The findings, say researchers, suggest that many family caregivers need help
as well — for the sake of their own health and that of the cancer patient.

Of the 60 female caregivers in the study:

1. 40 percent had significant anxiety symptoms
2. 12 percent were suffering from depression
3. About one-third reported substantial fatigue or sleep disturbances; and 
4. Another 15 percent complained of bodily pain

The women, mostly wives, were 64 years old, on average, and their rates of
each of these conditions surpassed the average for U.S. women their age, the
researchers point out.

Experts at the American Institute for Cancer Research (AICR) recently reported that whole foods, not dietary supplements, play a role in lowering cancer risk. Citing a huge and comprehensive AICR report on cancer prevention, the panel of experts cautioned against relying on pills and powders as a means of protection.

“When the panel examined the accumulated evidence from almost 50 different supplement trials, cohort studies and case-control studies, the results were simply too inconsistent to justify using supplements to protect against cancer,” said AICR Nutrition Advisor Karen Collins, MS, RD.

The panel also reported that under certain conditions, some high-dose supplements seemed protective at specific doses, some did nothing, and some actually increased the risk of cancer.

“Let’s be clear: although some people have misread the recommendation as simply, ‘Don’t take supplements ever,’ that’s not what the expert panel concluded,” said Collins. “The panel members were careful to make an important distinction, namely: Don’t rely on supplements to protect you from cancer.”

Different Grades for Different Cancer Links

Of all the supplements reviewed by the panel, only two seemed to have a potential role in protection, and even then the research was less than clear.

*According to the panel, selenium probably protects against prostate cancer, while calcium probably protects against colorectal cancer. Yet they also concluded that high calcium consumption probably increases risk for prostate cancer.*

Whole Foods vs. Supplements

The data on prevention are considerably more consistent, however, when it comes to foods that contain many of the same vitamins, minerals and other substances that are often sold in supplement form. The panel judged the evidence on several categories of such foods as protective against a variety of cancers, including:

* Foods containing lycopene are probably protective against prostate cancer.
* Foods containing selenium are probably protective against prostate cancer.

That said, no matter how you say it, “to-may-to” or “to-mah-to,” it’s good for you.  Have a pizza.

The findings, which appear in today’s issue of Clinical Cancer Research, reaffirm that patients should inform their doctors about any herbal or hormonal dietary supplements they are taking or considering taking. The researchers also recommend that documentation of supplement usage become part of routine health assessments for all patients, particularly cancer patients.

“Physicians need to ask their patients not only about the prescription drugs they may be taking, but – perhaps even more importantly – about the over-the-counter drugs and supplements, which may have a profound impact on certain health conditions,” said Dr. Claus Roehrborn, chairman of urology at UT Southwestern and one of the study’s authors.

The researchers began their investigation when two patients being seen by UT Southwestern doctors developed aggressive prostate cancer within months of starting daily consumption of the same dietary supplement. Both men purchased the same product, one to develop stronger muscles and enhance sexual performance, the other to gain muscle.

Dr. Roehrborn, Dr. Shahrokh Shariat, a resident in urology and the study’s lead author, and their colleagues analyzed the supplement, which is not named in the study. They found that the product’s label listed ingredients that were not present, misrepresented the concentrations of the ingredients present and failed to list all the steroid hormones contained in the product.

Hormone analysis revealed that the supplement contained testosterone and estradiol, a sex hormone. Researchers then tested the effect of the product on human prostate cancer-cell lines. The product proved to be a more potent stimulator of cancer-cell growth than testosterone. Additionally, attempts to stop the cancer-cell growth with increasing concentrations of the anti-cancer drug bicalutamide proved to be futile.

“Bicalutamide is an oral nonsteroidal anti-androgen used to treat prostate cancer,” Dr. Shariat said. “The fact that this supplement caused the drug to be less effective is very troubling.”

Based on the clinical data and cell culture experiments, the researchers filed an adverse event report with the Food and Drug Administration. The government agency in turn issued a warning letter to the manufacturers, which led to the removal of the product from the market.

“Unlike prescription and over-the-counter drugs, the law does not require nutritional supplements to undergo pre-market approval for safety and efficacy,” Dr. Shariat said. “The current FDA regulatory system provides little oversight or assurances that dietary supplements will have predictable pharmacological effects or even that product labels provide accurate information for consumers.”

The researchers say expanded research is needed to define the mechanism, safety and efficacy of common herbal and hormone dietary supplements.

“For most supplements efficacy is not established in randomized, controlled trials. What is worse, safety is often equally poorly established,” said Dr. Roehrborn, who directs the Sarah M. and Charles E. Seay Center for Pediatric Urology.

An estimated 42 percent to 69 percent of U.S. adults use dietary supplements, at an estimated out-of-pocket expenditure of about $34.4 billion, according to published reports cited in the study. Individuals often use supplements because they believe these natural products are safe and drug-free. The sale of androgenic steroids is exponentially increasing. In 2004, U.S. expenditures on testosterone supplements were estimated to be $425 million.

