Prostate Cancer

The prostate is a male sex gland. It produces a thick fluid that forms part of semen. The prostate is about the size of a walnut. It is located below the bladder and in front of the rectum. The prostate surrounds the upper part of the urethra, the tube that empties the urine from the bladder. The prostate needs male hormones to function, and the primary male hormone is testosterone, which is made mainly by the testicles.

Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. It may be worth noting that although benign, symptoms may appear remarkably similar for those of a cancerous condition. In BPH, the prostate grows larger and pushes against the urethra and bladder, blocking the normal flow of urine. More than half of the men in the United States between the ages of 60 and 70 and as many as 90 percent between the ages of 70 and 90 have symptoms of BPH.

Possible Causes: Studies in the United States show that prostate cancer is found mainly in men over age 55; the average age of patients at the time of diagnosis is 72. This disease is known to be more common among negro males, particularly in the U.S. where they are known to have the highest rate of prostate cancer in the world. Some studies have shown that a man has a higher risk for prostate cancer if his father or brother has had the disease. Studies on the effects of diet suggest that diet high in fat increases the risk, while a diet high in fruits and vegetables decreases the risk, although these claims are not conclusively proven. There are also beliefs, without hard evidence, that a vasectomy increases a man's risk; that farmers and workers exposed to the metal cadmium during welding, electroplating, or making batteries are at risk; that workers in the rubber industry are at risk.

Symptoms: Early prostate cancer often not cause symptoms. When symptoms of prostate cancer do occur, they may include some of the following problems:

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

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 family doctor or a urologist. Do not wait to feel pain, as early prostate cancer does not cause pain.

Diagnoses: If symptoms occur, the doctor asks about the patient''s medical history, performs a physical exam, and may order laboratory tests which may include the following:

  • Urine test - to check for blood or infection in the urine;
  • Blood tests - a measure the levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) in the blood is done. The level of PSA in the blood may rise in men who have prostate cancer, BPH, or an infection in the prostate. The level of PAP rises above normal in many prostate cancer patients, especially if the cancer has spread beyond the prostate. In many cases, however, elevated PSA or PAP levels may also indicate oher, noncancerous problems.
  • Digital rectal exam - the doctor inserts a gloved, lubricated finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.
  • Cystoscopy - a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube
  • Intravenous pyelogram - a series of x-rays of the organs of the urinary tract.
  • Transrectal ultrasonography - ultrasound is emitted by a probe inserted into the rectum. The waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.

If the test results suggest that cancer may be present, the patient will need to have a biopsy. A biopsy is a definite way of knowing whether a problem is cancer or not. During a biopsy, the doctor removes a small amount of prostate tissue, usually with a needle.

Stages: When a pathologist looks at a tissue sample under a microscope to check for cancer cells, if cancer is present, the pathologist will assess the grade of the tumor. The grade tells how closely the tumor resembles normal prostate tissue and suggests how fast the tumor is likely to grow. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. Tumors with lower scores are less likely to grow or spread than tumors with higher scores. If the presence of cancer from the exam is negative, the doctor may recommend medicine or surgery to reduce the symptoms caused by an enlarged prostate.

If cancer is found in the prostate, the doctor needs to know the stage, or extent, of the disease. Various blood and imaging tests can be employed to learn the stage of the disease, and treatment decisions can depend on these findings:

  • Stage I(A)  The cancer cannot be detected by rectal exam and causes no symptoms. The cancer is usually found during surgery to relieve problems with urination. Stage I tumors may be in no more than one area of the prostate, but there is no evidence of spread outside the prostate
  • Stage II(B)  The tumor is felt in a rectal exam or detected by a blood test, but there is no evidence that the cancer has spread outside the prostate
  • Stage III(C)  The cancer has spread outside the prostate to nearby tissue. 
    Stage IV(D)  Cancer cells have spread to lymph nodes 





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