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 What
is prostate gland? |
| What
is prostate cancer? |
| What
are the causes? |
| What
are the symptoms? |
| How
is it diagnosed? |
| What
are the treatment options? |
| Surgery |
| Radiation
therapy |
| Hormone
therapy |
| New
types of treatment |
| Benefits
and drawbacks |
|
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| What
is prostate gland? |
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| The prostate is a glandular organ,
about size of a walnut, present in males. The prostate
is normally about 3 cm long and it lies at the neck of
the bladder and in front of the rectum. The prostate gland
produces fluid that makes up part of the semen. |
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| What
is prostate cancer? |
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| Prostate cancer is found mainly in
older men. As men age, the prostate may get bigger and
block the urethra or bladder. This may cause difficulty
in urination or can interfere with sexual function. The
condition is called benign prostatic hyperplasia (BPH),
and although it is not cancer, surgery may be needed to
correct it. The symptoms of benign prostatic hyperplasia
or of other problems in the prostate may be similar to
symptoms of prostate cancer. Prostate cancer is often
a very slow-growing disease. It can take 10 years or more
for a small tumor to spread beyond the gland and pose
a serious threat to health. |
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 Cancer
occurs when normal cells undergo a transformation in which
they grow and multiply without any control. There are
four stages of prostate cancer:
Stage I - In stage I, cancer is found in the prostate
only. It is usually found accidentally during surgery
for other reasons, such as benign prostatic hyperplasia.
Stage II- In stage II, cancer is more advanced
than in stage I, but has not spread outside the prostate.
Stage III- In stage III, cancer has spread beyond
the outer layer of the prostate to nearby tissues. Cancer
may be found in the seminal vesicles.
Stage IV- In stage IV, cancer has metastasized
(spread) to lymph nodes near or far from the prostate
or to other parts of the body, such as the bladder, rectum,
bones, liver, or lungs. Metastatic prostate cancer often
spreads to the bones.
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Stages Of Prostate Cancer
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| What
are the causes? |
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| The cause of prostate cancer is unknown,
but hormonal, genetic, environmental, and dietary factors
are thought to play roles. The following risk factors
have been linked with development of this condition: |
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- Age: There is a strong correlation between increasing
age and developing prostate cancer. Autopsy records
indicate that 70% of men older than 90 years have
at least one region of cancer in their prostate.
- Race: African American men are 1.5-2 times more
likely than white men to develop prostate cancer.
- Genetic factors: Men, who have a history of prostate
cancer in their family, are at an increased risk.
- Diet: A diet high in fat has been associated with
an increased risk of prostate cancer.
- Chemical agents: Exposure to chemicals such as cadmium
has been implicated in the development of prostate
cancer.
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| What
are the symptoms? |
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| Prostate cancer can produce many symptoms.
Some of them have been listed below. But presence of these
symptoms does not necessarily indicate prostate cancer.
Other conditions may cause the same symptoms. A doctor
should be consulted if any of the following problems occur.
Some of the symptoms are: |
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- Weak or interrupted flow of urine.
- Frequent urination (especially at night).
- Trouble urinating.
- Pain or burning during urination.
- Blood in the urine or semen.
- A pain in the back, hips, or pelvis that doesn't
go away.
- Painful ejaculation.
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| How
is it diagnosed? |
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| The doctor may perform necessary test
to detect and diagnose prostate cancer. The following
procedures may be used: |
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- Digital rectal exam (DRE): The doctor inserts
a lubricated, gloved finger into the rectum and feels
the prostate through the rectal wall for lumps or
abnormal areas.
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Digital rectal exam (DRE)
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- Prostate-specific antigen (PSA) test: A test
that measures the level of PSA in the blood. PSA is
a substance made by the prostate that may be found
in an increased amount in the blood of men who have
prostate cancer. PSA levels may also be high in men
who have an infection or inflammation of the prostate
or BPH (an enlarged, but noncancerous, prostate).
- Transrectal ultrasound: A procedure in which
a probe that is about the size of a finger is inserted
into the rectum to check the prostate. The probe is
used to bounce high-energy sound waves (ultrasound)
off internal tissues or organs and make echoes. The
echoes form a picture of body tissues called a sonogram.
Transrectal ultrasound may be used during a biopsy
procedure.
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| Transrectal
ultrasound showing a series of prostate ultrasound images
used to construct a 3-dimesnsional image of the prostate
(volume study) and treatment plan. Key: Red line = prostate;
Blue line = limit of radiation to be delivered |
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- Biopsy: The removal of cells or tissues so they
can be viewed under a microscope by a pathologist.
The pathologist will examine the biopsy sample to
check for cancer cells and determine the Gleason score.
