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Prostate Cancer

cancer prostate


Most cases of prostate cancer develop in older men. In many cases the cancer is slow-growing, does not reduce life expectancy, and may not need treatment. In some cases it is more aggressive, spreads to other parts of the body, and may benefit from treatment

What is the prostate gland?

The prostate gland (just called prostate from now on) is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut.The prostate's main function is to produce fluid which protects and enriches sperm.

The prostate often gets bigger (enlarges) gradually after the age of about 50. By the age of 70, about 8 in 10 men have an enlarged prostate. It is common for older men to have urinary symptoms caused by a benign (non-cancerous) enlargement of the prostate. Some men also develop prostate cancer.

What causes prostate cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. Cancerous cell are abnormal and multiply out of control.
Although the exact cause is unclear, certain risk factors increase the chance that prostate cancer may develop. These include:

Ageing. Most cases occur in older men.
Family history and genetic factors. If your father or brother had prostate cancer at a relatively early age (before they were 60) then you have an increased risk
Ethnic group. Prostate cancer is more common in African-Caribbean men and less common in Asian men.
Diet is possibly a risk factor. As with other cancers, a diet high in fats and low in fruit and vegetables may increase the risk.
Exposure to the metal cadmium may be a risk.

What are the symptoms of prostate cancer?

Prostate cancer is often slow-growing. There may be no symptoms at first, even for years. As the tumour grows, symptoms may then develop and can include one or more of the following:

Poor stream. The flow of urine is weaker, and it takes longer to empty your bladder.
Hesitancy. You may have to wait at the toilet for a while before urine starts to flow.
Dribbling. A bit more urine may trickle out and stain your underpants soon after you finish at the toilet.
Frequency. You may pass urine more often than normal.
Urgency. You may have to get to the toilet quickly.
Poor emptying. You may have a feeling of not quite emptying your bladder.
Note: all the above symptoms are common in older men. Most men who develop the above symptoms do not have prostate cancer but have a benign (non-cancerous) enlargement of the prostate. However, it is best to get any new symptoms checked out by a doctor.
Other symptoms such as pain at the base of the penis or passing blood occasionally occur. (These do not occur with benign prostate enlargement.)
If the cancer spreads to other parts of the body, various other symptoms can develop. The most common site for the cancer to spread is to one or more bones, especially the pelvis, lower spine and hips. Affected bones can become painful and tender. Sometimes the first symptoms to develop are from secondary tumours in bones.

How is prostate cancer diagnosed?

Initial assessment

If a doctor suspects that you may have prostate cancer, he or she will usually examine the prostate gland. They do this by inserting a gloved finger through the anus into the rectum to feel the back of the prostate gland. An enlarged-feeling gland, particularly if it is not smooth to feel, may indicate prostate cancer. However, a normal-feeling prostate does not rule out prostate cancer.

Do a blood test to measure the level of prostate specific antigen (PSA). PSA is a chemical which is made by both normal and cancerous prostate cells. Basically, the higher the level of PSA, the more likely that you have cancer of the prostate. However, a mild-to-moderately raised PSA can occur in conditions other than prostate cancer. (If you have confirmed prostate cancer, the PSA blood test is also used to monitor treatment. If treatment is working and cancer cells are killed then the level of PSA falls.)
A PCA3 test may be offered. This is a new urine test which provides a more effective means of detecting prostate cancer than the PSA test. PCA3 is a chemical made particularly by prostate cancer cells. Up to 100 times more PCA3 is present in prostate cancer cells than non-cancerous cells.

Biopsy - to confirm the diagnosis

A biopsy is not always necessary to confirm a diagnosis of prostate cancer. Your doctor will be able to discuss the reasons for you to have a biopsy, if appropriate, with you in more detail.

A small biopsy of the prostate is taken by using a fine needle. This is usually done with the aid of a special ultrasound scanner. The probe of the scanner is about the size and shape of a finger. It is passed through the anus into the rectum to lie behind the prostate. Having a prostate biopsy can be uncomfortable. Therefore, local anaesthetic is used to reduce the pain as much as possible.

Assessing the severity and spread of prostate cancer
The severity of the disease is mainly based on three factors - the grade of the cancer cells, the stage of the cancer, and the blood PSA level.

Grade of the cancer

Biopsy samples are looked at under the microscope to asses the cancer cells. By looking at certain features of the cells, the cancer can be graded. The common grading system used is called the Gleason Score.

