Prostate/Genitourinary Cancer

The Prostate and Genitourinary Cancer Center at Loma Linda University Cancer Center treats cancer in the prostate and the genitourinary system. Our center has developed a cancer care system that understands the unique nature of each patient and treats each person who walks through our doors accordingly. With the use of leading diagnostic tools, a multidisciplinary team of oncologists and the latest treatment technology, we are able to offer more options for prostate cancer treatment than any other facility in the West.

Loma Linda University Medical Center has a vast array of resources available for cancer treatment. We work very closely with the James M. Slater, MD Proton Treatment Center and the LLU Robotic Surgery Department to provide our patients with technologically advanced treatment options and a seamless treatment experience.


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Prostate Cancer

What is prostate cancer?

Prostate cancer is the second leading cause of death in men in the United States. Nearly two-thirds of these men will be age 65 or older. Prostate cancer is a condition in which abnormal cells grow from a malignancy on the prostate. If untreated, it can metastasize to the bones, lymph nodes, rectum, bladder, and other parts of the body. The prostate gland is found only in men near the urethra, below the bladder and in front of the rectum. The prostate depends on adequate levels of testosterone to function properly. It produces seminal fluid, and regulates and controls urine flow by contracting and releasing muscle fibers.

Signs and symptoms

Prostate cancer symptoms may include:

  • Abdominal pain
  • Anemia
  • Bloody semen
  • Bloody urine (hematuriaFatigue)
  • Problems urinating and incontinence
  • Leg inflammation
  • Lower back pain/Spinal compression
  • Weight loss

More severe symptoms can present in late stages of prostate cancer depending on where the cancer has spread to other parts of the body. If the cancer has spread to nearby bones, bone pain, sensitivity and even fractures can occur. Urological problems can occur if the cancer spreads to urological areas.

The exact symptoms can depend on a variety of factors:

  • Patient’s age
  • Current state of health
  • How far along the cancer has progressed
  • Where the cancer may have spread to other parts of the body

Most men with early prostate cancer may not even know they have it since early prostate cancer seldom causes noticeable changes. Regular prostate exams can reduce the risk of prostate cancer.

Diagnosis

The American Urological Association (AUA) recommends that beginning at age 50 (age 40 if there is a family history of prostate cancer), men undergo a yearly PSA check and digital rectal exam (DRE).

It has been shown that PSA testing can lead to detecting prostate cancer at a stage when it is more likely to be cured, and that prostate cancer treatment can lengthen life. PSA level is determined by a blood test that can detect prostate cancer before there are any symptoms. Your urologist may order a free PSA to help improve the accuracy of the PSA test.

The digital rectal exam allows the doctor to examine the prostate through the rectal wall, feeling for areas of hardness.

Treatment

Treatment for prostate cancer depends on many factors:

  • Results of the biopsy
  • Whether the cancer has spread to other areas
  • Patient's general health
  • Patient's preference for treatment

Some treatment options are:

Nutrition, exercise and prostate Cancer

In general, our society combines low levels of exercise along with foods that are high in calories, fat, sugar and salt. Our bodies respond as they were designed- they store excess food as fat to prepare for times of prolonged starvation. Prolonged starvation does not typically happen in modern society and this safety mechanism means that we just continue to gain weight and store more fat.

This excess fat, especially the fat around the middle of your body has been associated with an increased risk of many diseases, including prostate cancer, and particularly aggressive prostate cancer. Body fat is actually an organ with functions. It secretes hormones and specialized proteins that can increase inflammation and oxidation in the cells or your body - two natural processes that are strong contributors to the development and progression of prostate cancer.

Effects of Oxidation and Inflammation

Oxidation is a normal chemical reaction that occurs when free radicals form ithin the cells of the prostate. Each oxygen atom contains two electrons that cling together. When heat or light breaks apart the atom, the electrons are separated, leaving unpaired oxygen radicals. These radicals are free to roam around and initiate a process of breaking down normal cellular structures, causing damage and promoting the development of cancer. The more free radicals present, the more cancer-causing damage occurs.

One of the most common causes of the loss of protective antioxidants is inflammation, a biochemical process that your body initiates when fighting off an infection. If the body senses invaders, such as bacteria, white blood cells are mobilized to go to the site of the invasion and to release oxygen and nitrogen radicals to help kill the invaders. Unfortunately, if they remain unchecked, these same oxygen radicals can also break down normal tissue and promote the development of cancer. Oxygen radicals damage normal DNA, causing errors that allow cancer growth.

In fact, researchers have noted the presence of inflammatory cells in virtually all prostate cancer tissue that is removed surgically and have found that inflammation leads to the atrophy or wasting away of normal prostate tissue adjacent to precancerous and cancerous areas of prostate tissue.

Based on these and other observations, evidence is mounting that inflammation and oxidation play key roles in the development of prostate cancer. Why is this important? Because although other contributory factors such as aging and altered hormone secretions are difficult or impossible to change, nutritional and exercise habits that reduce the development of inflammation and oxidation can be changed.

