Prostate Cancer
From Kidney Cancer Resource
Overview
The Prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system.
The Prostate Gland, is found only in men, it is a small gland about the size of a chestnut situated in the lower abdomen, at the base of the bladder.
The main function of the Prostate is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid. It contributes enzymes, proteins, sugars and fats to the seminal fluid to nourish spermatozoa, together they constitute semen. The rest of the seminal fluid is produced by the two seminal vesicles.
Much of the description and images have been taken from syndication.cancerconsultants.com
As men get older, changes occur due mainly to hormone activity, the Prostate Gland may become enlarged. This can causes pressure on the bladder and on the Urethra (the tube from the Bladder through the penis which allows urine to flow to void the Bladder). The pressure on the Urethra can lead to reduced flow and eventually to blockage of the flow and back pressure within the Bladder.
Most men who develop prostate problems, from middle age onwards, have Benign Prostate Hyperplasia (BHP) - this is a non-cancerous condition of the Prostate Gland. BPH (a Benign enlargement of the Prostate) is ten times more common than Prostate Cancer. Prostate Cancer is present in as many as 10% of men over the age of 60. The prostate is a male sex gland responsible for producing fluid that forms semen. It is located below the bladder, in front of the rectum and surrounds the urethra. The prostate is divided into three zones enclosed by a capsule. The prostate capsule separates the prostate from the rest of the body.
The prostate gland typically enlarges as men grow older. This growth of the gland is called benign prostatic hypertrophy (BPH) and most often occurs in the transition zone of the prostate, which surrounds the urethra. Prostate growth in this area may block the bladder or urethra and prevent the flow of urine. Men may experience frequent or painful urination; blood in the urine or semen; and stiffness or pain in the lower back. These symptoms may be caused by BPH or they may be signs of cancer.
The Prostate also contains some smooth muscles that help expel semen during ejaculation.
The Staging of Bladder Cancer in a male bladder showing the prostate
This diagram not only shows the Prostate Gland but also one of the sources of Prostate Cancer!
A Q&A Overview
A general Question & Answer style Overview in plain English can be found in Dr. Thomas Stuttaford's 2 Part article In The Times (London) which you can read if you Click Here
Caveat
In May 2004, at age 52, Dan Fogelberg was diagnosed with advanced prostate cancer. He was 56 when it finally claimed his life. Regrettably, with the help of two simple screening tools, his cancer almost certainly could have been detected and treated much sooner, before it had spread from his prostate gland.
Here is a corresponding plea in Dan's own words:
"To each and every man ... I cannot encourage you strongly enough to get a DRE (digital rectal exam) and a PSA (prostate specific antigen) test every year. The medical community suggests this for men over 50, but men with a family history of prostate cancer should start getting tested at age 40. You don't want to go through what I'm going through if you can avoid it."
Why am I so passionate about ensuring that Dan Fogelberg's death doesn't go unheeded? Because two years ago, at age 47, a simple blood test revealed that my PSA level was abnormally high for someone my age.
A subsequent biopsy revealed that I had early stage prostate cancer, after which I chose to have surgical treatment. Since then, I have been completely cancer-free.
I now hope to join other cancer survivors in sharing Dan's message and become, in some small way, "a living legacy to the leader of the band."
Don Geenen,
Appleton,
Wisconsin.
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What is Prostate Cancer?
Prostate Cancer is best understood by division into 3 categories:
Localised, Locally Advanced and Advanced.
Localised
this is contained within the Prostate Gland and causes no apparent Symptoms. This is usually a hidden cancer most often detected during screening or during investigation of some other problem. Many of the 'localised' cancer cases will never grow or spread.
Locally Advanced
this has spread in the area near the Prostate Gland
Advanced
here the cancer has spread beyond the Prostate Gland into the adjoining tissues including bone tissue.
Prostate Cancer is most unusual amongst young men, and dramatic increase in incidence from the age of 50.
Prostate cancer occurs when the cells in the prostate gland grow out of control. When cells grow out of control, they initially spread within the prostate and then grow through the capsule that covers the prostate into neighboring organs, or break away and spread through the bloodstream and lymphatic system to other parts of the body. Prostate cancer can be relatively harmless or extremely aggressive. Some prostate cancers are slow growing, causing few clinical symptoms. In these cases, a patient will often die with prostate cancer rather than from prostate cancer. Aggressive cancers spread rapidly to the lymph nodes, other organs and especially, bone.
