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The
commonest form of skin cancer in the United States today
is skin cancer but, to most people's surprise, prostate
cancer is the second most frequently seen type of cancer.
So just what is prostate cancer?
The human body starts its life as a single
cell which then divides repeatedly to form new cells. As
cell division continues so the newly created cells, acting
as the building blocks of the human body, form into walls
of tissue and create the component parts that we recognize
as the human body. But this is not the end of the process
as, throughout life, our bodies change constantly as old
cells wear out and die and other newer cells continue the
process of division to replace them.
From time to time however this process of division does
not follow the pattern that it should and cells that should
die do not and other cells divide incorrectly so that the
two cells formed do not carry the correct information for
the new cells to function correctly. At the same time this
often sets off a chain reaction so that these cells in turn
start to divide forming further faulty cells.
In some cases the mass of cells produced, known as a tumor,
is quite harmless (benign) while in other cases the cells
can be dangerous (malignant) or even life threatening.
This, in simple terms, is the basis of all cancers and,
where faulty cell division takes place in the prostate,
then the result is prostate cancer.
However, prostate cancer is not always limited to the prostate.
Occasionally, faulty cells in the prostate will break away
and then be carried through the bloodstream to other areas
of the body where they will eventually lodge themselves
and continue the process of division and invasion of the
new surrounding tissue. Although this cancer is not now
restricted to the prostrate it is nonetheless referred to
as prostate cancer as this was its point of origin.
Throughout this website we look in detail at prostate cancer
considering such things as its symptoms and treatment. We
also examine just what the prostate is, how it works and
problems that can arise with it, in addition to problem
of cancer.
For information on any specific area of interest, please
choose the relevant topic from the menu on the left-hand
side of this page.
prostate gland
The prostate gland, which is approximately
three centimetres in length and weighs about twenty grams,
sits between the bladder and the rectum and partially surrounds
the urethra the tube which carries urine from the bladder
and semen during ejaculation.
The primary function of the prostate gland is to produce
and store a clear fluid which makes up about thirty percent
of male semen.
To function properly the prostate gland requires male hormones
known as androgens. These hormones include testosterone,
which is made in the testes and to a lesser extent in the
adrenal glands, dehydroepiandrosterone, which is made in
the adrenal glands and dihydrotestosterone, which the prostate
manufactures itself.
Although we often think of prostate cancer whenever the
prostate is mentioned (simply because this form of cancer
is so prevalent in western society today), there are numerous
other problems that can affect the prostate gland, many
of which can be quite easily treated.
Because of its location, diseases of the prostate gland
can often result in difficulties with both urination and
defecation as well as with ejaculation.
prostate Problems
The majority of prostate problems are
caused by abnormal cell growth.
Throughout life the cells of our body age and die and are
replaced by new cells created from the division of younger,
healthy cells.
Occasionally however the process of cell division goes wrong
and cells divide incorrectly and set off a chain reaction
creating a mass of abnormal cells in the organ in which
they are formed, as well as sometimes invading the surrounding
tissue.
In addition, it is not uncommon for some of these cells
to break away and to be carried to other areas of the body
usually through the bloodstream or the lymphatic system.
In this case the cells will eventually come to rest at some
point and continue the process of abnormal division in a
new organ of the body.
The mass of cells formed by this process is known as a tumor
and, depending upon just what goes wrong with the process
of division, a tumor can either be relatively harmless in
itself, in which case it is known as benign, or can contain
harmful cancer cells, in which case it is said to be malignant.
Here is a general description of the two different types
of tumor:
Benign tumors:
o Do not carry cancer.
o Are seldom life threatening.
o Can normally be removed and will not return.
o Do not invade the tissue surrounding them.
o Do not spread to other areas of the body.
Malignant tumors:
o Do carry cancer cell.
o Can be life threatening.
o Can often be removed but sometimes return.
o Can invade surrounding tissue and organs.
o Can spread (metastasize) to other areas of
the body.
One of the more commonly seen prostate
problems is that of benign prostatic hyperplasia (BPH) in
which the growth of a benign tumor within the prostate causes
the gland to enlarge and restrict the flow of urine through
the urethra.
There are two main stages to the growth of the prostate
during a mans life. The first is a period of fairly rapid
growth in the early years of puberty with the prostate approximately
doubling in size. The second stage starts in a mans mid-twenties
and sees much slower growth which continues throughout life.
For most men this second phase of growth causes little if
any problems until they are well into their sixties or seventies
when the symptoms produced by the enlarged prostate may
start to appear. At this point a visit to your doctor will
reveal nothing more than the presence of a simple enlarged
prostate and your doctor will say that you are suffering
from benign prostatic hyperplasia, benign prostatic hypertrophy
or BPH.
