The prostate is part of a man's reproductive system and is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate is a gland.
The prostate cancer is the most common type of cancer in men. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. Adenocarcinoma of the prostate is the clinical term for a cancerous tumor of the prostate gland. As prostate cancer grows, it may spread to the interior of the gland, to tissues near the prostate, to sac-like structures attached to the prostate (seminal vesicles), and to distant parts of the body . Prostate cancer confined to the gland often is treated successfully.
Symptoms of Prostate Cancer
A man with prostate cancer may not have any symptoms. Symptoms of prostate cancer are often similar to those of benign prostatic hyperplasia (BPH). Men observing the following signs and/or symptoms should see their physician for a thorough examination:
· Urinary problems - Not being able to pass urine Having a hard time starting or stopping the urine flow
· Needing to urinate often, especially at night
· Weak flow of urine
· Urine flow that starts and stops
· Pain or burning during urination
· Blood in the urine or semen
· Frequent pain in the lower back, hips, or upper thighs If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.
Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample.
The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. The digital rectal exam and PSA test can detect a problem in the prostate. However, they can't show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis.
Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. It also measures the size of the prostate, which can help to determine if the PSA level is elevated for the size of the prostate. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It's the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.
If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options. The most commonly used system for grading is the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue
Staging of Prostate Cancer
If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Some men may need tests that make pictures of the body:
Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones. Many times a plain x-ray is taken to help evaluate an abnormality seen on a bone scan.
CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis or other parts of the body. Doctors use CT scans to look for prostate cancer that has spread to lymph nodes and other areas. You may receive contrast material by injection into a blood vessel in your arm or hand, or by enema. The contrast material makes abnormal areas easier to see.
MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread to lymph nodes or other areas.
When prostate cancer spreads, it's often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells.
Stage I The cancer can't be felt during a digital rectal exam, and it can't be seen on an imaging study, such as ultrasound. It's found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate and is very low grade (low Gleason score)
Stage II: o The tumor is more advanced or a higher grade than Stage I, but the tumor doesn't extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram. It is detected either after a needle biopsy or surgery done for other reasons, i.e. resection of the prostate for benign enlargement.
Stage III: o The tumor extends beyond the capsule (outer covering) of the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven't spread to the lymph nodes, bones or other organs.
Stage IV: o The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.
Treatment of Prostate Cancer in India
Men with prostate cancer have many treatment options. The treatment that's best for one man may not be best for another. Your doctor will make recommendations that are best for each individual. The options include active surveillance (also called watchful waiting), surgery, radiation therapy, cryotherapy, hormone therapy, and chemotherapy. You may have a combination of treatments. The treatment that's right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
Surgery
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Surgery is an option for men with early (Stage I or II) prostate cancer. It's sometimes an option for men with Stage III or IV prostate cancer. Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment. After removing the prostate, the bladder is reconnected to the urethra (tube that men urinate through). Once healed, this will allow men to urinate normally. There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:
Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts A laparoscope and a robot are used to help remove the prostate. Instruments are passed through the small cuts and are used to remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.
Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. The incision typically is from the umbilicus (belly button) down to the pelvic bone. This is called a radical retropubic prostatectomy.
Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts , rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon see. Other instruments are passed through the small cuts. These instruments are used to remove the prostate.
TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.
After surgery, a catheter (flexible tube) is often left through the penis into the bladder. This allows the area to heal where the bladder and urethra are reconnected. Oftentimes patients only have to stay in the hospital overnight and can go home the following day. With newer surgical techniques, the complications from surgery are significantly reduced.
Radiation Therapy
Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. It also may be used if the cancer recurs after surgery. In later stages of prostate cancer, radiation treatment may be used to help relieve pain. Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area. Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:
- External radiation
- Internal radiation (implant radiation or brachytherapy)
Hormone Therapy
A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment. Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body's main source of the male hormone testosterone.
Chemotherapy
Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy. Chemotherapy uses drugs to kill cancer cells. The drugs for prostate cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, at the doctor's office, or at home. Some men need to stay in the hospital during treatment. The side effects depend mainly on which drugs are given and how much. Most go away when treatment ends.
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