not serious about public health education in either tobacco or nutrition, given the size of the budgets for the efforts that we need. It’s said that nutrition education doesn’t work. Well, we have never really tried it, so maybe it works, maybe it doesn’t. To adequately fund marketing of a new product, we spend tens and tens of millions of dollars. To adequately fund nutrition, or tobacco education for that matter, it is going to be at least that much. So, that was an important point. Along those lines, we were urged, even during an economic downturn for public support for things like this, to continue to be very assertive and not apologetic about advocating for resources in these areas.

Another comment was that there is really not a single entity or organization empowered or resourced to do the job of primary prevention for tobacco and obesity and improved nutrition. There are scattered resources across disease specific centers and Institutes in the government. Different agencies have missions, either overlapping or not, leaving gaps between them. That is a problem that we allude to in the report, and that is a problem that I’d like to ask a pointed question about. Those of you who are at NCI and those of you who are at CDC, is there a hole between these two agencies when it comes to getting the job done on tobacco control and nutrition?

Dr. Peter Greenwald: I don’t think there is a hole between the agencies. Some people say NCI does research, and CDC does applications, but I don’t feel that way. I feel that if NCI doesn’t do some applications for NIH, we don’t keep our eye on the ball, and if CDC doesn’t do some research, they are behind the times, so we both have to do both. But one does more of one than the other. The problem in nutrition is what you pointed out first; there is not a serious intensive effort where the resource allocation is anywhere near the level needed to address the obesity and physical activity problem. There is individual variability, there is a lot of interest in bioactive food compounds, and there are a lot of other things besides obesity and fitness that fall under nutrition. So, it is a matter of the scope of the effort that is not up to the scope of the problem.

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The Medical and Psychological Concerns of Cancer Survivors After Treatment

The medical and psychological effects of cancer and its treatment have been recognized for many years, but it is only recently that survivorship is coming to be recognized as a distinct phase of the cancer trajectory. Findings from research studies that have tracked the health and well-being of individuals long after cancer treatment has ended have identified risks that both the survivors and their health care providers should recognize. Advances in knowledge of how to manage conditions that arise in the post-treatment period have led to the development of some guidelines for health care providers to follow. The survivorship period provides many opportunities to improve the health and quality of life of cancer survivors. This chapter begins with a general overview of the potential medical and psychological consequences of cancer and its treatment. Brief descriptions are then provided on the late effects associated with four cancer types (breast, prostate, colorectal, and Hodgkin’s disease) as well as information on the need for services to ameliorate them. Lifestyle issues of interest to cancer survivors are reviewed—smoking cessation, physical activity, nutrition and diet, healthy weight, and the use of complementary and alternative medicine. The chapter concludes with a review of the committee’s findings and recommendations.

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Traditional Chinese Medicine Recognized By The Chinese GovernmentAlthough almost all of the traditional Chinese anti-cancer medicine claims to be‍”a secret prescription handed down in the family from generation to generation”, theseries of “Tian Xian” medicine such as the Tian Xian Liquid and Tian Xian pill have‍undergone strict tests and research of its pharmacological action. With long-term clinicalexperiments done on a large scale and with approval from cancer patients, it has been‍nationally recognized as the traditional Chinese anti-cancer medicine.

Developed from Chinese medical and pharmaceutical theories, the series of Tianxian medicine falls into the category of “complex han prescription”. Specifically, the‍series of Tian Xian medicine abides by the theories of promoting the circulation of qi {atherapeutic method to relieve stagnation of qi by using medicines that regulate it};‍ promoting blood circulation by removing blood stasis (a method using blood-activatingand stasis-eliminating medicine); dissolving hard lumps, softening and dissolving hard‍masses (a therapy for the accumulation of phlegm and blood stasis); clearing away heatand toxic materials; eliminating dampness and removing phlegm; and removing necrotic‍tissues and promoting granulation (a method used to remove putrid tissues and promotegrowth of new tissues). The medicine pays special attention to the direct attack on cancer‍cells.

On the other hand, due to its direct attack on cancer cells as well as its effect onthe elimination of pathogenic factors, Tian Xian medicine also provides such functions as‍strengthening the spleen and stomach (improving and protecting the digestive system);invigorating the liver and reinforcing the kidney (supplementing the functions of both the‍liver and the kidneys and nourishing the liver too); restoring qi and enriching the blood;regulating yin and nourishing yang (for body balance), etc. In this manner, the original‍immunity of the body against cancer will be restored and the vital qi will be cultivated.

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Foods and Breast Cancer Survival

Healthful diets not only help prevent cancer; they also improve survival when cancer has been diagnosed. The first clues that foods might affect the course of breast cancer came from studies of women in Japan in the early 1960s. Compared to Western women, Japanese women were much less likely to develop the disease and much more likely to survive it if it occurred. Over the next several decades, researchers have followed up on these observations to try to clarify what is the best diet for cancer survival. Although this work is still in its early stages, important information has already come to light.