The suspicion of prostate cancer usually arises from an elevated prostate-specific antigen (PSA) blood level test and/or a digital rectal exam (DRE). PSA is a protein that is normally secreted and disposed of by the prostate gland. High PSA levels sometimes indicate the presence of cancer; however, more tests are needed to confirm this suspicion. During a DRE, a physician inserts a gloved finger into the rectum to assess the texture and size of the prostate.
If the results from a PSA blood test and/or a DRE suggest that prostate cancer may be present, this suspicion needs to be confirmed by a biopsy. Prostate cancer is diagnosed by performing one or more biopsies of the prostate gland. The biopsy will determine whether a patient has BPH, cancer or another medical problem. During a biopsy, a needle is used to remove several small pieces of prostate tissue through the rectum. These tissue samples are then examined under the microscope to determine whether cancer cells are present.
If cancer cells are present, the next step is to determine the stage or extent of spread of the cancer. Determining the extent of the stage of the cancer may require a number of procedures, including additional surgery (lymph node evaluation), blood tests, ultrasound, chest x-rays and occasionally, CT/MRI or bone scans. Cancer that is removed by surgical resection or needle biopsy will be classified according to the Gleason Grading System for prostate cancer. This grading system, on a scale of 2-10, helps physicians predict how rapidly the cancer is likely to spread. Higher Gleason scores are associated with more advanced and more rapidly growing cancers than lower scores.
All new treatment information concerning prostate cancer is categorized and discussed by stage. When patients have early stage cancer, the Gleason score and PSA blood level provide additional information that will help them make treatment decisions.
Prostate-specific antigen (PSA) blood test: PSA is a protein that is normally secreted and disposed of by the prostate gland. In patients with a known diagnosis of prostate cancer, the PSA level roughly reflects the total amount of cancer. The higher the PSA level, the more likely that the cancer is advanced.
Prostate Cancer Video
We offer a choice of links to view Prostate Cancer Videos from a diagramatic walk through of slides, explaining all the details as you proceed to a live viewing of a Laparoscopic Prostatectomy.
When you view the page for Prostate Cancer Videos we do ask you to read the whole introduction page before you proceed.
How is Prostate Cancer detected?
Detection Early is Very Important
If you have problems when passing urine, your GP should suggest tests to identify the cause.
A Digital Rectal Examination DRE should be done
In all cases, this test should be done. This involves the doctor inserting his finger into the rectum & feeling the Prostate for any signs of enlargement, rigidity, nodes or other signs of abnormality.
A Prostate Specific Antigen (PSA) blood test should also be done
This is a normal blood test but involves a check to test for the presence of cancer. The test measures how much Specific Antigen is leaking from the Prostate into the general bloodstream. This can determine whether or not the problem is Prostate related (prostatic), the doctor can thus find evidence of malignancy as cancerous cells tend to leak significantly more of the enzyme into the bloodstream than does a Benign Tumours.
A PSA reading
A reading of 1 to 4 tends to indicate a healthy Prostate Gland even if it is enlarged. A benign growth is not normally the start of a Prostate Cancer. A PSA reading over 10 or any irregularities revealed during the Digital Rectal Examination tends to indicate a 50% probability of Prostate Cancer.
When the results are positive and indicate a probability of Prostate Cancer an Ultrasound & a biopsy are usually performed by a Urologist. The biopsy is conducted by inserting a small tube into the rectum. A needle is then guided through the tube, by ultrasound pictures, to the site of the dubious material in the Prostate and a small pieces are pared off for microscopic analysis and examination.
Risks
The cause or causes of prostate cancer are as yet unknown; it is however suggested that age related changes in the hormones of older men might be instrumental. Men who have a diet high in fats seem to have an increased incidence of developing the disease. There is also reasearch that indicates a familially increased insidence/risk though it seems only to be present in around 5% of patients.
Symptoms
common symptoms of Prostate Cancer
Signs and symptoms
NEVER ignore Symptoms - They Are There To Warn You!
Prostate cancer often doesn't produce any symptoms in its early stages. That's why many cases of prostate cancer aren't detected until it has spread beyond the prostate.
