Total Views : 993

Posted On : 28 May 2007

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system.

As the name suggests, prostate cancer develops from cells of the prostate gland. The prostate gland is located in the pelvis, below the bladder, above the urethral sphincter and the penis, and in front of the rectum in men. The prostate gland is about the size of a walnut. It is made up of glandular tissue and muscle fibers that surround a portion of the urethra. It is found only in men, and produces some of the seminal fluid, which protects and nourishes sperm cells. Most prostate cancers grow very slowly and never cause symptoms or spread.

As prostate cancer grows, it may spread to the interior of the gland, to tissues near the prostate, to sac-like structures attached to the prostate (seminal vesicles), and to distant parts of the body (e.g., bones, liver, and lungs). Prostate cancer confined to the gland often is treated successfully.

Recurrent Prostate Cancer
Recurrent prostate cancer is cancer that has recurred (come back) after it has been treated. Recurrent prostate cancer may come back in the prostate or in another part of the body.

Types of Prostate Cancer

Prostate tissues contain several types of cells. Cancer can develop in each of these different types of tissues, but the most common form of prostate cancer develops within the glandular cells. This type of cancer is known in medical terms as adenocarcinoma. Usually, adenocarcinoma develops at the surface of the prostate and can be easily detected trough a digital rectal examination.

There are two other forms of prostate cancer i.e. Leiomyosarcoma and Rhabdomyosarcoma that are rarer and develop in the surrounding tissues of the gland.

Causes & Risk Factors of Prostate Cancer

Prostate cancer is the most common non-skin cancer, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer. Besides being male, there are other factors, such as age, race, and family history that may contribute to the risk.

Some research suggests that high levels of testosterone may increase a man's risk of prostate cancer. The difference between racial groups in prostate cancer risk could be related to high testosterone levels, but it also could result from diet or other lifestyle factors.

These causes or risk factors of prostate cancer include:

1. Age: The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after the age of 40 in black men and men who have a close relative with prostate cancer.
2. Race: Prostate cancer occurs about 60% more often in African American men than in white American men and when diagnosed is more likely to be advanced.
3. Diet: Research also suggests high dietary fat may be a contributing factor prostate cancer. The disease is much more common in countries where meat and dairy products are dietary staples, compared to countries where the basic diet consists of rice, soybean products, and vegetables.
4. Lifestyle: The risk of prostate cancer may be reduced by getting regular exercise and maintaining optimal weight.
5. Family history: The risk for developing prostate cancer is higher if there is a family history of prostate cancer among male members of the family. The risk doubles if a man's father had the disease, and if a brother had it, the risk triples
6. Medical conditions: The risk for developing prostate cancer is higher when the patient suffers from a medical condition called prostatic intraepithelial neoplasia (PIN).
7. Occupation:  Rubber industry and cadmium workers have more possibility of having prostate cancer.

Signs & Symptoms of Prostate Cancer
When prostate cancer is in the early stages, there are no noticeable symptoms. However, there are men that can experience symptoms that might indicate the presence of prostate cancer. But prostate cancer can cause any of these problems: 

• A need to urinate frequently, especially at night;
• Difficulty starting urination or holding back urine;
• Inability to urinate;
• Weak or interrupted flow of urine;
• Painful or burning urination; 
• Difficulty in having an erection; 
• Painful ejaculation; 
• Blood in urine or semen; or 
• Frequent pain or stiffness in the lower back, hips, or upper thighs.
• Loss of appetite and weight

Any of these symptoms may be caused by cancer or by other, less serious health problems, such as BPH or an infection. A man who has symptoms like these should see his doctor or an urologist.

Complications of Prostate Cancer
Complications from prostate cancer are related to both the disease and its treatment. One of the biggest fears of many men who have prostate cancer is that treatment may leave them incontinent or impotent.

The typical complications of prostate cancer and its treatments include:

1. Depression: Many men may develop feelings of depression after a diagnosis of prostate cancer or after trying to cope with the side effects of treatment. These feelings may last for only a short time, they may come and go, or they may linger for weeks or even months.
2. Erectile dysfunction (ED) or impotence: Like incontinence, ED can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments.
3. Pain: Although early-stage prostate cancer typically isn't painful, once it's spread to bones, it may produce pain, which can be intense. Not all people with cancer that has spread to bones have pain. Pain can be controlled, and there's no reason a person has to suffer with intense pain.
4. Spread of cancer: Prostate cancer can spread to nearby organs and bones and can be life-threatening.
5. Urinary incontinence: Both prostate cancer and its treatment can cause incontinence. Some men experience incontinence after surgery to remove the prostate.

