Early prostate cancer is curable

Former President Nelson Mandela had been diagnosed with prostate cancer in July 2001. He received radiotherapy for seven weeks, but his lifespan is unlikely to be reduced, his doctors said.

Mr Mandela’s cancer was not of a high grade and should not decrease his life span, his doctors told News24 in July last year after the diagnosis.

How was it diagnosed?
Mandela had been monitored regularly for the prostate specific antigen (PSA) that indicates cancer. Although the clinical picture revealed no alteration in his status, there has been a slight rise in the blood level of the PSA. In view of this, a decision was made to biopsy the prostate gland, which confirmed the presence of microscopic cancer within the prostate, his doctors confirmed at the time.

Mr Mandela received hormonal treatment (anti-androgens) for a while, and underwent a seven-week course of radiotherapy with curative intent. This treatment was localised to the prostate gland. He did not require any surgery or chemotherapy.

Most of Mandela's prostate gland was removed in an operation in 1990.

Facts about prostate cancer
Prostate cancer is the most common cause of cancer death in all men in South Africa.

One in ten men will develop prostate cancer in their lifetime.

Early prostate cancer is often completely asymptomatic, making detection difficult. For this reason, regular screening for prostate cancer needs to be done, especially in men over 50.

Prostate cancer is exceedingly rare before the age of 40, but 1 in 8 men between the ages of 60 and 80 years suffer from the disease.

Early prostate cancer curable
Men over 50 (and black men over 40) should undergo yearly prostate checks with serum PSA and digital rectal examination.

Cancer localised to the prostate gland – as diagnosed in Mr Mandela - is curable by radical prostatectomy or radiotherapy. Metastatic prostate cancer can be controlled by hormonal treatment.

Proven risk factors for prostate cancer include old age, a positive family history of cancer (and breast cancer in a man’s mother of sister) and black race. Probable risk factors include a high intake of dietary fat and high levels of serum testosterone.

Early prostate cancer is often completely asymptomatic. By the time the disease becomes symptomatic it is usually beyond cure.

Prostate cancer that is confined to the gland itself can be cured by radical surgery or radiotherapy, but the benefit of cure only becomes apparent after 10 years. This paradox is due to the slow growing nature of the disease.

Radical prostatectomy provides the best chance of cure but carries a high risk of complications. Metastatic prostate cancer cannot be cured. Most patients with metastatic disease will respond to hormonal treatment that deprives the cancer of male hormones. Prostate cancer is not sensitive to current chemotherapy regimes.

Symptoms
Symptoms related to the primary tumour include: problems with urinating, poor stream, retention of urine, urgency and frequency, and blood in the urine. Symptoms related prostate cancer after it has spread include bone pain (back and pelvis), bone fractures, enlarged lymph glands and kidney failure.

Other general effects of the cancer might include: Weight loss, Tiredness, Anemia, Loss of appetite.

Autopsy data indicate a 70% incidence of prostate cancer in 80 year old men. The vast majority of these men died with rather than from prostate cancer.

Slow growing
Prostate cancer is very slow growing. The natural history of the disease is long and variable. From early cancer at a cellular level to eventual death from metastatic disease may be as long as 20 - 25 years. The course of the disease will be influenced by the general health and immune status of the host, as well as by the treatment modalities that the cancer is subjected to.

Many patients only develop prostate cancer late in life. Due to the very slow growth rate of the disease many of these patients will outlive their prostate cancer and die from other causes before the cancer has had time to run its course. The implications of early prostate cancer are completely different for a healthy 50 year old as compared to an 80 year old man with other co-morbid disease.

(Liesel Powell, Health24)

Read more:
Screening tests for men
Are you at risk for prostate cancer?