Lying just below the bladder, the prostate gland partially
surrounds the urethra the tube that carries urine from
the bladder. As the prostate gland enlarges, the tissue
surrounding it restricts its expansion and causes the prostate
to close around the urethra, restricting the flow through
the urethra. At the same time, the bladder wall thickens
and the bladder begins contracting even when it contains
quite small amounts of urine. In the end, the bladder weakens
and loses its ability to empty itself, so that urine remains
in the bladder.
The exact symptoms experienced as a result of an enlarged
prostate will obviously vary from individual to individual
but, in general, the initial signs will be a change in your
pattern of urination or a difficulty in urinating. For example
you may experience:
A weak flow of urine.
A hesitant flow of urine which tends to stop and start.
An inability to "hold on" and calls to the bathroom
which become increasingly urgent.
A need to visit the bathroom more frequently, particularly
during the night.
A tendency to leak or dribble urine.
In certain cases you could be totally
unaware of any problem until you suddenly find that you
cannot urinate at all. In this case, referred to as acute
urinary retention, the problem is often triggered by common
medicines containing a decongestant and used in cold and
allergy treatments. Acute urinary retention can also be
brought on by cold, alcohol or an extended period of immobility.
In most cases these symptoms arise simply from an enlarged
prostate and this will be confirmed by a visit to your doctor
who can usually treat the condition quite easily. It is,
however, important that you visit your doctor if you encounter
any of these symptoms as, in some cases, they may indicate
a more serious underlying problem, such as cancer.
A visit to the doctor is also vital as, despite the fact
that many cases of BPH may be treated fairly easily, the
condition can lead to a urinary tract infection, bladder
and/or kidney damage, bladder stones and incontinence.
An early visit to the doctor can have the condition cleared
up quickly and considerably reduce the risk of developing
complications.
enlarged prostate
There are two main stages to the growth
of the prostate during a mans life. The first is a period
of fairly rapid growth in the early years of puberty with
the prostate approximately doubling in size. The second
stage starts in a mans mid-twenties and sees much slower
growth which continues throughout life.
For most men this second phase of growth causes little if
any problems until they are well into their sixties or seventies
when the symptoms produced by the enlarged prostate may
start to appear. At this point a visit to your doctor will
reveal nothing more than the presence of a simple enlarged
prostate and your doctor will say that you are suffering
from benign prostatic hyperplasia, benign prostatic hypertrophy
or BPH.
Lying just below the bladder, the prostate gland partially
surrounds the urethra the tube that carries urine from
the bladder. As the prostate gland enlarges, the tissue
surrounding it restricts its expansion and causes the prostate
to close around the urethra, restricting the flow through
the urethra. At the same time, the bladder wall thickens
and the bladder begins contracting even when it contains
quite small amounts of urine. In the end, the bladder weakens
and loses its ability to empty itself, so that urine remains
in the bladder.
The exact symptoms experienced as a result of an enlarged
prostate will obviously vary from individual to individual
but, in general, the initial signs will be a change in your
pattern of urination or a difficulty in urinating. For example
you may experience:
A weak flow of urine.
A hesitant flow of urine which tends to stop and start.
An inability to "hold on" and calls to the bathroom
which become increasingly urgent.
A need to visit the bathroom more frequently, particularly
during the night.
A tendency to leak or dribble urine.
In certain cases you could be totally unaware of any problem
until you suddenly find that you cannot urinate at all.
In this case, referred to as acute urinary retention, the
problem is often triggered by common medicines containing
a decongestant and used in cold and allergy treatments.
Acute urinary retention can also be brought on by cold,
alcohol or an extended period of immobility.
In most cases these symptoms arise simply from an enlarged
prostate and this will be confirmed by a visit to your doctor
who can usually treat the condition quite easily. It is,
however, important that you visit your doctor if you encounter
any of these symptoms as, in some cases, they may indicate
a more serious underlying problem, such as cancer.
A visit to the doctor is also vital as, despite the fact
that many cases of BPH may be treated fairly easily, the
condition can lead to a urinary tract infection, bladder
and/or kidney damage, bladder stones and incontinence.
An early visit to the doctor can have the condition cleared
up quickly and considerably reduce the risk of developing
complications.
prostate symptoms
As with many diseases it is possible to
develop prostate cancer without experiencing any symptoms.
Where prostate symptoms are present however they may include
the following:
Problems urinating.
o An inability to urinate at all.
o Difficulty in controlling the flow of urine (starting
or stopping the urine flow).
o A need to urinate frequently, particularly during the
night.
o A weak flow of urine.
o An intermittent flow of urine (a flow that starts and
stops uncontrollably).
o Pain or a burning sensation when urinating.
