Prevention of cancer development and of cancer progression ...these include

• lifestyle changes such as diet and exercise
  • usually very difficult to implement
  • if followed, do have a major impact
  • that which is “heart healthy is also prostate healthy”
• nutritional supplements
  • easy to use but often of questionable benefit
    • Selenium
            ...use < 200 mcg/day
            ...most multivitamins contain an adequate dose
            ...can measure via blood test or toe nail clippings
    • Lycopene
            ...benefits and risks remain inconclusive
            ...best obtained from food sources (tomatoes, watermelon)
            ...despite being the best anti-oxidant, probably the least useful
  • ASA
    • commonly known as aspirin
    • probably of some prostatic benefit
    • criteria for use has changed...can increase the chance of a hemorrhagic stroke
  • Some that are in common use may actually increase risk. These should be used only in safe amounts.
    • Vitamin E ...do not exceed 400 IU /day
    • Zinc ...try not to go above 25 mg/day
            ...this may increase the risk of aggressive prostate cancer
            ...it is best if this is not used over what is found in a multivitamin
• medications
• the types, and the indications, have changed
• some have proven to decrease risk of prostate cancer
• Multi-vitamin ...cheapest is best
• Vitamin D ...400 IU bid
• Statins ...they all seem to work about equally.
        ...3 are on patent
        ...3 are off patent and less costly
        ...cheapest may be best

Diagnosis

• PSA total, free and velocity (rate of change)
  • at present these have proven to be the most effective ways to suspect microscopic prostate cancer
  • however, there are inherent and significant false positive, and false negative, detection errors
  • the end result is a statistical risk-benefit choice
• Prostatic biopsy
  • it is not possible to diagnose prostate cancer without this procedure
  • is done in the office and is almost painless (local anesthetic is routinely used)
  • most patients are very apprehensive ...if needed appropriate oral sedation can be given
  • does have risks of bleeding and infection ... fortunately both are infrequent and treatable
• biopsy results
  • these are reviewed in detail, in the office, with the patient and if he wishes any other party
  • a copy of the results, and appropriate ancillary, information will be supplied...this will include data on the Gleason grading scores and the TNM staging system
  • if required, further testing (to complete the staging) and a follow-up visit will be arranged

Treatment

• the treatment algorithm combines the DRE (digital rectal examination) findings, the PSA (total, free, velocity) serum level, the Gleason grading score and the TNM staging system.
• The correct treatment choice will maximize cancer free survival while minimizing the side effects of therapy.