Apparently, most literature is biased to the United States and it shows that prostate cancer is leading cancer among the male population in this region. The American Cancer Society shows that 217,730 new cases of prostate cancer and 32,050 subsequent deaths occurred in 2010 (Phillips & Barqawi, 2011). A common health promotion message is that early detection of cancer through early screening is paramount in timely intervention and subsequent reduction in mortality rate and improved quality of life. However, the case of prostate cancer seems to oppose this ideology; hence, the purpose of this paper is to understand preventive approaches and therapies used to manage prostate cancer.
The US Preventive Services Task Force (USPSTF) gives recommendations against prostate-specific antigen (PSA) -based screening for prostate cancer. There was no association between early screening and reduced mortality rate10 years after increased efforts to encourage early screening. This recommendation to halt screening was made at the same time when UPSPSTF conclusively declared that there was a lack of adequate evidence that would form a basis for the comparison between benefits and harms of prostate cancer screening in men less than 75 years of age (Lin, Croswell, Koenig, Lam & Maltz, 2011).
According to Moyer (2012), treatments for prostate cancer upon diagnosis include palliative care, active surveillance, and curative treatment in the event that the disease has a poor prognosis. In the years between 1986 and 2005, PSA-based screening led to the use of surgery and radiation therapy. Innovative techniques, for example, external beam radiotherapy, adjuvant and neoadjuvant therapies, have led to significant improvements in the curative management of prostate cancer, but their viability is yet to be determined through more credible research.
Phillips & Barqawi (2011) highlight the various chemopreventive approaches used in the prevention of this cancer. Currently, evidence supports the use of 5-alpha reductase inhibitors (5-ARI) and micronutrients to act as inhibitors of this disease. Unfortunately, the use of 5-ARIs is not economically viable; hence, socioeconomic status is likely to influence the choice and use of chemoprevention agents. Ethnicity and socioeconomic status intertwine because black Americans, Africans and Asians face the challenge of cancer chemoprevention due to the high costs associated with some of the chemoprevention strategies. The use of 5-Alpha reduc-tase inhibitors and natural substances are used for both primary and secondary prevention (Phillips & Barqawi, 2011). Primary prevention entails preventing the cancer before it forms. Secondary prevention prevents the progression of premalignant lesions to cancer. Finasteride and dustasteride (5-ARI medications) are used to slow and halt prostate growth with benign prostatic hypertrophy (BPH) (Phillips & Barqawi, 2011). In the event of prostate cancer, the expression of type 1 isoenzyme is enhanced while there is no effect on isoenzyme 2 with the advent of this cancer. The 5-ARIs, which inhibit androgen receptor (activation), reduce prostatic volume by 30% in addition to reduced PSA levels of 50% to 60% (Phillips & Barqawi, 2011). The main micronutrient that has been in focus is selenium. Antioxidants slow cellular proliferation, initiate apoptosis an enhance the modulation of genes that suppress prostatic tumor.
Most research articles generally associate the occurrence of cancer with environmental factors such as poor diet and a sedentary lifestyle. Despite the fact that more evidence is required, it is theorized that physical activity reduces prostate cancer occurrence by reducing chronic low-grade inflammation and weight control (Courneya & Friedenreich, 2011). Age, in contemporary society where computerization has taken over, makes it impossible for an individual who is 50 years and above to engage in physical activity. As individuals grow older, they tend to become sluggish, and they have limited mobility. In addition, their dietary patterns change because people are too busy working. Therefore, commercial foods are relied on as the main sources of meals.
Various therapy modalities, for example, radiation, hormone therapy, surgery, and chemotherapy are used, but each has a particular success rate due to associated side effects. Treatment for prostate cancer dates back to1941, and it is based on Huggins and Hodges theory that androgens, which escalate prostate cancer growth, can be blocked. As a result, the androgen deprivation therapy (ADT), also known as hormonal therapy is regarded as the first line of treatment for metastatic prostate cancer. Various ADT approaches are used. Surgical castration is deemed the gold standard in achieving gonadal testosterone deprivation. This method is associated with reduced cost, low morbidity, effective in attaining castrate testosterone levels and simplicity (Horwich, 2010). Other treatment modalities, for example, focal therapy, are used to manage prostate cancer with the intention of retaining a section of the prostate gland (Polascik, 2011). Radical radiation and radical surgery are such treatment options
All the treatment options mentioned above seem to improve oncological outcomes by relieving pain and improving quality of life. However, there are incidences of recurrence over the long term (Gulley, 2011). Gulley indicates the effectiveness of brachytherapy in low-risk prostate cancer patients towards attaining a biochemical progression-free survival. The use of external beam radiotherapy in combination with hormonal therapy and brachytherapy produces positive outcomes by alleviating symptoms and enhancing overall survival.
It is a disease with high prevalence, incidence, morbidity and mortality rates, yet available data on treatment options for prostate cancer is insufficient. Nutritional agents and enzymatic functions of 5-ARIs are associated with chemoprevention of prostate cancer. Curative approaches are diverse, and tailored to individual needs.
References
Phillips, J., & Barqawi, A. (2011). Chemoprevention in Prostate Cancer: Current Clinical Evidence. In A. Chen & S. Viijaykumar (Eds.), Prostate Cancer. New York: Demos Medical publishing LLC.
Courneya, K., & Friednreich, C. (Eds.). (2011). Physical Activity and Cancer. New York: Springer Science.
Gulley, J. (Ed.). (2011). Prostate Cancer. New York: Demos Medical publishing LLC.
Horwich, A. (Ed.). (2010). Systemic treatment of Prostate Cancer. Oxford: Oxford University Press.
Lin, K., Croswell, J., Koenig, H., Lam, C., & Maltz, A. (2011). Prostate-specific Antigen- Based Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force. Web.
Moyer, V. (2012). Screening for Prostate Cancer: U. S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 157 (2), 120-134.
Polascik, T. (Ed.). (2013). Imaging and Focal Therapy of Early Prostate Cancer. New York: Springer Science.