There are many anti-inflammatory and antioxidant substances found in colorful fruits and vegetables, whole grains and spices, nearly all of which are absent from the processed foods that rely on sugar, salt and fat for flavor. By focusing your diet on fresh fruits and vegetables, ocean-caught fish and whole grains, you can increase the protective anti-inflammatory components of your diet and to benefit from their effects.

The Contribution of Carcinogens

A carcinogen is a chemical that directly or indirectly causes or leads to more aggressive forms of cancer. Hundreds of chemical have been definitively linked to cellular changes that lead to cancer development and hundreds more have been implicated in processes that might be involved.

Overcooking of any type of meat at very high temperatures produces a set of carcinogens that causes prostate cancer in animal studies. In addition, charbroiling red meat or chicken, with its skin intact produces yet another set of carcinogens. Laboratory research findings have suggested that intake of these charred meat carcinogens trigger mutation in prostate cell DNA and leads to a chronic inflammatory response in the prostate. This combination of mutations and inflammation appear to be a key to the development of prostate cancer.

Switching to alternate source of protein that are not prone to forming carcinogens when cooked, such as soy, is an important first step in minimizing the damage caused by overcooking and charbroiling meats. Also, using alternate methods to cook meat can significantly cut down on the amount of carcinogens produced. Choose steaming or baking over char-broiling or pan-frying, marinate the meat and turn the meat frequently to prevent over-cooking. Finally, increase your consumption of cruciferous vegetables, which have unique properties that enable them to help “sponge up” carcinogens and possibly even counteract some of the damage caused by these carcinogens.

Effects of excess sugar

Sugar is a prime energy source for many cancers, including prostate cancer. Most normal cells can adapt to an environment low in sugar and use other energy sources. A process developed through evolution when people would go through periods of starvation. However, cancer, which grows faster than normal cells, does not have the same ability to adapt to low sugar environments. Thus, the more excess sugar is consumed, the more the tumor is stimulated. Indeed, several animal studies suggest that cutting simple sugar intake can slow prostate cancer growth.

Obesity is the result of an imbalance of food intake and exercise. When you eat more and exercise less, fat accumulates in the body. The first place that fat accumulates in men is in the middle of the body around the belly and abdomen.

Belly fat is specially evolved to store fat quickly and release it quickly. Thus, this is the first place the fat settles when you gain weight and the first place it leaves when you lose weight. Since this fat grows so quickly, it can sometimes outgrow its blood supply, causing the fat cells to dies. When this happens, the body’s immune systems sends out scavenger white blood cells to clean up the debris which, as we described earlier, set off a cascade of inflammatory and oxidative events that can ultimately promote heart disease, diabetes, and certain types of cancer including prostate cancer.

Beyond the effects of the excess body fat, the consequences of caloric imbalance that lead to fat accumulation can be significant. Cancer cells grow faster than do normal cells and require excess energy for their growth. Thus, excess calories, above your body’s need, will help feed tumor growth. Also, rapidly growing tumors live on the edge of survival due to a lack of an adequate blood supply and low levels of oxygen. Without oxygen, the cells can’t break down fat so instead rely on sugars and carbohydrates for energy. Thus, the higher your sugar intake, the more nutrients you are providing to the tumor.

Effects of Muscle Loss

Muscle plays a number of roles in maintaining health. Not only are muscles critical to posture, balance and movement, they also maintain healthy bones by putting a physical stress across the bones. Hormonal therapies often used in men with advancing prostate cancer can have a detrimental effect on muscle, leading to muscle atrophy or wasting. Thus, with muscle loss, from aging, inactivity and hormonal therapies, the bones become more brittle and the loss of balance can also lead to bone fractures.

Incorporating Good Nutrition and Exercise Into Your Everyday Routine

In the majority of cases, when prostate cancer is detected early, primary surgical or radiation treatment is curative and taking additional steps to prevent the growth of the cancer might seem unnecessary. Nevertheless, men at this stage would do well to take an opportunity to inventory and tune up their nutritional habits. Remember, maintaining a healthy diet and regularly exercising can be important steps toward preventing other diseases that commonly occur with aging, including heart disease and diabetes.

Men with advanced prostate cancer or with disease that has recurred can begin by incorporating a healthy diet and regular exercise into their regular routines to help slow the progression of disease while recognizing that there is limited direct proof of the effectiveness of such changes. The key in this phase of the disease is to rationally make dietary and exercise changes in a way that complement any ongoing treatments.

Men who have received hormonal treatments are at particularly increased risk of developing weaker bones and muscles. For these men, endurance training to keep the cardiovascular system strong and resistance or weight training to keep the muscles strong coupled with healthy dietary choices focusing on achieving a goal weight, can be integrated into the treatment plan on an ongoing basis.

Finally, in men with metastatic or advanced disease, supportive nutrition is most important. Because weight loss and loss of appetite is common in men at this stage of disease, healthy nutrition and ensuring adequate calories is critical to the success of therapy and to the support of a healthy immune system.