Prostate cancer is found in men. The incidence of acquiring prostate cancer is relatively rare before the age of 50, though it increases thereafter with most men being diagnosed at the average age of 72. African American men tend to have a higher incidence of prostate cancer accompanied by twice the mortality rate compared with other races.
Symptoms
Early stages of prostate cancer, like many cancers, show no signs at all. Later symptoms include urinary frequency, nocturia, hesitant urine, urgent urination, genital pain, hard nodules on the prostate, bloody urination, or impotence. If metastasis has already occurred, there may be pain in the hips, spine, or ribs. Pain in the spine may be accompanied by weak or numb feet and loss of bladder or bowel control.
Prostate Specific Antigen (PSA)
PSA is a substance made by the prostate gland and is usually found in the semen and small amounts are found in the blood. The PSA test is the test used for early detection of prostate cancer. It has a 96% sensitivity and 95% specificity for the early detection. Normal PSA values are 4ng/mL. If a PSA test shows results of 4ng/mL – 10ng/mL there is a 25% chance of prostate cancer. If PSA test results show levels greater than 10ng/mL there is a >50% chance of prostate cancer. As the PSA values increase, so does the chance of having prostate cancer. It should be noted, however, that 15% of individuals with prostate cancer show PSA values of less than 4ng/mL.
PSA levels may also increase if there is non-cancerous enlargement of the prostate, prostatitis, ejaculation, finasteride, dutasteride, and if certain herbs are taken. PSA levels also increase with age and this must be taken into consideration when diagnosing elderly men. Thus, while PSA is an incredibly valuable tool in early detection of prostate cancer, other tests are used to confirm its presence, such as a prostate biopsy.
After a diagnosis of prostate cancer has been made, regularly testing PSA levels can help determine tumor grade, if there is metastasis, and if treatments have been successful. In those with metastatic, inoperable or incurable cancer, changing PSA levels can show the progress of the disease.
Diagnosis
Prostate cancer diagnosis usually results from a number of the following: patient history, physical exam, digital rectal exam, ultrasound, CT scan,MRI, Serum prostate specific antigen (PSA), Serum prostate acid phosphatase (PAP), serum alkaline phosphatase, complete blood count, liver function test, chest radiograph, bone scan, abdominal and pelvic CT scan, transrectal ultrasound, and biopsy.
Grading Systems
Like many cancers, the grading scale is the TNM scale, though they also use the Gleason System. The Gleason System is a rating between 1-5 which depicts how much cells look like normal tissue. The score is taken from two different areas in the prostate and the two scores are added together to get a final score out of 10.
- Primary Tumor:
- TX – tumor cannot be assessed
- T0 – no evidence of primary tumor
- T1 – clinically inapparent tumor, not palpable or visible by imaging
- T2 – tumor confined within prostate
- T3 – tumor extends through prostatic capsule
- T4 – tumor is fixed or invades adjacent structures other than seminal vesicles
- Regional Lymph Nodes (N):
- NX – regional lymph nodes cannot be assessed
- N0 – no regional lymph node metastasis
- N1 – metastasis in regional lymph nodes
- Distant Metastasis (M):
- MX – distant metastasis cannot be assessed
- M0 – no distant metastasis
- M1 – distant metastasis
- Histopathalogic Grade (G):
- GX – grade cannot be assessed
- G1 – well differentiated
- G2 – moderately differentiated
- G3-4 – poorly differentiated
- Total Gleason Score
- 2-4 – well differentiated
- 5-6 – moderately differentiated
- 7 – moderately poorly differentiated
- 8-10 – poorly differentiated
Prostate Cancer according to TCM
In TCM, prostate cancer often involves hematuria, retention of urine and consumptive stranguria. It usually involves the Kidney, Bladder and Lower Jiao
| Differentiation | Prostate Symptoms | Other Symptoms | Formulas |
| Damp Heat Stagnation | Hesitant, thin or no urine, blood in urine, distending pain in genitals | Bitter taste in mouth, dry throat, fever, red tongue, yellow greasy coating, smooth and fast pulse | Modified Ba Zhen Tang |
| Stagnation of Qi & Blood | Dripping or blocked urination, low abdominal/back pain, genital pain | Difficulty moving, anxiety, dark purple tongue or petechia on tongue, unsmooth pulse | Modified Tao Ren Hong Hua Jian |
| KI Yang Deficiency | No urination or dripping urination, hesitant urine | Fatigue, low back and knee pain, cold pain, cold aversion, cold extremities, craving warmth, diarrhea, pale tongue, moist coating, deep and thin pulse | Modified Zhen Wu Tang |
| Qi & Yin Deficiency | Urine progressively becomes thinner, no urine | Pale complexion, anemia, fatigue, palpitations, dizziness, low appetite, whole body pain, hectic fever, night sweating, red or pale tongue, less or no coating, thin and fast pulse | Modified Sheng Mai San |
Common herbs used for prostate cancer include: Long Kui, Shan Ci Gu, Xian He Cao, Lao Guan Cao. Acupuncture points often used are: ST 36, RN 12, SP 6, SP 9, moxa RN 4, RN 6
Caroline Prodoehl, D. Ac
References:
Zhu, Annie Yawen (2011). Integrated Treatments: Internal Medicine Course. Toronto School of Traditional Chinese Medicine. Toronto, Ontario.