When signs and symptoms do occur, they may include any of the following:
- Dull pain in your lower pelvic area
- Urgency of urination
- Difficulty starting urination
- Pain during urination
- Weak urine flow and dribbling
- Intermittent urine flow
- A sensation that your bladder doesn't empty
- Frequent urination at night
- Blood in your urine
- Painful ejaculation
- General pain in your lower back, hips or upper thighs
- Loss of appetite and weight
- Persistent bone pain
common symptoms of Benign Prostate Hyperplasia (BPH) are:
Urinary Irregularities e.g.
Having to get up several times during the night to urinate.
Not being able be out for a couple of hours without needing a lavatory, or being unable to get through a meal or a meeting without a 'break'.
Urine Process Delay i.e.
A delay in time between when you are ready to urinate and when the urine flow.
Being unaware when the bladder is empty and not feeling your bladder has been fully emptied.
Late or poor cut off where there is unexpected release of urine after urination Dribbling. The bladder closes and shuts of flow sharply in young healthy males, but Prostate problems can damage this 'cut off'.
Intermittency, which can occur due to Prostate problems - where the flow varies from strong to stop to weak and back within a single episode of urination.
Pain
Prostate problems do not normally give rise to pain though an enlarged Prostate can give rise to discomfort during urination or in the area from the base of the penis through to the lower Bladder area.
**ALL The Above Symptoms are common to men with BHP but do not necessarily mean that they have or have not got Prostate Cancer. Although the symptoms of both Benign and Malignant Tumours may be similar, sufferers of Prostate Cancer may also pass blood in their urine Haematuria, experience pain during urination or ejaculation and some also have pain in the lower back. If you experience ANY of these symptoms, you should see your GP immediately who will carry out tests or refer you to a Urologist.
PC Treatment
What treatments are available?
Several factors influence the choices of treatment:
- Age
- Normal life expectancy
- General health
- The Stage of the cancer: Local, Locally Advanced or Advanced or Metastasised
Local Prostate Cancer can be treated by:
- observation - regular checks and see if there is developement
- Radical Radiotherapy (deep X-ray treatment).
Locally Advanced prostate Cancer can be treated by:
Advanced prostate cancer can be treated by:
Treatments for specific symptoms:
It is often necessary to remove the part of the Tumour which is blocking the Urethra and causing problems urinating. The commonest operation carried out is TURP (trans-urethral resection of the Prostate). It is usually carried out with an Epidural or general anaesthetic then through a tube type instrument into the Urethra. A series of instruments are introduced via the tube to remove the blockage. The Surgeon conducts the operation with a camera transmitting a picture to a TV style screen.
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Staging
Doctors will refer to the stage of prostate cancer by either a number or a letter. In order to learn more about the most recent information available concerning the treatment of prostate cancer, click on the appropriate stage
Stage I: The tumor (cancer) is not detectable with a physical examination.
T1a: The tumor is found when the prostate tissue is taken for some other reason. The tumor involves 5% or less of the prostate sample.
T1b: The tumor is found when the prostate tissue is taken for some other reason. The tumor involves more than 5% of the prostate sample.
T1c: The tumor detected by needle biopsy, or because the patient has a high blood level of PSA.
Stage II: The cancer is detectable with a physical examination, but is confined within the prostate.
T2a: The tumor involves half or less of a section (lobe) of the prostate.
T2b: The tumor involves half or more of a section (lobe) of the prostate, but the other section isn't involved at all.
T2c: The tumor involves both sections (lobes) of the prostate.
Stage III: The cancer extends through the capsule of tissue that surrounds the prostate.
T3a: The tumor has extended outside of the prostate on one side.
T3b: The tumor has extended outside of the prostate on both sides.
T3c: The tumor has invaded one or both of the seminal vesicles, which are small bag-like organs near the bladder.
Stage IV: The cancer involves structures outside the oprostate other than the seminal vesicle.
T4: The tumor has invaded other nearby organs, including part of the bladder, the sphincter, or the rectum.
D1: The tumor has spread to pelvic lymph nodes or is obstructing the ureters (the tubes from the kidneys to the bladder), or both.
D2: Cancer spread (metastasis) to lymph nodes outside the pelvic area, bone involvement, or spread to other distant parts of the body.
Recurrent/Relapsed: The prostate cancer has been detected or has returned (recurred/relapsed) following an initial treatment with surgery, radiation, hormonal therapy, or chemotherapy.
D3: Distant cancer spread as in D2, and the cancer is resistant (does not respond) to hormonal therapy.
PC Follow-up
Prostate_Cancer_MD Anderson (Oncology)
Prostate_Cancer_Veripath OncoDiagnostics
References
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