“Given that testosterone supplements are in high demand, there is significant concern that supplements, in addition to the one we evaluated, may pose an urgent human health risk,” Dr. Shariat said.

Researchers from Baylor College of Medicine in Houston also contributed to the research.

When we take any test, it is preferable to get a definite answer: “yes, you have the cancer” or “no, you don’t”. Unfortunately the PSA test is not that good. At best, it is an indicator of the probability or risk that you have prostate cancer. This can be very helpful, because it guides the decision about whether you should have further tests. However it does mean that the interpretation of PSA levels is not necessarily straight forward.

What conditions other than cancer cause the PSA level to rise?

The prostate typically enlarges as men grow older, and because small amounts of PSA are produced by the healthy prostate, its blood level tends to rise. Benign prostate enlargement (a condition which causes urinary symptoms such as poor flow, getting up at night), is a common non-cancer condition causing PSA levels to rise. For this reason, age-based thresholds, shown in Table 1, can be used to decide if a test result is abnormal. The percentage Free to Total PSA (described below) also gives an indication whether raised PSA is due to benign enlargement.

A temporary rise in the PSA can be caused by a number of conditions ¹. Urinary infection, prostatitis (inflammation of the prostate), or a biopsy of the prostate can cause large rises while small rises can be caused by ejaculation and even bicycle riding. Because of these non-cancer causes of PSA rises, it is not surprising that if you have an abnormally high test result, it may not be due to prostate cancer. The chance that you have prostate cancer is only about one in three.

Note: These levels are used only as a guide. It is possible to have prostate cancer and have a PSA level in the normal range, although this is uncommon.

If, in addition to the PSA test, you have a rectal examination, and it also is abnormal, your chances of having prostate cancer are higher, (one in two).

Other ways of measuring PSA have been developed in an effort to make the test more specific for prostate cancer. One of these is called the “Free to Total” PSA. This is a ratio, expressed as a percent. Much of the PSA in the blood is bound to protein, including that produced by cancer cells. But men with benign prostate enlargement have higher levels of free (unbound) PSA and so a higher Free to Total ratio. If the total PSA level is abnormal, the Free to Total PSA ratio will give an idea of whether the rise is due to benign disease or cancer. Cancer is more likely if the Free to Total percentage is below 10% ². This test is available and widely used throughout Australia.

What is a normal PSA level?

Most authorities agree that if you have a PSA greater than 4 ng/ml, you should have further investigations. Some suggest that if your PSA is greater than the ‘normal for age’ range shown in Table 1, or if it is rising rapidly, it should be investigated.

Depending on your age and family history, your doctor may then refer you directly to a Urologist, or may repeat the test before referring you for further investigation.

If cancer is present, the level of PSA in the blood rises as the tumour grows. This means that small rises in PSA are found in association with small tumours which may be still confined to the prostate gland (localised). PSA levels of 10ng/ml or less have the best chance of being localised ³. The PSA level and the cancerous characteristics of the tumour cells themselves (called “grade”) can indicate the risk that a tumour has grown beyond the prostate.

If cancer is present, the rate at which the PSA level increases over a series of tests (called PSA velocity) also gives information about the risk that cancer will recur after treatment.

The prostate is a small organ about the size of a walnut. It is found below the bladder (where urine is stored) and surrounds the tube that carries urine away from the bladder (urethra). The prostate makes a fluid that becomes part of semen. Semen is the white fluid that contains sperm.

Prostate problems are common in men age 50 and older. Sometimes men feel symptoms themselves, or sometimes their doctors find prostate problems during routine exams. Doctors who are experts in diseases of the urinary tract (urologists) diagnose and treat prostate problems.

There are many different kinds of prostate problems. Many don’t involve cancer, but some do. Treatments vary but prostate problems can often be treated without affecting sexual function.

Common Problems

There are several common prostate problems including: 

Acute prostatitis

Acute prostatitis is an infection of the prostate caused by bacteria. It usually starts fast and can cause fever, chills, or pain in the lower back and between the legs. It also can cause pain when you urinate. If you have these symptoms, see your doctor right away. Antibiotic drugs usually help heal the infection and relieve the symptoms. Your doctor also may suggest that you drink more liquids.

Common Problems

There are several common prostate problems including: 

Acute prostatitis

Acute prostatitis is an infection of the prostate caused by bacteria. It usually starts fast and can cause fever, chills, or pain in the lower back and between the legs. It also can cause pain when you urinate. If you have these symptoms, see your doctor right away. Antibiotic drugs usually help heal the infection and relieve the symptoms. Your doctor also may suggest that you drink more liquids.

