Prostate cancer runs in his family, and there's nothing Don Hackett can do about that fact. His older brother was just diagnosed at the age of 61, and his father and grandfather have also dealt with the disease.
Yet Hackett, who calls himself "a serial eHealth entrepreneur" as the publisher of this website, figures his genetic background accounts for only 50 percent of the battle front. The other half of the fight is up to him - and he's doing what he can to stave off the number one cancer in men.
What is the prostate?
There's nothing simple about the prostate, a mysterious structure which isn't a vital organ. A man can live without the gland, but it does play a role in a man's reproductive system. The exact nature of that role isn't even totally understood. Women don't have prostates, by the way.
In his best-selling book, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, Patrick C. Walsh, M.D. professor of urology with The Johns Hopkins Medical Institutions, writes, "The prostate is as tucked away - and as surrounded by booby traps - as any of the prizes sought by Indiana Jones in Raiders of the Lost Ark."
This walnut-sized gland sits beneath a man's bladder and surrounds the urethra - the tube that actually runs through the prostate to carry urine and semen out of the body. Also nearby are the muscles that control urination, the rectum, some major arteries and veins and what Dr. Walsh calls "a host of delicate nerves."
Semen isn't made in the prostate. Instead, the gland produces substances that go into the fluid that make up part of semen. These substances help the sperm survive and travel to its destination.
What is prostate cancer?
When cells in the prostate start multiplying out of control, cancer develops.
The good news is that when it's caught early, prostate cancer has a cure rate of 99 percent, making it the most treatable cancer known to man.
In most cases, it takes years for tumors form, which is why it's often referred to as a "slow-growing" cancer. However, some men have aggressively growing cancers that can be more difficult to treat.
Some prostate cancer facts worth noting:
- Prostate cancer is the most common cancer found in men of all ages
- In fact, except for skin cancer, it is the most common form of cancer in the United States
- More than two million men in United States are estimated to be living with the disease
- Prostate cancer strikes one in six men
- It's diagnosed in about 240,000 men annually
- This is the second leading cancer-related cause of death in men
- Roughly 34,000 men a year die from it
- Studies suggest that most men over the age of 70 have some form of prostate cancer
- There are 25 different types of prostate cancer
- When caught early prostate cancer has the highest "cure" rate of all cancers
- Not all prostate cancers even need to be treated
Who's at risk of getting prostate cancer?
The greatest risk factors for prostate cancer relate to genetics. Men who have one family member who has it are two times more likely to develop prostate cancer than men who do not have relatives with the disease.
If the one relative was diagnosed before the age of 65, or there are multiple relatives, the risk doubles. Men from these families are four times more likely to get prostate cancer than men with no family history.
Hackett falls into this category.
Here are some other risks facts and factors:
- African-American men are at greater risk of prostate cancer than white men
- Risks increase as a man gets older, starting at age 50 (some say) or 60
- Exposure to certain chemicals - cadmium and agent orange (used in Vietnam) ups risks
- It's more common in certain occupations - farmers, painters and tire plant workers
- Lifestyle risks include alcohol abuse and diets high in fat, particularly animal fat
Controlling genetic risks with lifestyle
There's no absolute way to prevent prostate cancer. As with every other serious diseases, though, a healthy lifestyle can improve the odds.
Hackett takes a logical approach to his health. He looks at his risks as being 50 percent genetic, 25 percent environment and 25 percent diet and exercise.
The 55-year-old believes - and Dr. Walsh agrees - that environment plays a role in the gene expression. In other words, stress and the quality of air, food and water have an impact on whether the bad genes do their dirty work
After having lived and worked in and around New York City for years, Hackett finally moved his family to Austin, Texas - an environment he considers to be healthier and cleaner.
Secondly, Hackett says, over the past 25 years, he has drastically cut down on red meat and eliminated all pork. Occasionally he'll have a high quality cut of beef at a restaurant, but other than that, he sticks to fish and chicken.