Problems achieving or maintaining an erection.
The presence of blood in the urine or
semen.
Pain in the lower back, upper thigh
or hips.
In the majority of cases these prostate
symptoms will result from an infection or other health problem
but will not be indicative of cancer.
Where prostate symptoms are detected however you should
of course consult your doctor so that a diagnosis can be
made.
If you would prefer not to see your own doctor then you
should visit the urologist (a doctor specializing in diseases
of the urinary system) at your local hospital.
the risks of getting prostate cancer
The precise cause (or causes) of prostate cancer is unknown
but a number of factors have been identified that appear
to put an individual at greater risk of contracting this
disease. These prostate cancer risk factors include:
Age. It is extremely rare for a man to contract the disease
under the age of 40. About one quarter of all cases appear
between the ages of 40 and 65, with the remaining three
quarters of cases diagnosed appearing after the age of 65.
It is interesting to note too that prostate cancer generally
develops quite slowly and sufferers can remain free of symptoms
for many years. As a result the average age at which the
disease is diagnosed is 70.
Race. The disease appears more frequently
in African American men than in white or Hispanic men. It
is seen least of all in Asian men and American Indian men.
Family history. A man is more likely
to contract the disease if his father or a brother has suffered
from it.
Diet. Although there is some uncertainty
about the role that diet plays, it is generally felt that
a diet that is high in meat and animal fat produces a greater
risk of contracting the disease. It is also believed that
a diet rich in vegetables and fruit can decrease the risk
of contracting the disease. There is insufficient data at
this time to show the effect of dietary supplements although
studies are currently being undertaken.
In addition to the prostate cancer risk factors identified
here there is also a school of thought that believes that
such things as smoking, obesity, lack of exercise and sexually
transmitted viruses may also put individuals at greater
risk of contracting prostate cancer. At this time however
there is little if any evidence to support this.
prostate screening
As with many diseases, your doctor can carry out prostate
screening before any symptoms develop but, although prostate
screening is available, it does not seem at present to produce
any noticeable decrease in the number of deaths from prostate
cancer.
Whether or not you should be screened is, like many other
medical choices, very much a personal decision and is something
that you should discuss with your doctor. In this case however
there are clearly benefits but also disadvantages to prostate
screening and so you need to think carefully before committing
yourself either way.
If you do decide to opt for prostate screening then there
are two options open to you:
A digital rectal examination in which the doctor examines
the prostate using a lubricated gloved finger inserted through
the rectum. The prostate can be felt through the rectal
wall and the doctor will be looking at its general size
and feeling for any unusual lumps or hardness.
A blood test designed to check for the presence of a prostate
specific antigen. High levels of this antigen would not
in itself be indicative of cancer but would indicate the
presence of inflammation of the prostate. Such inflammation
could result from a condition known as benign prostatic
hyperplasia (BPH) in which an abnormal, but otherwise harmless,
growth of cells causes an enlargement of the prostate gland.
As this growth continues, and the benign tumor enlarges,
the gland will close around the urethra and restrict the
normal flow of urine.
With both forms of prostate screening a problem with the
gland can be detected, but further tests would be necessary
to confirm that this problem was the result of cancer.
prostate cancer Diagnosis
If you or your doctor has reason to suspect that prostate
cancer may be present then your doctor will carry out some
preliminary tests to make a prostate cancer diagnosis. These
might include a digital rectal examination, a check of your
urine for signs of blood or infection and a blood test to
check for levels of prostate specific antigen (PSA).
If these tests indicate the possibility of cancer then further
tests will be undertaken which might include:
Transrectal ultrasound. A probe is inserted into the rectum
and emits ultrasound waves which are bounced off the prostate
gland. The reflected sound waves are then analyzed by computer
to produce a picture of the gland known as a sonogram.
Cystoscopy. A thin light probe is inserted
into the urethra allowing the doctor to examine both the
urethra and the bladder.
Transrectal biopsy. A needle is inserted
into the prostate through the rectum and small samples of
tissue are taken from different areas of the gland. These
tissue sample are then examined for the presence of cancer
cells. This is the only sure way to diagnose prostate cancer.
If the results of these preliminary prostate
cancer diagnosis tests do not indicate the presence of cancer
then your doctor may prescribe medication to reduce inflammation
of the gland or may recommend surgery to reduce the size
of the gland. In the case of surgery a procedure called
transurethral resection of the prostate is often used in
which an instrument is inserted through the urethra and
the tissue that is restricting the urethra is removed.
