Q: My present urologist claims there is a lump on my prostate that is cancerous. My PSA s 9.6, up from 5. I am in my 80s. Because I am on warfarin, when I stopped to do the biopsy I ran into blood clot problems. He gave me a pill to take at a cost of $519.99 for 30 pills (bicalutamide 50 mg tablets) and I feel sick from many of its side effects. Because I am living on a Social Security payment of $900 a month, I can only figure there must be something else or another way to check out my condition. How about an MRI? Do you, with all your experience, have any suggestions?
A: Cancer of the prostate is that which forms in the tissues of the prostate gland in males. The gland is approximately the size of a walnut that sits low in the pelvis below the bladder. Because this gland tends to enlarge with age, it may squeeze the urethra and result in problems passing urine. Three common issues involving the prostate include inflammation known as prostatitis, enlargement known as benign prostatic hyperplasia, and prostate cancer. It is estimated that there were a whopping 233,000 new prostate cancer cases reported this year alone, yet the decision as to whether or not to have a healthy individual tested for prostate cancer when there are no symptoms remains controversial. One school of thought for others who have not been diagnosed yet is screening when a man is in his 50s 50s or sooner if there is a potential risk. Another is to advise against such screening. This is a difficult call that should be discussed by the patient and his physician.
Screening will likely begin with a digital rectal exam to determine if there are abnormalities present and to determine the size and shape of the prostate gland itself. This may be followed with a PSA (prostate specific antigen) lab test. Controversy again enters the picture since studies have failed to prove that the PSA or other tests actually save lives. When a physician remains in doubt, he or she may order an ultrasound or perform a biopsy to determine if cancer cells are present. If there is cancer present, grading will determine how pronounced the cancer is. Tissue samples are then compared with healthy cells. The more the cells differ, the more aggressive the cancer may be and the greater the chances it may be likely to spread. If a physician suspects the cancer may have spread beyond the prostate, there are a number of imaging tests from which to choose in order to zero in on the appropriate treatment option. Testing may include a CT, MRI, bone scan, ultrasound, or PET scan and a PSA. The cancer will then be graded between stage I and stage IV, depending on the severity of the findings.
Symptoms may include blood in the semen or urine, a diminished urinary stream, bone/low back/hip/thigh pain, erectile dysfunction, and more. The risk for developing this cancer is greater as a man ages and because of a family history of the disorder.
The bicalutamide you have been prescribed is a non-steroidal antiandrogen taken by mouth for such conditions as prostate cancer and hirsutism. The drug is endorsed for the treatment of stage D2 metastatic prostate cancer and has also been used in clinical trials for ovarian cancer. Bicalutamide will keep testosterone levels from rising, but the effect of elevated estrogen levels will remain unopposed and will lead to some feminine effects such as gynecomastia.
While many alternative remedies remain unproven in fighting medical problems, some alternative products, in conjunction with prescription cancer-fighting drugs can work together to aggressively fight and defeat prostate cancer. The key is to take the most effective action possible in an attempt to have the greatest chance for success. Be sure to tell your physician that you cannot afford the original medication he or she recommended and would like something that is more in keeping with your income. Or, the manufacturer may have a trick or two up its sleeve to make the product available to you at a markedly reduced fee. It will do no harm to ask and there may be a lot to gain.
