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The prostate is a gland found in the male reproductive system that produces a fluid which is a component of sperm. This gland has the size of a nut and is located next to the bladder, surrounding the upper part of the urethra (the tube through which the urine is eliminated). A functioning prostate gland is influenced by testosterone (a type of hormone produced inside the testicles). Prostate cancer became an important health problem in most countries. The disease is rare in men under 50 years old, but experts believe that a periodical medical check-up is required at any age.
The cells that will eventually form the actual tumor won’t develop and multiply normally – they grow uncontrollably and spread to other locations in the body (the same goes with other types of cancer). Prostate cancer involves a slow-growing tumor, reason why symptoms are usually encountered in advanced stages. Most men that suffer from prostate cancer die from other various causes. Many people are not aware they are suffering from this condition until they undergo thorough investigations. Once cancer starts growing faster and expanding to other tissues in the body, it can represent a risk for the patient. Aggressive prostate cancer can occur at any age. Even though this disease is popular for its slow progress, it is important to know that it can be deadly once the tumor grew past the normal limits.
When prostate cancer is discovered on time, it can be easily cured. The only situation when prostate cancer can no longer be cured is when the disease extends beyond the prostatic tissue to the bones, lungs or lymph nodes. Yet, it can be controlled for long periods of time. Due to today’s available treatments, most men whose cancer has spread beyond the normal parameters encounter a life expectancy of five or more years.
Prostate cancer usually affects elderly men, as mentioned above. Four out of five cases are being diagnosed in men who reached the age of 65. Less than 1% of the prostate cancer cases are being diagnosed before the age of 50. Although it is rare, prostate cancer can be also found in patients aged 30-40. Men who know that they have other cases of prostate cancer in the family should undergo more investigations since they are at higher risk of developing this illness than the rest of the people. Doctors are not able to tell what the causes of prostate cancer are in each particular case, but it is well-known that diet and lifestyle habits are influencing factors. Men who consume large amounts of fat (especially red meat or animal fat) are at a greater risk of developing prostate cancer. Plus, this condition is much more common in countries where meat and dairy products are exaggeratedly consumed. In countries where foods like rice, soy, and vegetables are consumed predominantly, the risk of developing prostate cancer is lower.
Another factor that can influence the apparition of prostate cancer would be the over-production or the lack of certain hormones in the body. Consuming fatty foods stimulates an increased production of testosterone and other hormones, which eventually stimulates the tumor growth. An increased level of testosterone in the body can stimulate dormant cancer cells, thus becoming active. Several studies suggest that often meat consumption is risky because of a multitude of reasons since it leads to producing carcinogenic substances that directly affect certain tissues in the body (e.g. prostate gland). People who work in such environments that are exposing them to cadmium are more likely to develop prostate cancer at some point in their lives. Researchers also took into account what other causes of prostate cancer might be possible and they found out that there is no link between prostate cancer and a sexually active life.
In the early stage of prostate cancer, there are no visible signs and symptoms that can warn a person regarding this affection. Once the malignant tumor which was already formed causes a significant increase in the prostate gland’s size, the following symptoms can occur:
Yet, the patient must understand that these are not symptoms of cancer itself, but of the blockages the growth of the tumor causes. In aggressive cases of prostate cancer, one can encounter permanent pain in the pelvic area or the lumbar region, weight loss, lack of appetite, fatigue, nausea, vomiting etc.
When do I need to see a doctor?
Since the symptoms of prostate cancer are quite confusing, the patient should go to see a doctor periodically (preferably annually) in order to make sure that there is nothing wrong. Yet, seeking medical advice is paramount when urinating difficulties are encountered. A doctor should examine the prostate to determine whether it is enlarged or inflamed due to an infection. Also, chronic back pain requires the attention of a medic. Pain in different locations of the body can have diverse causes and prostate cancer is not necessarily involved. A patient should see a doctor if he encounters an unexplained weight loss at any given moment.
There are two main tests that should be used in order to diagnose prostate cancer when no symptoms are present. One of them is called a rectal examination (or a prostate exam). The doctor will check if there are any nodules present on the surface of the prostate gland or if it is increased in size. Another test includes blood samples that are used to detect if there is prostate-secreted substance present in the body. This substance is represented by a prostate-specific antigen (PSA). The best results are obtained when both of these tests are taken into account. Many patients who did had a mild PSA growth in their bodies were not diagnosed with prostate cancer, in the end, so the tests are not completely reliable. Some men can have the PSA value within the normal range, yet suffer from prostate cancer.