If this initial prostate cancer diagnosis does reveal the
presence of cancer cells then further investigation is necessary
to determine the extent of the cancer.
prostate cancer stages
Once cancer has been diagnosed your doctor will need to
assess the extent of the disease. (The disease, like many
other cancers will progress through a series of prostate
cancer stages). This assessment will look at the size of
the tumor, whether or not the disease has spread to other
areas of the body and, if it has, just where in the body
it has spread to.
Normally a further blood test will be carried out in the
first instant to assess whether or not the disease has spread
outside the prostate gland and then further test options
will include:
A bone scan: A small quantity of a radioactive substance
is injected into a blood vessel, travels through the bloodstream
and collects in the bones. A scanner is then used to detect
and measure the radiation and to create a series of pictures
of the bones on computer which show cancer that has spread
to the bones.
A CT scan: An x-ray machine which is
linked to a computer is used to take a series of pictures
of various areas of the body.
A MRI scan: This is similar in principle
to the CT scan but uses a strong magnet rather than x-rays
to make detailed pictures of areas inside the body.
Once the results of one or more of these
tests are to hand the doctor will asses your prostate cancer
as falling into one of the following prostate cancer stages:
Stage I: Cancer is confined to the prostate. Stage I cancer
is not detectable by digital rectal examination and is normally
found by chance during surgery for some other reason - often
for benign prostatic hyperplasia (BPH).
Stage II: Cancer is again confined to
the prostate but is now more advanced.
Stage III: Cancer has spread outside
of the prostate, perhaps into nearby seminal vesicles, but
has not yet spread to the lymph nodes.
Stage IV: Cancer may have spread to
nearby muscles and organs (beyond the seminal vesicles)
as well as to the lymph nodes and other parts of the body.
prostate cancer treatment
If your cancer is at an early stage your doctor may recommend
that prostate cancer treatment is not carried out at this
point but that your health is simply monitored closely.
This is often referred to as watchful waiting. Once the
disease becomes more advance, treatment options might include
surgery, radiation therapy, hormone therapy or a combination
of these treatment methods.
Prostate cancer treatment is frequently referred to as being
either local therapy or systematic therapy:
Local therapy. Both surgery and radiation therapy are
forms of local therapy aimed specifically at the prostate
gland, or other specific areas of the body if the cancer
has spread.
Systematic therapy. Hormone therapy is a form of systematic
therapy aimed at a wide area of the body and designed to
treat the spread of cancer.
Prostate cancer treatment should be tailored to suit the
requirements of each individual patient and treatment that
is right for one patient may not be suitable for another.
In addition, prostate cancer treatment often damages healthy
cells and tissue in the surrounding area and can create
considerable side-effects. These side-effects will also
vary considerably from one person to the next and, as treatment
is often ongoing for a period of weeks or months, can also
vary greatly over time in one individual.
For this reason patients must consider carefully not only
the benefits of a particular course of prostate cancer treatment
but also the price that will have to be paid to achieve
these benefits.
prostate cancer surgery
In early stage prostate cancer, where the disease is confined
to the prostate gland, prostate cancer surgery is often
the preferred treatment.
There are various different forms of prostate cancer surgery
that can be performed including:
Radical retropubic prostatectomy. The entire gland, and
nearby lymph nodes, is removed through an incision in the
abdomen.
Radical perineal prostatectomy. The
entire gland is removed through an incision between the
scrotum and the anus. Nearby lymph nodes can also be removed
at the same time through a separate incision in the abdomen.
Laparoscopic prostatectomy. The entire
gland, and nearby lymph nodes, is removed through a number
of small incisions, rather than a single long cut in the
abdomen. A thin, lighted tube known as a laparoscope is
used to remove the prostate.
Transurethral resection of the prostate
(TURP). Part of the gland is removed using a long, thin
device which is inserted through the urethra. TURP may not
remove all of the cancer, but it can remove tissue that
is blocking the flow of urine.
Pelvic lymphadenectomy. This procedure
is routinely carried out during prostate surgery. Lymph
nodes in the pelvis are removed to see if cancer has spread
to them, indicating that the disease may have spread to
other parts of the body.
Prostate cancer surgery can cause a number
of short-term problems, such as incontinence, although these
normally disappear within a few weeks of surgery.
In some cases however prostate cancer surgery results in
impotence which may be permanent. This normally occurs where
nerves are damaged during surgery and while nerve-sparing
surgical techniques can be employed to help prevent impotence,
the extent of the prostate cancer surgery necessary to remove
the cancer cells means that sometimes nerve damage is inevitable.
You should also note that, if your prostate is removed,
you will no longer be able to produce sperm and will experience
what is known as a dry orgasm. You should therefore consider
sperm retrieval and sperm banking if you wish to retain
the ability to father children.
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