"I try to eat healthy, including plenty of fruits and vegetables," he says. "I stay away from sugar and all white products. I'm not perfect with these things - no one is, but I try to do the best I can."
Claiming the Hacketts have always been "an athletic bunch," he also keeps moving. "My family recently got me a bike to ride from home to work, so I wasn't jogging in this 110-degree [Austin] heat."
This healthy lifestyle has helped Hackett maintain a consistent, healthy weight throughout the years.
What are the symptoms of prostate cancer?
Prostate cancer is a devious disease. Sometimes it causes no symptoms. Other times, it makes itself known. Common symptoms include:
- Difficulty starting or stopping urination
- Painful or burning urination
- Leaking or dribbling urine
- Slow or weak urine stream
- Trouble emptying bladder
- Blood in urine or semen
- Painful ejaculation
- Lower back or pelvic pain, though this usually doesn't occur unless the cancer has spread beyond the prostate
Could these be symptoms of something else?
Yes. Many men develop an enlarged prostate, usually in mid-life or beyond. The technical term for this is benign prostathetic hyperplasia (BPH). It's not cancerous, but can cause symptoms that mimic those of prostate cancer.
A couple of drugs are available to treat this condition, including Proscar (finasteride) and Avodart (dutasteride). Finisteride has been prescribed as a drug to help prevent the onset of prostate cancer. The drug does seem to have prophylactic (preventive) value.
It should be noted that Health Canada recently reported that finisteride, which is also used to treat baldness in men, has been linked to a small number of male breast cancer cases.
How is prostate cancer diagnosed?
Like everything else having to do with this organ and disease, even diagnosing prostate cancer isn't a clear cut procedure. There are several options.
The most common ways to look for prostate cancer involve a blood test and a physical exam. Neither is foolproof, so they should be performed together for greatest accuracy.
- Prostate specific antigen (PSA) is a biomarker that can indicate the presence of the disease
- PSA levels are measured with a blood test
- A digital rectal exam (DRE) is performed by a physician
If PSA levels are elevated, this isn't an automatic cancer diagnosis. Various medical procedures, infections and non-cancerous growths can boost PSA levels.
There are several next steps in confirming a diagnois, all of which need to be discussed with a healthcare professional. These include:
- PCA3 is a biomarker that may indicate cancer; blood tests are available to screen for PCA3
- A needle biopsy takes out a small sample of tissue to examine under a microscope
New blood and urine tests are also currently being studied to accurately diagnose prostate cancer without biopsies.
If cancer is detected, additional tests will be ordered to determine the severity of the disease and learn if it has spread outside the prostate.
How is prostate cancer treated?
Not all prostate cancers are treated. Depending on initial findings, doctors may suggest that PSA levels be monitored over a period of time before other treatment is considered.
Today, these treatments are available:
- Surgery - radical prostatectomy - removes the entire prostate
- Radiation therapy uses a beam of radiation that is directed to the target area
- Proton therapy is another form of radiation therapy that may have fewer side effects than the standard intensity modulated radiation therapy (IMRT)
- Brachytherapy surgically inserts tiny radioactive seeds into the prostate to kill the cancer
- Hormone therapy is used along with radiation, either before, during or after treatment
- Cryotherapy or cryoablation involves freezing the tumor cells to death
- High-intensity focused ultrasound, or HIFU, does just the opposite - heats the cells to death
What are the prostate screening recommendations?
The medical community doesn't have a one-size fits all answer to effective screening for prostate cancer. It's something men need to discuss carefully with their healthcare providers.
When screening begins, what it entails and the frequency of testing depend on a man's age, family history and symptoms.
Generally speaking, though, men who are at high risk of prostate cancer due to a family history are advised to begin screening at age 40.
Not to worry
Don Hackett is screened every year. This, along with a healthy diet and lifestyle, are his best weapons at this point.
"I'm intensely interested in the topic and read all I can about new medical developments," he says. "I don't worry about yesterday, and I don't really worry about prostate cancer in the future. I do the best I can today."