The Gleason score ranges from 2-10 and describes how
likely it is that a tumor will spread. The lower the
number, the less likely the tumor is to spread. There
are 2 types of biopsy procedures used to diagnose
prostate cancer:
- Transrectal biopsy: The removal of tissue
from the prostate by inserting a thin needle through
the rectum and into the prostate. This procedure
is usually done using transrectal ultrasound to
help guide the needle. A pathologist views the
tissue under a microscope to look for cancer cells.
- Transperineal biopsy: The removal of
tissue from the prostate by inserting a thin needle
through the skin between the scrotum and rectum
and into the prostate. A pathologist views the
tissue under a microscope to look for cancer cells.
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| If prostate cancer is diagnosed, the
other tests( e.g Radionuclide bone scan, MRI. Pelvic lymphadenectomy,
Seminal vesicle biopsy) are done to find out if cancer
cells have spread within the prostate or to other parts
of the body. |
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| What
are the treatment options? |
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| Treatments for prostate cancer are
effective in most men. But one should remember that they
do cause both short- and long-term side effects that may
be difficult to accept. So you and your life partner or
family members must discuss the treatment options in detail
with their urologist and other physicians. It is essential
to understand which treatments are available, how effective
each is likely to be, and what side effects can be expected.
All these must be weighed carefully before making a decision
about which course to pursue. |
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| Surgery |
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| There are different types of treatment
for patients with prostate cancer. Patients in good health
are usually offered surgery as treatment for prostate
cancer. The following types of surgery are used: |
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- Pelvic lymphadenectomy: A surgical procedure
to remove the lymph nodes in the pelvis. A pathologist
views the tissue under a microscope to look for cancer
cells. If the lymph nodes contain cancer, the doctor
will not remove the prostate and may recommend other
treatment.
- Radical prostatectomy: This approach makes
especially good sense for relatively healthy patients
under age 65. For one thing, such men generally have
the strength to handle a major operation. A surgical
procedure to remove the prostate, surrounding tissue,
and seminal vesicles. There are 2 types of radical
prostatectomy:
- Retropubic prostatectomy: A surgical
procedure to remove the prostate through an incision
(cut) in the abdominal wall. Removal of nearby
lymph nodes may be done at the same time.
- Perineal prostatectomy: A surgical procedure
to remove the prostate through an incision (cut)
made in the perineum (area between the scrotum
and anus). Nearby lymph nodes may also be removed
through a separate incision in the abdomen.
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The two types of radical prostatectomy
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- Transurethral resection of the prostate (TURP):
The standard surgical treatment for an enlarged prostate
is Transurethral Resection of the Prostate or "TURP".
This is sometimes called a scraping or "Roto-Rooter"
of the prostate. It is the "gold standard"
against which all other prostate remedies are compared.
Under a full general or spinal anaesthetic, a resectoscope
(a thin, lighted tube with a cutting tool) is inserted
through the urethra. Under direct vision, an electric
current passes through the loop, this can then carve
out the channel inside the prostate. The chips or
pieces of prostate tissue are rinsed out of the bladder
with water. After surgery, a soft rubber tube or catheter
is left in the bladder for several days to help control
bleeding and allow healing to begin. This procedure
is sometimes done to relieve symptoms caused by a
tumour before other cancer treatment is given. Transurethral
resection of the prostate may also be done in men
who cannot have a radical prostatectomy because of
age or illness.
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Transurethral resection of the
prostate (TURP).
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- Bilateral Orchidectomy- Orchidectomy is a
surgical procedure in which one or both testicles
are removed. Testicles are sex organs in the males
that produce sperms and testosterone (a hormone).
It is performed under general anaesthesia. Testicles
are removed through an incision in the scrotum or
the groin. Some of the lymph nodes that are located
deep in the abdomen or inguinal area may also be removed.
Prostate cancer is known to regress after Orchidectomy,
as the source of testosterone is removed.
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| Radiation
therapy |
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| Instead of removing the entire gland,
healthy tissue and all, doctors can use radiation to target
and kill the cancer cells. There are two ways to deliver
the radiation. In a process called external beam radiation,
a machine produces a highly focused beam of energy aimed
directly at the tumour. It usually takes about five sessions
a week over seven weeks to treat the tumour. Alternatively,
a doctor can implant radioactive pellets or "seeds"
in the tumour. This is called seed therapy or brachytherapy.
Brachytherapy is a technique for treating prostate cancer,
using tiny radioactive seeds of Iodine-125 (I125) that
are inserted permanently into the prostate gland. 'Brachy'
means close and, in this treatment, the radioactivity
is inserted directly into the cancerous organ. It's a
minor procedure, and most patients go home the same day
it is performed. The way the radiation therapy is given
depends on the type and stage of the cancer being treated.
