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Prostate Cancer

Only men have prostate gland, a small walnut size gland that is located below the bladder in front of rectum and surrounds the urethra (tube men urinate and ejaculate through). It is important part of the male reproductive system and its main job is to make semen that enriches sperm. The male hormone testosterone helps the prostate to grow and develop also prostate gland that produces some of the fluid in semen and plays a role in urine control in men. It can tighten and restrict the flow of urine through the urethra using thousands of tiny muscle fibers. The prostate is a gland found only in males.

Prostate cancer is one of the most common cancers in men and is usually comprised of adenocarcinoma cells that arise from glandular tissue. It usually grows slowly and may initially confine to prostate only that may need minimal or even no treatment and has a better chance of successful treatment whereas some other types of prostate cancers are more aggressive and can metastasizes quickly. It is common in men over 50, especially in African-Americans and in men who eat unhealthy fatty food and/or it can be genetic also.

The exact causes of prostate cancer are not clear. Prostate cancer occur when some specific genes (inherited from parents) that control the growth or death of the cell are affected resulting in abnormal cell growth or death. Mutation in theabnormal cells’ DNA causes the cells to grow and divide quickly than normal cells do. The abnormal cells live while other cells die. These abnormal cells accumulate and form a tumor that can spread to nearby tissue. Some abnormal cells can grow to invade other parts of the body (called metastasize).

Symptoms of prostate cancer include urinary problems (little or no urine output, difficulty starting (straining) or stopping the urine stream, frequent urination, dribbling, pain or burning during urination), erectile problem, less ejaculation, blood in urine or semen, hip, pelvic or pain in abdomen, weight loss, bone pain and lower extremity swelling.

There are some factors that can increase the risk of prostate cancer including :

• Age – the chances of prostate cancer increases with age. It is most common in men above 50 years of an age.

• Race or ethnicity – African –American men (black) carry higher risk of progressive or advanced prostate cancer than others.

• Genetic –have more chances of developing prostate cancer if the patient’s father or brother has it in their genes as it runs in families.

• Nationality – it occurs more frequently in North America, Europe, Caribbean island and Australia as compared to Asia, Africa, South and Central America.

• Obesity- obese men have increased chances of developing prostate cancers or some other advance diseases that’s more difficult to treat.

• Other factors –regular smoking and diets rich in red meats and fatty foods are associated with a higher risk of developing prostate cancer.

Prostate cancer is usually difficult to diagnose during the early stages. Some of the signs of prostate cancer and advanced prostate are:

• Frequent urges to urinate (at night also)

• Difficulty in starting and maintaining urinating

• Blood in urine

• Pain during urination or ejaculation

• Erectile dysfunction

• Urinary inconsistence

• If cancer spreads to the spine and compresses the spinal cord resulting in leg weakness or fecal incontinence

• Bone pain (in advance prostate cancer)

• Bone fractures

• Unexplained weight loss

• Fatigue

Doctor will perform several important tests that may help in diagnosing the prostate cancer such as:

• Prostate Specific Antigen (PSA) blood test to see if there is an increase in specific protein. • Digital rectal examination (DRE) – to check the size of the prostate and assess if there are any abnormalities.

Doctor may recommend some further tests if there are any abnormalities detected in DRE or PSA tests such as:

• Ultrasound – transrectal ultrasound to further evaluate the prostate. A small probe is inserted into the rectum which uses sound waves to create a picture of the prostate gland.

• Prostate biopsy – a sample of cells is collected from the prostate. It is done with the help of a thin needle that is inserted into the prostate to collect tissue to detect the presence of any cancer cells.

• A biomarker test – to check the blood, urine or body tissue of a person with cancer.