Chronic prostatitis

Chronic prostatitis is a prostate infection that keeps coming back time after time. Symptoms may be milder than in acute prostatitis, but they can last longer. Chronic prostatitis can be hard to treat. Antibiotics may work if bacteria are causing the infection. But if bacteria are not the cause, antibiotics won’t work. Massaging the prostate sometimes helps to release fluids. Warm baths also may bring relief. Often chronic prostatitis clears up by itself.

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the term used to describe an enlarged prostate. BPH is common in older men. Over time, an enlarged prostate may block the urethra, making it hard to urinate. It may cause dribbling after you urinate or a frequent urge to urinate, especially at night. Your doctor will conduct a rectal exam to diagnose BPH. The doctor also may look at your urethra, prostate, and bladder. 

Treatment choices for BPH include:

• Watchful waiting. If your symptoms are not troubling, your doctor may suggest that you
  wait before starting any treatment. In that case, you will need regular checkups to make sure the condition does not get worse.
• Alpha-blockers (some generic names are doxasozin, terazosin) are medicines that can relax muscles near the prostate and ease symptoms. Side effects may include headaches, dizziness, or feeling lightheaded or tired.
• Finasteride (Proscar) acts on the male hormone (testosterone) to shrink the prostate. Side effects of this medication can include less interest in sex and problems with erection or ejaculation. 
• Surgery also can relieve symptoms. But surgery can cause complications. Also, it does not protect against prostate cancer.

Talk with your doctor about this treatment choice. Regular checkups are important even for men who have had BPH surgery.

There are three kinds of surgery:

• Transurethral resection of the prostate (TURP) is the most common type of surgery. While the patient is under anesthesia, the doctor uses a special device to take out part of the prostate and remove the blockage.
• Transurethral incision of the prostate (TUIP) may be used when the prostate is not too enlarged. The doctor makes a few small cuts in the prostate near the opening of the bladder. This relaxes the bladder muscles and improves the flow of urine.
• Open surgery is used when the prostate is very enlarged. In this process, prostate tissue is removed directly rather than through the urethra.

Prostate Cancer

Prostate cancer is one of the most common types of cancer among American men. It is more common among African American men than white men. Treatment for prostate cancer works best when the disease is found early.

Diagnosing Prostate Cancer

Doctors will ask questions about your medical history and perform a physical exam to find the cause of prostate problems. In the exam, the doctor feels the prostate through the rectal wall. Hard or lumpy areas may mean that cancer is present. 

Your doctor also may suggest a blood test to check your prostate specific antigen (PSA) level. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. PSA tests are very useful for early cancer diagnosis. But PSA test results alone do not always tell whether or not cancer is present. 

When doctors suspect cancer, they also may perform a biopsy. Using this simple method, doctors can take out a small piece of the prostate and look at it under a microscope.

Prostate Cancer Treatment

There are many options for treating prostate cancer. Each treatment plan is based on details, such as whether or not the cancer has spread beyond the prostate (stage of cancer), your age and general health, and how you feel about the treatment options and side effects. Some of the treatment choices include:

• Watchful waiting, as with BPH, if the cancer is slow growing and not causing problems, you may decide not to have treatment right away. Instead, your doctor will watch closely for changes in your condition. Men who are older or have another serious illness often choose this option. 
• Surgery is used to take out the cancer. Among the different types of surgery for prostate cancer are:
  • Radical prostatectomy. This surgery takes out the entire prostate and nearby tissues. Side effects may include lack of sexual function (impotence) or problems holding urine (incontinence). Improvements in surgery now make it possible for some men to keep their sexual function. Some men with trouble holding urine may regain control within several weeks of surgery. Others continue to have problems that require them to wear a pad.
  • Cryosurgery kills the cancer by freezing it. 
• Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation therapy sometimes is beamed into the prostate from outside the body. It can cause problems with impotence and bowel function.
  • Brachytherapy is a type of radiation therapy often used when the cancer is found only in the prostate gland. It also is sometimes called internal radiation, implant radiation, or interstitial radiation therapy. In this treatment, the doctor places radioactive “seeds” directly into the prostate. This focuses the radiation directly on the cancer and lowers the chance of affecting other, healthy areas around the prostate.
• Hormone therapy stops cancer cells from growing. The growth of prostate cancer often depends on testosterone. Drug treatment is one effective way to block testosterone. This treatment is often used for prostate cancer that has spread to other parts of the body. 

You can get more detailed information on the pros and cons of these treatment choices by calling the National Cancer Institute’s Cancer Information Service at 1-800-422-6237. Ask for prostate cancer information in “PDQ for Patients.”

Protecting Yourself

These are the signs of prostate problems: 

• Frequent urge to urinate
• Blood in urine or semen
• Painful or burning urination
• Difficulty in urinating
• Difficulty in having an erection
• Painful ejaculation
• Frequent pain or stiffness in lower back, hips or upper thighs
• Inability to urinate
• Dribbling of urine

If you have any of these symptoms, see your doctor right away to find out if you need treatment.