One of the best-established factors affecting breast cancer survival is body weight. Women with breast cancer who are near their ideal body weight at the time of diagnosis are more likely to survive than are women with higher body weights. And although weight gain often occurs after diagnosis, studies suggest that women who avoid weight gain after diagnosis tend to have longer diseasefree survival.

The link between lower body weight and better survival may relate to estrogens, female sex hormones that can encourage the growth of cancer cells. In essence, body fat acts like an estrogen factory, producing estrogens from other compounds coming from the adrenal glands (small organs situated atop each kidney). As a result, women with more body fat tend to have higher amounts of estrogens circulating in their blood, compared to leaner women.

Reduced Fat Intake Specific dietary factors appear to play key roles in cancer survival. First, two studies of women diagnosed with breast cancer showed that those who had been consuming less fat prior to diagnosis generally had smaller tumors with less evidence of cancer spread, compared to women whose diets had included more fatty foods. One of these studies identified benefits among premenopausal women; the other, among postmenopausal women.

Studies that have followed women for several years after diagnosis have generally found that those with less fatty diets prior to diagnosis live longer than other women. In one of the first such studies, researchers at the State University of New York in Buffalo, N.Y., found that women with advanced cancer had a 40 percent increased risk of dying at any point in time for every 1,000 grams of fat they consumed per month. Note that this does not mean a person’s risk of dying is 40 percent. It means that, if a person’s diet contains an extra 1,000 grams of fat per month at the time of diagnosis, that person’s risk of dying is 40 percent higher than it would otherwise have been. There is, of course, tremendous variation from one woman to another, so this figure is simply an overall observation drawn from the group of participants. To make this more concrete: The difference between a typical American diet and a low-fat, vegan diet is approximately 1,000–1,500 grams of fat per month, which corresponds to a 40–60 percent difference in mortality risk at any point in time.

Other studies found much the same thing—fatty diets are associated with increased risk, and that is particularly true for saturated fat, the kind that is common in meat, dairy products, eggs, and chocolate. Some studies have failed to confirm the dangers of fatty diets. However, most evidence indicates that women consuming less fat tend to do better after diagnosis.

Why should a low fat intake improve survival? For starters, low-fat diets tend to be modest in calories, since fats and oils are the densest source of calories of any food we consume. In fact, some investigators believe that the main problem with fatty diets is simply their high calorie content. In addition, women who eat less fat tend to have less estrogen coursing through their veins (independent of the difference in their body weight). They may also have stronger immune defenses that can help them fight cancer cells.

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Cancer Epidemiology

The magnitude of the human and economic costs of cancer in the United States is enormous. At current rates, invasive cancer will be diagnosed in approximately 1 of every 2 American men and 1 in 3 women in their lifetimes. Cancer afflicts 2 out of every 3 families. The annual costs of cancer are estimated at about $107 billion—37 billion for direct medical costs, $11 billion for lost productivity, and $59 billion for indirect mortality costs.

This chapter describes the use of epidemiologic methods to monitor trends in cancer occurrence and to identify factors that cause or prevent cancer. It does not address the application of epidemiology to health services research or program evaluation. Because, by definition, epidemiology is the study of disease occurrence in populations rather than in individuals, epidemiologic concepts are less familiar to clinicians than are issues related to the diagnosis, treatment, and pathophysiology of disease in individual patients. We will examine how population-based research contributes to our understanding of cancer.

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Few compounds reach clinical trials. A low therapeutic index (the ratio of maximum tolerated dose to minimum effective dose), undesirable side-effects or high toxicity may outweigh beneficial tumor-inhibitory activity. Of 25, 000 screens conducted annually by the NCI (including both synthetic and natural materials), only 8-12 compounds are likely to be selected for pre-clinical testing, and only 6-8 may go on to clinical trials.

The random-selection screening program for natural products was terminated by the NCI in 1983. In over 25 years, the program did not identify a single agent for use in the allopathic treatment of cancer. Nevertheless, the number of cytotoxic and anti-tumor agents identified was enormous. The NCI has certainly not lost confidence in the potential of natural products as leads for new anti-cancer agents. Instead of the random-selection screening program, anew screening system was begun in 1986, reducing the scale of the operation, and concentrating on the less thoroughly investigated groups of organisms, including plants, marine animals, fungi and cyanobacteria.

When found using the approach outlined above, tumor-inhibiting constituents are often new to science, and span a wide range of structure. Occasionally, however, they are well known but had not been screened the correct way. Examples relevant to the phytotherapist include usneic acid (Usnea spp.), ellagic acid (Quercus spp.), the anthraquinone aloe-emodin (Cascarasagrada), juglone (Juglans spp.), pyrrolizidine alkaloids, aristolochicacid (Aristolochia spp.), hellebrigenin (Helleborus niger: Black Hellebore), the well known alkaloids used to treat gout from the Autumn Crocus (Colchicum autumnale) and cucurbitacins found in species of Euphorbia, Hypericum and Ecbalium elaterium (the squirting cucumber).

