What is Prostate?

The prostate is a walnut-sized gland located behind the base of the penis, in front of the rectum and below the bladder. It surrounds the urethra, the tube-like channel that carries urine and semen through the penis. The prostate’s main function is to produce seminal fluid, the liquid in semen that protects, supports, and helps transport sperm. It is common for the prostate to get larger as men grow older. This is called benign prostate hyperplasia (BPH). This is not cancer even though the symptoms can be similar to those of prostate cancer.

What is prostate cancer?

Prostate cancer is a malignant tumor that begins in the prostate gland. It is most common cancer in men. Some prostate cancers grow very slowly and may not cause problems for years. Early prostate cancers (also known as localised prostate cancers) are contained within the prostate. These early cancers often do not produce symptoms and may not become advanced cancer. Such cancers may not need treatment. However some prostate cancers grow and spread to the tissues around the prostate. This is called invasive prostate cancer.

What are the causes/risk factors?

Since the exact cause of prostate cancer is still unknown, it is also unknown how to prevent prostate cancer. The following factors can raise a person’s risk of developing prostate cancer:

1. Age

The risk of prostate cancer increases with age, rising rapidly after age 50. More than 80% of prostate cancers are diagnosed in men who are 65 years old or older.

2. Family history

A man who has a father or brother with prostate cancer has a higher risk of developing the disease than a man who does not.

3. Hormones

High levels of testosterone (a male sex hormone) may speed up or cause the development of prostate cancer.

What are the symptoms of prostate cancer?

• Weak or interrupted urine flow
• The urge to urinate frequently at night
• Frequent urination
• Pain or burning during urination
• Pain during ejaculation
• Blood in urine or semen

If you have this symptom please consult your doctor for further management.

How is prostate cancer diagnosed?

1. Prostate-specific antigen (PSA) test

Prostate-specific antigen is a substance (a type of protein released by prostate tissue) found in higher levels in a man’s blood when there is abnormal activity in the prostate, including prostate cancer, BPH, or prostatitis (inflammation of the prostate). A PSA test detects higher than normal levels of PSA that can indicate the presence of prostate cancer.

2. Digital rectal examination (DRE)

A doctor inserts a gloved, lubricated finger into a man’s rectum and feels the surface of the prostate for any irregularities. This test is not very sensitive; thus, most men with early prostate cancer have normal DREs.

3. Transrectal ultrasound (TRUS)

A doctor inserts a probe into the rectum and takes a picture of the prostate using sound waves that bounce off the prostate.

4. Biopsy

The only way to be sure of a cancer diagnosis is with a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope.

5. Computed tomography (CT or CAT) scan

A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine

6. Magnetic resonance imaging (MRI)

An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.

How you staging prostate cancer?

• Stage 1 Cancer confined to the prostate gland (<5% involvement)
• Stage 2 Cancer confined to the prostate gland(>5% involvement)
• Stage 3 Cancer involving the capsule of the prostate and/or seminal vesicles
• Stage 4 Cancer involving the a) surrounding organs, such as the bladder or rectum; b) pelvic lymph nodes; or c) other parts of the body (most commonly bone)

Treatment for prostate cancer?

The treatment of prostate cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health

1. Surgery
   There are two treatment options for stages 1 and 2: radical prostatectomy or radical radiotherapy.
   • Radical (open) prostatectomy
     A radical prostatectomy involves surgical removal of the whole prostate and accompanying seminal vesicles and possibly lymph nodes in the pelvic area. The 10-year survival rate following treatment is usually in the 80-90 per cent range.
   • Transurethral resection of the prostate(TURP)
     TURP is most often used to relieve symptoms of urinary obstruction, not to cure cancer.
2. Radiation therapy
   Radiation therapy uses high-energy rays to destroy cancer cells. Radiotherapy is usually employed instead of surgery in stage 3 and some cases of stage 4 cancer. Radiation therapy can be useful at all stages of localized cancer, either to try to cure the disease. Also, it is used as a method of relieving symptoms, such as pain in patients with advanced or metastatic cancer. Several treatments or “fractions” may be needed. Radiation therapy may cause the following side effects:
   • Diarrhea or other disruption of bowel function
   • Increased urinary urge or frequency
   • Fatigue
   • Impotence (inability to get an erection)
   • Rectal discomfort, burning, or pain
3. Hormone therapy
   Since prostate cancer growth is driven by male sex hormones known as androgens, reducing levels of these hormones can help slow the growth of the cancer. Hormone treatment is also called androgen ablation or androgen deprivation therapy. The most common androgen is testosterone. The production of testosterone can be reduced either surgically, with surgical castration, or through the use of drugs that turn off the function of the testicles
4. Chemotherapy
   Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy can be taken orally (by mouth) or intravenously, and it may help patients with advanced or hormone-refractory prostate cancer Treatment should be started earlier without waiting for symptoms to occur. This has been shown to prolong survival. Treatment is usually successful in the short term. Either method achieves a median survival of 30 months and 80% symptom relief. A patient with prostate cancer should be managed in a multidisciplinary manner consisting of an oncologist and the urologist. In this way the patient will be able to make an informed decision. If chemotherapy is to be given, it should be given by an oncologist.