Prostate Cancer

Prostate Cancer

Prostate Cancer

What is Prostate Cancer?

Prostate

Prostate is a gland found only in males and is a vital part of male reproductive system. The prostate gland makes fluid that forms part of semen. It lies just below the bladder in front of the rectum. It surrounds the urethra.

Functions:

  • Prostate gland produces a thick, clear fluid that makes the semen more fluid and protects and nourishes sperm cells in the semen.
  • The prostate mixes its fluids with those from the seminal vesicles to transport the sperm made in the testicles.
  • The prostate also filters and removes toxins for protection of the sperm, which enhances the chance of impregnation and ensures that men seed with the optimum quality of sperm.
  • The prostate erection nerves are responsible for erections. These nerves trigger the penis to swell and harden with extra blood flow into it, producing an erection.

Prostate Cancer

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way. It is usually a very slow growing cancer and most patients do not have significant symptoms until the cancer reaches an advanced stage.

Types of Prostate Cancer

Acinar Adenocarcinomas: Adenocarcinomas are cancers that develop in the gland cells that line the prostate gland. They are the most common type of prostate cancer.

Ductal Adenocarcinoma: Ductal adenocarcinoma starts in the cells that line the ducts of the prostate gland. It tends to grow and spread more quickly than acinar adenocarcinoma.

Transitional cell cancer: Transitional cell cancer of the prostate starts in the cells that line the tube carrying urine to the outside of the body. This type of cancer usually starts in the bladder and spreads into the prostate.

Squamous cell cancer: These cancers develop from flat cells that cover the prostate. They tend to grow and spread more quickly than adenocarcinoma of the prostate.

Small cell prostate cancer: Small cell prostate cancer is made up of small round cells. It’s a type of neuroendocrine cancer.

Prostate Cancer Occurrence Rate in India

Previously it was thought, that prevalence of prostate cancer in India is far lower as compared to the western countries but with the changing life styles, increased awareness, and easy access to medical facility, more cases of prostate cancer are being picked up and it is coming to the knowledge that we are not very far behind the rate from western countries.

Prostate is the second leading site of cancer among males in large Indian and it is among the top ten leading sites of cancers in the rest of the PBRCs of India.

Incidence Mortality 5 years Prevalence
19,095 12,231 63,818

The incidence rates of this cancer are constantly and rapidly increasing in all the PBRCs. The cancer projection data shows that the number of cases will become doubled by 2020.

Anatomy of Prostate Cancer (Gastric)

prostate cancer

What are the general symptoms of Prostate Cancer?

Prostate cancer, at its early stage, usually causes no symptoms. But more advanced prostate cancers can sometimes cause symptoms, such as:

  • Problems passing urine, including a slow or weak urinary stream or the need to urinate more often, especially at night.
  • Urgency to pass urine.
  • Discomfort in the pelvic area.
  • Blood in the urine/ semen.
  • Erectile dysfunction.
  • Pain in the hips, back (spine), chest (ribs).
  • Weakness or numbness in the legs or feet.
  • Loss of bladder or bowel control from cancer pressing on the spinal cord.
What are the general causes of Prostate Cancer?

Every type of Cancer has risk factors, but they don’t tell us everything. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors. Some risk factors for Prostate Cancer include:

Age: Risk of Prostate Cancer increases with increasing age. Prostate Cancer is very rare in men below 40 and the risk increases rapidly after the age 50.

Family history: Men who have a family history of Prostate Cancer (father or brother) have a higher chance of developing it themselves. The risk is more in case of an effected brother than father.

Gene changes: Including inherited mutations of the BRCA1 or BRCA2 genes raises chances of developing Prostate Cancer and men with Lynch syndrome have an increased risk for a number of cancers, including Prostate Cancer.

Workplace exposures: Firefighters are exposed to substances (toxic combustion products) that may increase their risk of Prostate Cancer.

Cadmium: Cadmium and cadmium compounds are possible causes of Prostate Cancer. Cadmium is a type of metal that is in tobacco smoke and food. Non smokers are exposed to it through food. It is in most types of food including vegetables, meats, grains and fish.

Can Prostate Cancer be prevented?

The exact cause of Prostate Cancer is currently unknown. Hence, at this time it is not possible to prevent most cases of the disease. Natural and genetic factors are uncontrollable, but there are some precautions one may be able to take.

