PROSTATE CANCER

Introduction:-

Prostate is a glandular organ present only in males. It surrounds the neck of bladder & the first part of urethra and condributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter.It has got five lobes anterior,posterior,two lateral and a median lobe.Since the first part of the urethra pass through it any lesion in the prostate will produce difficulty in passing urine.

Diseases of the prostate gland:-

1) Prostatitis:-
This is the inflamation of the prostate gland due to bacterial infection.

2) Benign enlargement of the prostate:-
This is a non cancerous tumour of the prostate seen after the age of 50. 3,Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males.

Cancer of the prostate.
Cancer of the prostate is directly linked with the male sex hormones(androgens).If the levels of sex hormone increases the growth rate of cancer also increases.It is found that after the removel of testes there is marked reduction in the size of tumour.

Site of tumour:-
Prostate cancer is seen mainly in the posterior lobe.Non cancerous enlargement is seen in other lobes.

Changes in the gland in cancer:-
The gland becomes hard with irregular surface with loss of normal lobulation .Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland)

Growth :-
Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.

Spread of tumour:-
Metastasis in cancer of prostate is very early.

1) Local spread:-
From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles.Tumour cells also move to the neck and base of the urinary bladder.

2) Lymphatic spread:-
Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes.From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest)

3) Spread through the blood:-
Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae.

Signs and symptoms of prostate cancer:--
Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.

1) No symptoms:-
Tumour is small and only in the posterior lobe. This is diagnosed accidentely.

2) Slight difficulty in urination:-
Here the tumour is enlarged and urethra is slightly compressed.Shortly there will be frequent urge for urination with difficult urination.

3) When the tumour spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding.Urine comes drop by drop.

4) Retention of urine:-
When the urethra is completely compressed there will be retention of urine.This can lead to hydronephrosis, renal failure ect.In this condition patient may get convulsions due to renal failure and finally coma.

5) Signs of metastasis:-
Some patients come with the signs and symptoms of metastasis.

a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.
b) Fracture of spine due to cancerous growth in the spine.
c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.
d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.
e) General weakness due to spread of cancer to different parts of the body.
f) Anaemia due to involment of bone marrow and increased destruction of RBCs.

Clinical examination :-
Includes per rectal examination to feel the prostate gland,palpation of abdomen to feel the swelling in kidneys and any tumours.Patient is examined from head to foot to find out any lesions.

Investigations:-
1) Complete blood investigations;-
RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.

2) Urine analysis:-
Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.

3) Renal function tests:-
Blood urea level,serum creatinine level,electrolyte level ect.

4) Serum acid phosphatase:-
Increased in cancer of prostate.

5) x-ray of the spine:-
To detect any tumour or fracture.

6) Ultra sonography;-
Gives idea about prostate,bladder,kidney ect.

7) C T scan:-

More detailed information about organs and tumour.

8) MRI of the spine:-
Gives detailed information about spine ,disc and nearby soft tissues.

9) Lymphangiography:-
Gives idea about lymphatic spread of cancer.

10) Biopsy to confirm cancer:-
Biopsy is taken from the tumour and is send for histopathological examination under the microscope.This will detect the presence of cancer cells.

Treatment:-
1) If there is retention of urine catheterisation is needed.
2) Dialysis if kidney failure.
3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.
4) Specific treatment is prostatectomy(removal of prostate)

Partial prostatectomy :-
Here only the affected lobe is removed.

Radical prostatectomy :-
Total removal of prostate along with nearby lymphnodes.

5, Hormone therapy :-
Stilbestrol is given to reduce tumour growth.Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.

6) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given.

7) Radiotherapy is also done for some cases.

8) Homoeopathy:-
Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms.Constitutional homoeopathic medicine will give great relief and can increase the life span.

9) Yoga and meditation is also helpful.

DNA Test May Gauge Risk of Prostate Cancer's Return

A new DNA test can identify prostate cancer patients at high risk for a return of their cancer, researchers say.

The test uses DNA from biopsy (tissue) samples taken before patients undergo surgery or radiation therapy for their cancer. The test is about 80 percent accurate in predicting which men have a high or low risk of their cancer returning within two years, according to the study.

The findings are scheduled for presentation Saturday at a meeting of the European Society for Radiotherapy and Oncology in Vienna.

Surgery and targeted radiation therapy are the main treatments for cancer that's confined to the prostate. However, cancer returns in 30 percent to 50 percent of patients because its spread outside the prostate was undetected during the initial treatment, said study author Robert Bristow. He is a clinician-scientist at the Princess Margaret Cancer Center in Toronto and a professor at the University of Toronto.

"Men who fail treatment within two years may be at the highest risk of dying from their prostate cancer," he said in a society news release.

"Existing methods for identifying high-risk patients are imperfect, so new tests are required that are better at predicting which patients will have their cancer recur," Bristow said. "These men can then be offered additional treatments, such as chemo- and hormone therapy, that will combat the prostate cancer throughout their entire body, rather than therapies solely focused on the prostate, in order to improve their chances of survival."

The test was assessed in 276 prostate cancer patients with an intermediate risk of cancer recurrence. It needs to be validated over the next few years in different and larger groups, the researchers said.

"If all goes well, then this will lead to a new test for cancer patients that can be turned around in three days and will tell doctors which patients will do well with local treatment alone -- surgery or radiotherapy -- and which will need extra treatment," Bristow said.

Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed journal.

(Source: MedicineNet)