Once the test confirms the cancer, doctor will determine the level (stage) of aggressiveness of the cancer cells. A higher grade shows more aggressive cancer which is more likely to spread quickly. If cancer has spread to other parts of the body then some more imaging tests may be recommended that include:

• Bone scan

• Computerized Tomography (CT scan)

• Magnetic resonance imaging (MRI scan)

• Positron emission tomography (PET scan)

After completing tests, doctor assigns cancer a stage to help in determining the best treatment options. These stages are:

• Stage 1 – this is very early stage of cancer which is confined to a small part of the prostate. These cancer cells can be viewed under a microscope and aren’t considered aggressive.

• Stage 2 – even at this stage, cancer may still be small but may consider aggressive when cells are viewed under the microscope.

• Stage 3 – cancer spreads beyond the prostate to seminal vesicle or other nearby tissues.

• Stage 4 – cancer grown to invade other nearby organs such as the bladder, or to lymph nodes, bones or lungs.

Treatment for prostate cancer depends on several factors such as how fast is cancer growing, how vast it has spread, and overall health of the patient. Men diagnosed with low risk prostate cancer may not require immediate treatment but may need regular follow – up blood tests, rectal exam and biopsies to monitor the progression of the cancer. If it is progressing then patient may go for surgery or radiation.

Radical prostatectomy – is a surgery that involves removing of the prostate gland, surrounding tissues and few lymph nodes. It carries a risk of urinary incontinence and erectile dysfunction.

This surgery can be performed mainly in two ways:

• Robot assisted surgery- in this surgery; the instruments attached to a robot are inserted into the patient’s abdomen through many small incisions. The surgeon at console can use a hand controls to guide the robot to operate. In robotic prostatectomy, surgeon can make more-accurate movements with the help of surgical tools as compared to traditional minimally invasive surgery.

• Making an incision in your abdomen - the prostate gland is taken out through an incision in the lower abdomen of the patient.

Radiation therapy- High-powered energy is used in the prostate cancer radiation therapy to kill cancer cells.

This therapy can be delivered in two ways:

• External beam radiation – in this therapy, radiation comes from outside the body i.e. patient will lie on a table while machine moves around the body, directing high-powered energy beams like X-rays or protons to the prostate cancer. This therapy is done five days a week for several weeks.

• Brachytherapy – in brachytherapy, radiation is given inside the body. Many rice-sized radioactive seeds are placed in the prostate tissue using a needle guided by ultrasound images. These radioactive seeds deliver a low dose of radiation over a long period of time. The implanted seeds don’t need to be removed as it stops emitting radiation after some time.

There are some side effects of radiation therapy such as painful, frequent or urgent urination, rectal problems like loose stools or pain while passing stools or erectile dysfunction.

Hormone therapy – this treatment stops the body from producing the male hormone testosterone. Testosterone help prostate cancer cells to grow and cutting off the supply of testosterone may cause cells to die or make them grow slowly. Some hormone therapy options include medications that stop the body from producing testosterone or medications that block testosterone from reaching cancer cells. Sometimes surgery is also done to remove the testicles called orchiectomy to reduce testosterone levels in the body. Some of the side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, weight gain and reduce sex drive.

Cryosurgery or cryoablation – this involves freezing tissue to kill cancer cells. During this treatment, many small needles are inserted in the prostate under the guidance of ultrasound images. A very cold gas in the needles causes the nearby tissue to freeze. A second gas is then placed in the needle to reheat the tissue and this cycle of freezing and thawing kill the cancer cells along with some surrounding healthy tissues. This cryosurgery treatment is used more frequently in patients who have failed radiation therapy.

Chemotherapy – drugs are used to kill fast growing cells including cancer cells in chemotherapy. It can be given through a vein in the arm of the patient or in pill form or both. Chemotherapy can be an option for cancers that doesn’t respond to hormone therapy.

Immunotherapy – also known as biological therapy uses body’s immune system to fight cancer cells. In this treatment, some of the patient’s immune cells are used to genetically engineer them in a laboratory to fight prostate cancer and then injects the cells back into the body through a vein. This treatment is very expensive and requires multiple treatments.

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