Stages of Prostate Cancer

Once prostate cancer has been diagnosed, more tests are done to find out the size and location of the cancer, and if the cancer has metastasized (spread) beyond the prostate. This process is called staging. Knowing the stage of the cancer is important for planning the right treatment.

Several systems are used to stage prostate cancer. The most common are the ABCD system and the TNM system.

• Stage A: The cancer is confined to the gland. In this stage, the tumor cannot be detected through a digital rectal examination and is discovered by chance when the patient undergoes surgery for a different reason such as benign prostatic hyperplasia (BPH).
• Stage B: The cancer reaches an advanced form but is still confined to the prostate. It is now big enough to be detected by DRE or ultrasound imaging
• Stage C: The cancer spreads outside the prostate. In this stage, it might affect the seminal vesicles, but has not spread to the adjacent lymph nodes from the pelvic area.
• Stage D: The cancer spreads beyond the seminal vesicles and might affect the lymph nodes, or the pelvic muscles and organs.

 

TNM System
The most widely used system in the United States for staging prostate cancer is called the TNM System. It describes the extent of the primary tumor (T stage), the absence or presence of spread to nearby lymph nodes (N stage) and the absence or presence of distant spread, or metastasis (M stage) to other areas of the body.

The TNM system is more specific in how it categorizes prostate cancer and is more widely used.

T = Tumor size

• T1: Clinically unapparent tumor, neither detected by DRE nor visible by imaging
  • T1a: Incidental histologic finding; <5% of tissue resected during TURP
  • T1b: Incidental histologic finding; >5% of tissue resected during TURP  
  • T1c: Tumor identified by needle biopsy due to elevated PSA  
• T2: Confined within the prostate (detectable by DRE, not visible on TRUS) 
  • T2a: Tumor involves half of the lobe or less
  • T2b: Tumor involves more than one half of one lobe but not both lobes
  • T2c: Tumor involves both lobes
• T3: Tumor extends through the prostate capsule but has not spread to other organs 
  • T3a: Unilateral extracapsular extension
  • T3b: Bilateral extracapsular extension
  • T3c: Tumor invades seminal vesicle(s) 

• T4: Tumor is fixed or invades adjacent structures other than seminal vesicles 
  o T4a: Tumor invades bladder neck and/or external sphincter and/or rectum 
  o T4b: Tumor invades levator muscles and/or is fixed to pelvic wall 

N = Nodes (extend of spread to the lymph nodes)

• N0: Cancer has not spread to any lymph nodes.
• N1: Cancer has spread to a single regional lymph node (inside the pelvis) and is not larger than 2 centimeters (  inch).
• N2: Cancer has spread to one or more regional lymph nodes and is larger than 2 centimeters (  inch), but not larger than 5 centimeters (2 inches).
• N3: Cancer has spread to a lymph node and is larger than 5 centimeters (2 inches).

M = Metastasis (extent of spread to other parts of the body)

• M0: The cancer has not metastasized (spread) beyond the regional lymph nodes.
• M1: The cancer has metastasized to distant lymph nodes (outside of the pelvis), bones, or other distant organs such as lungs, liver, or brain.

 

Diagnosis & Medical Tests of Prostate Cancer

Diagnosis of Prostate Cancer

1. Anamnesis (a personal medical history) : The first step in establishing a diagnosis is a detailed and complete medical review of past health problems, and medical family history
2. Physical examination : The next step is a rectal examination of the prostate. This type of physical examination, called Digital Rectal Exam (DRE), is one of the simplest and oldest screening tests for prostate cancer. During this examination, the doctor (usually a urologist) inserts one finger into the rectum to check the size of the prostate or any possible tissue growth.

Tests of Prostate Cancer

• Prostate-specific Antigen: One of the blood tests performed for diagnosing prostate cancer is PSA (prostate-specific antigen) test. Prostate-specific antigen is a glycoprotein produced by the prostate's epithelial cells that can be measured in the blood. However, the level of PSAs is not a direct indicator of prostate cancer, but can offer important information about possible modifications to the prostate tissue.
• CT scan: The CT scan is an advanced x-ray procedure that produces a more detailed cross-sectional image of the body. A doctor can check for swollen or enlarged lymph nodes. This procedure is used to establish whether or not the prostate cancer spread to adjacent areas or organs, or, after the treatment to monitor for a possible relapse. 
• Magnetic Resonance Imaging (MRI) : MRI is an advanced technique that uses radio waves, strong magnets and a contrast substance to outline the image of a targeted area of the body. MRI is a useful procedure to visualize the prostate and identify any abnormal tissue growth. 
• ProstaScintT scan : ProstaScint scan is a medical procedure that can help determine if the cancer spread beyond the prostate. In order to perform this scan, the patient is injected with a low level of radioactive agent that is absorbed by the prostate cells in the body. This test is not recommended in men that have just been diagnosed with prostate cancer.
• Core needle biopsy : A biopsy is a medical procedure that removes a certain amount of tissue for microscopic investigation. One of the most common types of biopsy used to diagnose prostate cancer is a core needle biopsy. This procedure is performed using a transrectal ultrasound for a better visualization of the prostate gland. It usually last between 15 and 35 minutes and is performed under local anesthesia. During this procedure, the doctor inserts a special instrument called a biopsy gun with a thin needle inside, through the rectum wall and into the prostate. This needle will help remove a cylinder shape sample of prostate tissue. 
• Cystoscopy or Bladder Scope Test : Cystoscopy, also called a cystourethroscopy or a bladder scope, measures the health of the urethra and bladder. It is used to diagnose disease or pain.