A Gleason score of between 2 and 6 is a low-grade prostate cancer. A Gleason score of 7 is an intermediate grade t. A Gleason score of 8 to10 is a high-grade cancer

Staging

If you are confirmed to have prostate cancer, further tests may be advised to assess if it has spread. Tests which may be done include a bone scan, a CT scan, an MRI scan, an abdominal ultrasound scan or other tests.

This assessment is called staging of the cancer. The aim of staging is to find out:

How much the tumour has grown, and whether it has grown through the wall of the prostate and into nearby structures such as the bladder wall.
Whether the cancer has spread to local lymph nodes.
Whether the cancer has spread to other areas of the body (metastasised).

What are the treatment options for prostate cancer?

The treatment of prostate cancer is complicated. It varies tremendously between different cases.Treatment options which may be considered include: surgery, radiotherapy, hormone treatment and, less commonly, chemotherapy. Often a combination of two or more of these treatments is used. The treatments used depend on:

Size and stage and the grade of the cancer cells, the PSA level; AND
the man with the cancer - your age, your general health and also personal preferences for treatment.

Treatment options for early prostate cancer

Active surveillance

Many prostate cancers are diagnosed at an early stage by PSA testing. Prostate cancer is often very slow-growing and, for many men with prostate cancer, the disease may never progress or cause any symptoms. In other words, many men with prostate cancer will never need any treatment. Active surveillance may be suitable if you have low- to medium-risk prostate cancer. It will involve regular check-ups with PSA tests, rectal examination of the prostate and possibly repeat prostate biopsies.

Surgery

Removing the prostate (radical prostatectomy) can be curative if the cancer is in an early stage (confined to the prostate and not spread). It is a major operation and so tends to be advised more often for younger men whose general health is good, especially if the cancer grade means the cancer is likely to spread in the future. Side-effects such as impotence and/or incontinence of urine may occur following a prostatectomy.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation to kill cancer cells, or stops cancer cells from multiplying. See separate leaflet called 'Radiotherapy' for more details.Radical radiotherapy may be used as an alternative to surgery. Radiotherapy is often more suitable for men who are not fit enough to have an operation or choose not to have an operation.

External radiotherapy. This is where radiation is targeted on the prostate cancer from a machine. (This is a common type of radiotherapy used for many types of cancer.)
Internal radiotherapy (brachytherapy). This treatment involves inserting a small radioactive implant into the cancerous tumour, or next to the tumour.

Treatment options for locally advanced prostate cancer

When the cancer has spread into the capsule of the prostate or into the surrounding tissues near to the prostate then it is called locally advanced prostate cancer.
You may be offered hormone treatment with radiotherapy. As the choice of treatment depends on many factors, your doctor will discuss the treatment with you in more detail.

Hormone treatment

Prostate cancer cells need the male hormone called testosterone to grow and multiply well. Hormone treatments aim to stop you from making testosterone or to block the effect of testosterone on prostate cancer cells. Hormone treatments do not cure prostate cancer but may greatly slow down the growth of the cancer .Hormone treatments can cause side-effects such as erectile dysfunction (impotence), hot flushes, sweating and other problems.

Treatment options for late or advanced prostate cancer

Late or advanced prostate cancer is when the cancer has spread to other parts of the body. Hormone treatments are usually given, as the cancer cells in other parts of the body still need testosterone to grow and multiply.Another type of hormone treatment which may be offered is surgical removal of the testes (orchidectomy). Without testes you no longer make testosterone.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Chemotherapy is not commonly used for the treatment of prostate cancer. It may be used for more advanced cancers.

Radiotherapy

Even if the cancer is advanced and a cure is not possible, radiotherapy may have a place to ease symptoms.

Newer treatments

Cryotherapy,It involves placing a number of metal probes through the skin and into the affected area of the prostate gland. The probes contain liquid nitrogen, which freezes and destroys the cancer cells.

High-intensity focused ultrasound (HIFU) treatment may be offered to some men, with early prostate cancer. HIFU  is high-energy beam of ultrasound which then heats and destroys the cancer.

What is the prognosis (outlook)?

The outlook for prostate cancer is very variable. Some prostate cancers are slow-growing and do not affect life expectancy. On the other hand, some have already spread to other parts of the body when they are diagnosed. The response to treatment is also variable.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer are likely to respond to treatment.

Screening for prostate cancer

Screening for prostate cancer is controversial. High PSA may indicate that you have prostate cancer. However, there are other causes of a high PSA.


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