An interesting finding in such research concerns the controversial pyrrolizidinealkaloids, known for their hepatotoxic properties, especially to grazinganimals. Those found in Senecio spp., however, have shown antitumoractivities at dose levels lower than that which is toxic. Indicine-N-oxidefrom Heliotropium indicum (a botanical relative of Comfrey) showedno marked hepato-toxicity, possessed significant anti-tumor activity, and went to clinical trials. The compound showed substantial activity in acute leukemia, but hepatotoxicity was more severe than expected, and the cause is not known.

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Finally, in 1954, an independent team of ten physicians from around the United States made a two-day inspection of Hoxsey’s Dallas clinic and issued a remarkable statement. After examining hundreds of case histories and interviewing patients and ax-patients, the doctors released a signed report declaring that the clinic. . . is successfully treating pathologically proven cases of cancer, both internal and external, without the use of surgery, radium or x-ray.

Accepting the standard yardstick of cases that have remained symptom-free in excess of five to six years after treatment, established by medical authorities, we have seen sufficient cases to warrant such a conclusion. Some of those presented before us have been free of symptoms as long as twenty-four years, and the physical evidence indicates that they are all enjoying exceptional health at this time.

We as a Committee feel that the Hoxsey treatment is superior to such conventional methods of treatment as x-ray, radium, and surgery. We are willing to assist this Clinic in any way possible in bringing this treatment to the American public.

But the treatment was denied to the American public. In 1924, according to Hoxsey’s autobiography, Dr. Malcolm Harris, an eminent Chicago surgeon and later president of the AMA, had offered to buy out the Hoxsey anticancer tonic after watching Hoxsey successfully treat a terminal patient. Hoxsey would get 10 percent of the profits, according to the offer, but only after ten years. The AMA would set the fees, keep all the profits for the first nine years, then reap 90 percent of the profits from the tenth year on. The alleged offer would have given all control to a group of doctors including AMA boss Dr. Morris Fishbein.

Hoxsey refused the offer, or so he claims. The AMA denies that any such incident ever occurred. In any event, two things are certain: The “terminal” cancer patient, police Sergeant Thomas Mannix, fully recovered and lived another decade. And Morris Fishbein became a powerful, relentless enemy of Hoxsey.

Another opponent was Assistant District Attorney Al Templeton, who arrested Hoxsey more than 100 times in Dallas over a two-year period. Then, in 1939, Templeton’s younger brother, Mike, developed cancer. He had a colostomy, but the cancer continued to spread; his doctors told him nothing more could be done for him. When Mike secretly went to Hoxsey and was cured, Al Templeton had a change of heart. The once-hostile prosecutor became Hoxsey’s lawyer.

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Lawrence R. Coia, MD
Southern Ocean County Radiation Oncology
Manahawkin, New Jersey

William J. Hoskins, MD
Curtis and Elizabeth Anderson Cancer Institute
Memorial Health University Medical Center
Savannah, Georgia

Lawrence D. Wagman, MD
Division of Surgery
City of Hope National Medical Center
Duarte, California

And the publishers of the journal ONCOLOGY

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Tobacco The incidence of head and neck tumors correlates most closely with the use of tobacco.

Cigarettes Head and neck tumors occur six times more often among cigarette smokers than nonsmokers. The agestandardized risk of mortality from laryngeal cancer appears to rise linearly with increasing cigarette smoking. For the heaviest smokers, death from laryngeal cancer is 20 times more likely than for nonsmokers. Furthermore, active smoking by head and neck cancer patients is associated with significant increases in the annual rate of second primary tumor development (compared with former smokers or those who have never smoked). Use of unfiltered cigarettes or dark, aircured tobacco is associated with further increases in risk.

Cigars Total cigar smoking increased by nearly 50% in the United States in the 1990s. Often misperceived as posing a lower health risk than cigarette smoking, cigar smoking results in a change in the site distribution for aerodigestive tract cancer, according to epidemiologic data. Although the incidence of cancer at some sites traditionally associated with cigarette smoking (eg, larynx, lungs) is decreased in cigar smokers, the incidence of cancer is actually higher at other sites where pooling of saliva and associated carcinogens tends to occur (oropharynx, esophagus).

Smokeless tobacco Use of smokeless tobacco also is associated with an increased incidence of head and neck cancer, especially in the oral cavity. Smokeless tobacco users frequently develop premalignant lesions, such as oral leukoplakia, at the site where the tobacco quid rests against the mucosa. Over time, these lesions may progress to invasive carcinomas. The use of snuff has been associated with an increase in cancers of the gum and oral mucosa.

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