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Cross-sectional diagram of the
implant process
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| Hormone
therapy |
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| Hormone therapy is a cancer treatment
that removes hormones or blocks their action and stops
cancer cells from growing. Hormones are substances produced
by glands in the body and circulated in the bloodstream.
Some hormones can cause certain cancers to grow. |
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| New
types of treatment |
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| There are other new types of treatments
that are being tested in clinical trials. These include
the following: |
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 Cryosurgery-
Cryosurgery is a treatment that uses an instrument to
freeze and destroy prostate cancer cells. This type of
treatment is also called cryotherapy. Because it is minimally
invasive, prostate cancer cryotherapy has fewer complications
than surgery. The goals of minimally invasive therapies
are:
- To destroy the local disease
- To shorten hospital stay
- To reduce the number of postoperative morbidities
- To shorten recovery time
- To reduce the cost of the procedure
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| Chemotherapy |
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| Chemotherapy is a cancer treatment
that uses drugs to stop the growth of cancer cells, either
by killing the cells or by stopping them from dividing.
When chemotherapy is taken by mouth or injected into a
vein or muscle, the drugs enter the bloodstream and can
reach cancer cells throughout the body (systemic chemotherapy).
When chemotherapy is placed directly into the spinal column,
an organ, or a body cavity such as the abdomen, the drugs
mainly affect cancer cells in those areas. The way the
chemotherapy is given depends on the type and stage of
the cancer being treated. |
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| Biologic therapy |
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| Biologic therapy is a treatment that
uses the patient's immune system to fight cancer. Substances
made by the body or made in a laboratory are used to boost,
direct, or restore the body's natural defenses against
cancer. This type of cancer treatment is also called biotherapy
or immunotherapy. |
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| High-intensity focused ultrasound |
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| High-intensity focused ultrasound
is a treatment that uses ultrasound (high-energy sound
waves) to destroy cancer cells. To treat prostate cancer,
an endorectal probe is used to make the sound waves. |
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| Benefits
and drawbacks |
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| Whatever approach your doctor recommends,
be sure to ask about the potential risks and benefits.
And be sure to stay positive. With so many options available,
most patients have a good chance of beating their disease. |
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| TREATMENT |
BENEFITS |
DRAWBACKS |
| Radiation Therapy |
The patient avoids major surgery.
The recovery time is minimal. One should be able
to resume normal activities within a few days. However,
it is advised to lift heavy things for the first
two weeks after the implant.
There is little risk of serious complications, even
if the patient is relatively old and sick.
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It can be hard on the body.
Patients often feel exhausted at the end of their
treatment.
Up to 30% of all patients briefly suffer from other
unpleasant side effects such as rectal bleeding,
burning during urination, frequent urination, and
diarrhoea.
Roughly half of all radiation patients become impotent
within two years, according to the American Academy
of Family Physicians. This complication is more
common with external beam radiation than with seed
therapy.
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| Radical Prostatectomy |
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It is major surgery. Most patients
have to stay in the hospital for 2-3 days, and they
usually have to recuperate for a month before returning
to work.
The operation can also damage nearby nerves, often
causing problems with urine control and erections.
There are side-effects( like erectile dysfunction)
associated with this operation
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| Cryosurgery |
less invasive than a radical
prostatectomy |
Not considered the first line
of treatment because of uncertainity about its long-term
effectiveness.
Since freezing also damages nerve cells near the
prostate, most men who undergo cryosurgery will
be impotent.
Other side effects may include blood in the urine,
soreness, and swelling for a few days after surgery.
Sometimes cryosurgery affects the bladder and bowels,
causing pain and the urge to go to the bathroom
frequently, but this usually goes away in time.
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| Hormone Therapy |
The patient avoids major surgery.
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Many men develop enlarged, tender
breasts. Other possible side effects include hot
flashes, erectile dysfunction, and loss of interest
in sex. |
| Chemotherapy |
The patient avoids major surgery.
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While chemotherapy can't cure
prostate cancer, it can often slow it down -- prolonging
a patient's life and easing his symptoms. |
| TURP |
The "gold standard' treatment-
very effective surgery with little pain or discomfort
Best permanent treatment for severe prostatic disease,
especially if permanent damage to the bladder or
kidneys has occurred. It's also appropriate where
other treatments have failed to control symptoms
adequately or protect the bladder and kidneys. No
other treatment is as effective in relieving the
blockage from prostatic enlargement
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Requires several days in the
hospital, has a prolonged recovery period after
surgery
May infrequently have complications such as bleeding,
infection, urinary leakage and scar tissue formation.
It will cause retrograde ejaculation, which means
that during sexual activity there will be no semen
expelled from the penis. Instead, any semen produced
will go directly into the bladder. This is not dangerous
or harmful in any way and it doesn't affect sensation
or enjoyment, but it's disturbing to some patients.
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