Myths about Prostate Cancer
A lot of people think that they know at least the basics about prostate cancer, and some people believe that they really have the essentials of prostate cancer down - even though they're not doctors or cancer experts. But people's beliefs about prostate cancer and cancer in general, are often flat out wrong. Check out the following myths about prostate cancer and the accompanying facts

Myth: Prostate cancer is solely an elderly man's disease
Fact: The reality is that older men do have a greater risk for prostate cancer, but younger men can also develop the disease.

Myth: If you have cancer, you'll know because of the symptoms
Fact: Some forms of early cancer have symptoms, but prostate cancer, especially in its early stages, usually has no symptoms at all.

Myth: Nobody dies of prostate cancer
Fact: It's the second leading cancer killer for men

Myth: Surgery or Radiation is always best treatment
Fact: To determine which treatment is best, each individual situation needs to be considered, including the man's age, how advanced his cancer is, his attitude about side effects and quality of life issues, and other factors.

Myth: Patients of Prostate cancer become permanently disabled
Fact: Many men continue to work after being treated for prostate cancer, while some take four to six weeks off (or longer) to recover from surgery or other treatments.

Myth: Impotence always follows Treatment
Fact: Half of all men who receive treatment for prostate cancer will experience some impotence, even though this is temporarily. However, some men have few or no problems.

Treatments of Prostate Cancer
Once prostate cancer is diagnosed, the next step is a treatment plan. The prostate cancer treatment is established according to several factors such as: the cancer stage and grade, the patient's age and expected life span, and the general health state. Prostate cancer can be treated with surgery, radiation therapy, hormone therapy, occasionally chemotherapy, proton therapy, or some combination of these.

There are two main types of cancer treatment: 

1. Local therapy:  A type of treatment that either removes or destroys the cancer cells.
2. Systemic therapy: A treatment that involves medication that is administrated in various ways such as orally or intravenously.

 

Surgery: This is a local type of therapy and is recommended in early stages of cancer that can remove the whole prostate, prostatectomy, or part of the prostate transurethral resection of the prostate (TURP). There are three types of prostatectomies:

1. Radical retropubic prostatectomy is a common medical procedure where the entire prostate and adjacent affected lymph nodes are removed through an abdominal incision.
2. Radical perineal prostatectomy is a rare medical procedure where the prostate is removed through a small incision cut between the scrotum and the anus. This type of prostatectomy is less invasive and the patient recovers faster.
3. Laparoscopic prostatectomy: During this procedure the prostate and affected lymph nodes are removed through a small abdominal incision.

Transurethral resection of the prostate (TURP) is a type of surgery that is a palliative treatment approach (relieves the symptoms, but does not cure). This surgery is usually performed for those patients that have urinary problems (the urine flow is blocked by the size of the tumor).

Radiation Therapy
Radiotherapy is another local type of cancer treatment that uses high-energy rays or particles to destroy cancerous cells. It is used as a treatment option for early stages of cancer, and for advanced stages of cancer

Chemotherapy
Chemotherapy is not a common treatment option for prostate cancer. However, it is used for advanced forms or recurrent cancer that did not respond to other types of treatment.

Hormone Therapy
Hormone therapy is also known as androgen deprivation or suppression therapy and focuses on reducing the level of male hormones in the body. The majority of prostate cancer cases are hormone sensitive because tumors require male hormones to grow. A reduced level of androgen (male hormone) causes the prostate to shrink and have a slower growth process. This type of treatment is effective in treating early cancer stages and high grade tumors.

When to seek medical advice
If you have difficulties with urination, see your doctor. This condition doesn't always relate to prostate cancer, but it can be a sign of prostate-related problems.

If you're a man older than 50, you may want to see your doctor to discuss beginning prostate cancer screening.

Other Categories
• Back And Neck	• Bone And Joints	• Cancer	• Child Health
• Eye And Vision	• Kidney And Liver	• Lungs And Chest	• Pregnancy
• Women Health