PROSTATE CANCER

The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder. Its main function is to produce fluid for semen, which transports sperm.

Prostate cancer is a malignant tumour that begins most often in the outer part of the prostate. It may spread to the inner part of the prostate and beyond the prostate to other parts of the body.

Most men who get prostate cancer are above the age of 50 years and the risk increases with age. Other risk factors are family history and smoking

In the early stages, when prostate cancer is a small, treatable tumour, there are usually no symptoms. When the growth becomes more advanced, urinary symptoms may develop. These include:

• frequent urination (especially at night)
• poor urinary stream
• inability to urinate
• interruption of urinary stream (stopping and starting)
• pain or burning on urination
• blood in the urine or semen
• persistent bone pain
• loss of weight or appetite

Rectal examination is the first step in diagnosing prostate cancer. Using a gloved finger to examine inside the rectum, the doctor may be able to feel a hard lump or growth in the prostate. This examination should be part of a regular checkup for all men over the age of 50. Another test that helps to detect prostate cancer is the presence of elevated levels of Prostate-Specific Antigen (PSA) in the blood. PSA is a substance produced by both normal and malignant prostate cells. Some men with BPH   or prostatitis (inflamed prostate) have increased levels of PSA without cancer. If initial clinical evaluation suggests the presence of prostate cancer, a biopsy of the prostate is usually recommended. This is done under ultrasound guidance and usually as day care procedure. If the biopsy is positive, then a F-18 bone scan and / or MRI scanning may be needed to help determine the extent of the cancer.

Stage 1  The doctor is unable to feel the tumor, but has been found during  TUR-P or was found by needle biopsy that was done for elevated PSA
Stage 2 The doctor can feel the tumor by rectal examination and it appears confined to the prostate gland.
Stage 3 Cancer has spread beyond the prostate to nearby tissues like seminal vesicles
Stage 4 Cancer has spread to other organs like bladder, rectum, the pelvic lymph nodes or to distant parts of the body, most commonly to the bones.  

Your doctor may use one or more of the following methods – surgery, hormone treatment, radiation and anti-cancer drugs. The choice depends on the stage of the cancer, your age and other medical co-morbidities. Radical prostatectomy is used to treat cancer localized in the prostate and involves complete removal of the prostate. Often the pelvic lymph nodes are removed as well. Radiation therapy uses high energy x-ray beam to kill cancer cells. Radiation may be given from a machine located outside the body (external radiation therapy), or from a radioactive substance introduced directly into the tumour. Sometimes a combination of these methods is used.   Both surgery and radiation provide excellent 10-year survival rates. Your doctor can help advise you about the best treatment for your cancer. Hormonal therapy is used to treat prostate cancer which has spread beyond the prostate. The 2 basic techniques involve:

• drugs that prevent the release or counter the action of male hormones
• surgical removal of the testicles, which make the male hormones. Because male hormones stimulate the growth of prostate cancer, treatments that interfere with the effect of these hormones can slow the cancer’s growth, sometimes dramatically. Occasionally, chemotherapy is used.

Watchful waiting has also been advocated as a reasonable approach for some men with prostate cancer. Not all men diagnosed with the disease require immediate treatment. Some cancers grow slowly and may take 10 years or more to cause problems or to spread. Immediate treatment may not be necessary for men with an early-stage cancer whose age or general health make it unlikely that they will live at least 8 to 10 years.

• Side effects of treatment

Surgical treatment of prostate cancer raises many questions about a man’s ability to remain sexually active. For some men, changes including impotence may be temporary but for others, these problems may be permanent. Urinary incontinence may be present. During radiation therapy, patients may notice a number of side effects, which usually disappear when treatment ends. For example, patients may have skin reactions (redness, dryness or wetness) in the area being treated, and they may feel unusually tried. Patients also may have diarrhea and frequent and uncomfortable urination. Some patients are impotent after radiation therapy. Hormone therapy also may cause side effects. Female hormones (estrogen) may cause breast tenderness and enlargement, nausea, vomiting and water retention. High doses of estrogen also increase the risk of heart problems. Sexual desire and impotence. The side effects of chemotherapy depend on the drugs given and the response of the individual patient. Chemotherapy commonly affects hair cells, blood-forming cells, and cells lining the digestive tract. As a result, patients may have side effects such as hair loss, lowered blood counts, nausea, or vomiting. Most side effects end after the treatment is over.

• Your future after treatment for prostate cancer: After treatment for prostate cancer, you should continue to visit your doctor for regular checkups. At various times after your treatment, your doctor will examine you and perform various tests to determine whether any further treatment is necessary. The PSA test has proved to be particularly useful in monitoring the response of prostate cancer to treatment.