Prostate cancer is a disease which only occurs in the prostate gland present in the male reproductive system and is most common among men over ages 50 years. Mostly are slow growing; however, it can grow quickly if ignored, at first it causes no symptoms but in later stages it can lead to difficulty in urinating, blood in urine or pain in the penis.
Advanced (metastatic) prostate cancer:-
Advanced or metastatic cancer of the prostate gland is when the cancer has spread beyond the prostate gland to other parts of the body. Prostate cancer is usually diagnosed in the early stages before it starts to spread outside the prostate gland. But in some men, the prostate cancer will be advanced when it is first diagnosed. Advanced prostate cancer can also occur in men who have previously been treated for early or locally advanced prostate cancer but their cancer has come back (relapsed or recurred). Prostate cancer cells can sometimes spread beyond the prostate gland. The cancer cells may travel around the body in the bloodstream or, less commonly the lymphatic system. When these cells reach a new area of the body, they may go on dividing and form a new tumor called a metastasis or secondary tumor.
The most common places for prostate cancer to spread are to bones such as the spine, pelvis, thigh bone (femur) and ribs. Usually, the cancer cells will spread to a number of different places in the bones rather than to a single site. Sometimes prostate cancer can affect the bone marrow. This is the spongy material that’s found in the center of most bones. It’s also where the body’s blood cells are made. Prostate cancer can also spread to the lymph nodes, and occasionally it may affect the lungs, the brain and the liver.
Prostate Cancer Signs and Symptoms:-
Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra.
This normally results in problems associated with urination. Symptoms can include:
- needing to urinate more frequently, often during the night
- needing to rush to the toilet
- difficulty in starting to pee (hesitancy)
- straining or taking a long time while urinating
- weak flow
- feeling that your bladder has not emptied fully
Many men′s prostates get larger as they get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia.
Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss.
Independent factors include:-
- Men over 65: prostate cancer is not very common in men under 50.
- African ancestry: Men of African ancestry have a higher risk of developing prostate cancer. They have about a 60% higher rate of prostate cancer than Caucasian men. Men of African ancestry are more likely to be diagnosed at a younger age and with more aggressive and advanced tumor.
- Family history: the risk of developing prostate cancer is higher if a first-degree relative (father or brother) has been diagnosed with the disease.A Men are at the most risk if more than one relative has been diagnosed and if the relatives were diagnosed at a younger age. The risk doubles if a man′s father had the disease, and if a brother had it, the risk triples; hereditary prostate cancer typically begins among a cluster of relatives before age 55.
Dependent risk factors include:-
- High-fat diet: a diet high in fat, especially animal fat, may increase the risk of prostate cancer.
- Exposure to cadmium: Cadmium is a metallic element known to cause cancer and is a possible risk factor for prostate cancer.
Tests and diagnosis:-
- Digital rectal exam (DRE): This is an exam of the prostate via the rectum. The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps, hardness of abnormal areas.
- Prostate-specific antigen (PSA) test: This test 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 (a non-cancerous enlargement of the prostate).
- Transrectal ultrasound (TRUS): 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 is used during a biopsy procedure.
- 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.
- 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.
Prostate Cancer Treatment:-
Because prostate cancer often grows very slowly, some men (especially those who are older or who have other major health problems) might never need treatment for their cancer. Instead, their doctor may suggest approaches known as watchful waiting, expectant management, observation, or active surveillance.
Some doctors use these terms to mean the same thing. For other doctors the terms mean something slightly different:
- Active surveillance is often used to mean watching the cancer closely with PSA blood tests, digital rectal exams (DREs), and ultrasounds at regular intervals to see if the cancer is growing. Prostate biopsies may be done as well to see if the cancer is starting to grow faster.
- Watchful waiting (observation) is sometimes used to describe a less intense type of follow-up that may mean fewer tests and relying more on changes in a man’s symptoms to decide if treatment is needed.
Surgery for prostate cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the gland.The main type of surgery for prostate cancer is known as a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it. A radical prostatectomy can be done in different ways.
Open approaches to prostatectomy
In the more traditional approach to doing a prostatectomy, the surgeon operates through a single long cut (incision) to remove the prostate and nearby tissues. This type of surgery, sometimes referred to as an open approach, is now done less often than before.
- Radical retropubic prostatectomy: In the retropubic approach, a cut is made in the lower belly (abdomen), as shown in the picture below. The doctor will then remove the prostate and some nearby tissues. He or she can also remove nearby lymph nodes to check for cancer spread.A small tube (catheter) will be put in your penis to help drain your bladder after surgery. The catheter usually stays in place for 1 to 2 weeks while you are healing.
You will probably stay in the hospital for a few days after the surgery, and your activities will be limited for about 3 to 5 weeks.
- Radical perineal prostatectomy: In the perineal approach, the surgeon makes the cut in the skin between the anus and the scrotum. This approach is used less often because it’s more likely to lead to erection problems and because the nearby lymph nodes can’t be removed. But it might be an option if you aren’t concerned about erections and you don’t need lymph nodes removed. It also might be used if you have other medical problems that make retropubic surgery hard to do.
The perineal approach often takes less time than the retropubic approach, and may result in less pain.A tube for draining urine (called a catheter) will be put into the bladder through the penis to drain urine for 1 to 2 weeks while you are healing.You will probably stay in the hospital for a few days after the surgery, and your activities will be limited for about 3 to 5 weeks.
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