  • Maintain a healthy weight.
  • Regular physical activity.
  • Limited intake of high-calorie foods and drinks.
  • Eat at least 2½ cups of vegetables and fruits each day.
  • Limit the intake of processed meat and red meat.
  • Limit the alcohol intake to no more than 2 drinks per day.
  • Reduce intake of dairy foods and diets rich in calcium.
What are the stages of Prostate Cancer?

Stage I: Tumor is limited to prostate

  • The PSA level is lower than 10
  • Tumor is found in one-half or less of one lobe of the prostate.

Stage II: Tumor is limited to prostate but PSA levels are higher

  • The PSA level is more than 10 but lower than 20
  • Tumor is found in one-half or less of one lobe of the prostate.

Stage III: Tumor has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level.

Stage IV: Tumor has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, lymph nodes, bones or pelvic wall. The PSA can be any level.

Survival rates of Prostate Cancer?

Survival depends on many different factors. It depends on your individual condition, type of cancer subtype, treatment and level of fitness. So it is difficult to predict as to how long a particular Prostate Cancer patient will live.

10 year survival rate according to AJCC staging

Stage Survival Rate
StageI 85%
StageII 72%
StageIII 55%
StageIV 30%
Can Prostate Cancer be detected early?

Various methods can be used for screening and diagnosis. Most important of them for screening high risk patients is the blood levels of Prostate specific Antigen (PSA). Other methods for confirming Prostate Cancer is digital rectal examination, CT, MRI or bone scan as recommended by a consultant.

Medical history and physical exam: A general physical examination is conducted by the doctor to investigate the signs and symptoms of the disease. Further, a digital rectal examination (DRE) is conducted where a lubricated gloved finger is inserted into the rectum to feel for any hard areas on prostate.

PSA blood test: Prostate specific antigen (PSA) blood test is mainly used as a screening test to detect Prostate Cancer early in asymptomatic men.

The levels of PSA are < 4 nanograms/mililitre (ng/ml) in most healthy men. As PSA levels go up, the chances of having Prostate Cancer increase. However, a PSA level of

Imaging tests: Imaging tests help to identify the spread of the Prostate Cancer.

Bone Scan: Prostate Cancer often spreads to bones first (metastases), among the various sites for distant spread, which is detected by bone scan.

Computed Tomography (CT) scan: Helps in detecting spread of Prostate Cancer to nearby lymph nodes or other organs.

Magnetic Resonance Imaging (MRI): Produces a clear picture of prostate and is useful to detect whether the cancer has spread outside the prostate into the seminal vesicles or nearby structures.

What are the Treatments available?

Prostate cancer is the most common cancer among men, but it can often be treated successfully. Depending on the stage of disease, prostate cancer can be treated in various ways.

Stage I and Stage II

  • Surgery for prostate cancer involves removing the prostate gland, some surrounding tissue and a few lymph nodes.
  • Radiation therapy: Uses non-invasive beam therapy using electron, proton, or neutron beams.

Stage III

  • Surgery
  • Radiation / hormonal therapy
  • Cryotherapy is a revolutionary minimally invasive therapy that uses ultrathin needles and freezing gases to destroy the cancerous tissue

Stage IV

  • Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Medications that stop the body from producing testosterone are given.
  • Surgery to remove the testicles. Removing the testicles reduces testosterone levels in the body.
  • Chemotherapy: works by destroying quickly-dividing cells and is usually reserved for patients with advanced prostate cancer.
Is there curative treatment for Prostate Cancer?

This is dependent on the stage the Cancer has reached. However, if the Cancer is detected at an advanced stage, where the cancer cells have spread to distant parts of the body, then in spite of treatment it can be rarely cured.

How frequently should one visit doctor for early diagnosis?

Having some of the symptoms associated with Prostate Cancer may not necessarily indicate the presence of the disease. However, expert advice to rule out the possibility is prudent, making curative treatment possible. So, regular self examination and a physical examination at least once a year is recommended to facilitate early diagnosis of the disease.

How can I as a patient know it early?

If any of the symptoms mentioned in the Symptoms section is experienced, then consulting a doctor is highly recommended. Furthermore, a genetic make-up test can also be done to see if one is prone to Prostate Cancer.

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