A way to confirm whether a person has prostate cancer or not would be undergoing a microscopic examination of the prostate cells of a patient. For this, the urologist should perform a biopsy, where a small piece of the tissue is sampled from a patient’s potentially affected area.
In the early stages of prostate cancer, the tumor can be limited and even removed using certain types of treatment. For instance, when the tumor is metastatic and neither the surrounding tissues nor the nearby organs are affected, it is very likely to treat cancer completely. One in two men diagnosed with prostate cancer which is in a final stage face the risk of dying. There are three main types of treatment that can be used in an early stage of cancer:
The treatment scheme is chosen according to several factors that can influence their effects:
When it comes to surgical treatment, the tumor can be removed. This procedure is called a radical prostatectomy. This is the most suitable option for younger men, who are not suffering from any other kinds of diseases. Before this surgery is performed on a patient, the doctor needs to make sure that the tumor did not spread to the lymph nodes in the area, because – in this case – the disease is extensive and there are minimal chances of healing through surgery. For this, the doctor should perform a pelvic lymphadenectomy, a procedure which involves removing the lymph nodes present in the pelvis area. The ganglia will then be analyzed by anatompathologists under the microscope. If cancer cells are present, then the surgeon will not opt for a radical prostatectomy.
The less invasive method of prostatectomy would be the laparoscopic one, which involves using tools that are inserted into the patient’s body through small incisions. This procedure is associated with fewer complications and faster recovery.
In the case of benign prostate adenoma, it would be recommended to use a transurethral prostate resection. The surgeon inserts a small surgical instrument through the urethra, then removes the prostatic tissue that causes problems such as difficult or painful urination. The prostate is not completely removed. Intervention is sometimes used to relieve symptoms of prostate cancer in elderly patients who do not represent suitable candidates for a radical prostatectomy.
What complications can occur?
Since there are delicate, fine nerves that are passing through/near the prostate, even the most experienced and attentive surgeon won’t be able to avoid complications. The most common complication would be erectile dysfunction. Yet, this affection tends to improve once time passes by, considering that nearly half of the patients whose nerves remained intact after the operation experienced a complete recovery.
Another common complication would be represented by urinary or fecal incontinence (some involuntary urine/feces leakages). As mentioned before, these complications can or cannot improve over time. It depends on how the patient recovers and how the doctor performs the surgery. Approximately 10% of the patients experience permanent incontinence after the surgery.
There are two main types of radiotherapy: first would be the external irradiation and the second would be brachytherapy. In the first case, the prostate gland is exposed to high energy X-Rays that are released into a patient’s body through a medical device. In the latter case, small radioactive sealed sources are placed near the area which requires treatment. Thus, healthy tissues are not being exposed to high doses of radiation as they would be using other methods, taking into account the fact that modulated intensity radioactive therapies allow using a precise distribution of the radiation.
This method is suitable for elderly patients who are suffering from other conditions. Applying a treatment scheme to this category of patients can be even more damaging than cancer itself. With standby management, patients with early, low-risk tumors can simply make appointments for periodical checkups to see how cancer evolves.
Several studies showed that patients with small tumors, limited to the prostate gland and a non-aggressive stage, had an excellent survival rate. These results were valid irrespective of the age of the patient. None of the men in the study was diagnosed by PSA testing.
PSA testing is relatively recent and controversial as a method for detecting prostate cancer. Part of the controversy is that the test can detect cancers at a very early stage that otherwise does not cause any problems. In another study, the same group of men was surveilled for a longer time. After an average of 21 years, 91% of the subjects were already deceased. 16% of deaths were attributed to prostate cancer.
Most prostate tumors grow faster in the presence of testosterone and other male androgenic hormones. Yet, there are certain kinds of therapy that can help with blocking the androgen action or interrupt their production entirely. This may significantly delay the progression of the disease without being as invasive as a surgery. The androgen deprivation therapy, also known as ADT therapy can be administered in different ways. These ways can be used either alone or in combinations. The treatment can be:
Possible side effects:
As mentioned before, there is no known cause of the apparition of prostate cancer. However, there are a number of risk factors that can be involved. See below a list of prostate cancer development risk factors: