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Tuesday, August 22

Prostate Cancer

Did you know about the prostate. Where is it situated? What are the symptoms of prostate cancer? What treatments are available?

Prostate cancer is the most common cancer among males. The diagnosis and treatment of prostate cancer continue to evolve. With the development of prostate-specific antigen (PSA) screening, more men are identified earlier as having prostate cancer. While prostate cancer can be a slow-growing cancer, thousands of men die of the disease each year. Education is important to help men understand the risk of progression and the various treatment


a. Incidental Findings

In the modern era, most patients present because of abnormalities in a screening PSA level or digital rectal examination (DRE) and not because of symptoms. However, prostate cancer can be an incidental pathologic finding when tissue is removed at the time of transurethral resection for obstructive prostatic symptoms.

b. Local symptoms

In the pre-PSA era, patients with prostate cancer commonly presented with local symptoms. Urinary retention occurred in 20-25%, back or leg pain occurred in 20-40%, and hematuria occurred in 10-15%. Currently, with PSA screening, patients report urinary frequency (38%), decreased urine stream (23%), urinary urgency (10%), and hematuria (1.4%). However, none of these complaints is unique to prostate cancer and each could arise from a variety of other ailments.

Simpelly The main symptoms are: difficulty passing urine, inability to urinate, passing urine often (particularly at night), weak or interrupted urine flow, pain when urinating, blood in the urine and pain in the lower back, hips and upper thighs. However, all of these symptoms can also be caused by other conditions such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.

Metastatic symptoms include weight loss and loss of appetite; bone pain, with or without pathologic fracture (because prostate cancer, when metastatic, has a strong predilection for bone); and lower extremity pain and edema from nodal metastasis obstructing venous and lymphatic tributaries. Uremic symptoms can occur from ureteral obstruction caused by local prostate growth or retroperitoneal adenopathy secondary to nodal metastasis.

c. case of prostate cancer (by genetic)

In most cases, we do not yet know the cause of prostate cancer. Exposure to high levels of radiation is one known cause, but this only accounts for a tiny proportion of cases. However, Alteration of genes on chromosome 1, 17, and the X chromosome have been found in some patients with a family history of prostate cancer,

The hereditary prostate cancer 1 (HPC1) gene and the predisposing for cancer of the prostate (PCAP) gene are on chromosome 1, while the human prostate cancer gene is on the X chromosome. In addition, genetic studies suggest that a strong familial predisposition may be responsible for as many as 5-10% of prostate cancer cases. Recently, several reports have suggested a shared familial risk (inherited or environmental) for prostate and breast cancer. Men with a family history of prostate cancer have a higher risk of developing prostate cancer and are also likely to present 6-7 years earlier.

d. Peole are at risk from this case

Prostate Cancer is very rare in men under 50. The risk increases after the age of 50 with half of all cases occurring in men over 75. Men from families with a history of prostate cancer are at higher risk than normal.

e. Diet For reduce the risk of prostate cancer

Some evidence suggests that a low-fat diet can reduce the risk of prostate cancer. Other studies have suggested that a diet high in tomatoes, Vitamin E, cruciform vegetables (such as broccoli, cabbage, cauliflower and brussel sprouts) and selenium can also reduce your risk. However, apart from selenium (see below), these findings have not been confirmed.


Prostate cancer develops when the rates of cell division and cell death are no longer equal, leading to uncontrolled tumor growth. Following the initial transformation event, further mutations of a multitude of genes, including the genes for p53 and retinoblastoma, can lead to tumor progression and metastasis. Most prostate cancers are adenocarcinomas (95%).

Approximately 4% of cases of prostate cancer have transitional cell morphology and are thought to arise from the urothelial lining of the prostatic urethra. Few cases have neuroendocrine morphology. When present, they are believed to arise from the neuroendocrine stem cells normally present in the prostate or from aberrant differentiation programs during cell transformation.

Cases of prostate cancer, 70% arise in the peripheral zone, 15-20% arise in the central zone, and 10-15% arise in the transitional zone. Most prostate cancers are multifocal, with synchronous involvement of multiple zones of the prostate, which may be due to clonal and nonclonal tumors.

Differential diagnosis:

* Benign prostatic hypertrophy
* Calculi
* Prostatic cysts
* Prostatic tuberculosis
* Prostatitis

If prostate cancer is diagnosed early, it can be treated very successfully. However, when the cancer is advanced, it becomes very difficult to cure. All men over 50 should be aware of the warning signs and take themselves to their doctor.

There are some tests can be used to detect prostate cancer
  • Rectal examination - by inserting a gloved finger into the back passage your doctor can actually feel the prostate gland, to find out whether it is larger than it should be. Even if it is enlarged, this does not mean that it is cancerous.
  • PSA blood test - if the level of Prostate Specific Antigen (PSA) in your blood is too high, this suggests that there is a prostate cancer, but there are several other conditions which cause an increase in blood PSA levels.
  • Ultrasound - a small probe is inserted into the back passage and used to do an ultrasound scan, showing the exact size of the prostate.
  • Biopsy - this involves taking a tiny sample of tissue from the prostate. A probe is inserted into the back passage and a small needle jabbed into the prostate itself.
  • X-rays - an x-ray can reveal whether there is any cancer which has spread to the bones near the prostate.
Treatments are available for prostate cancer

  • Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.
  • Radiotherapy - in radiation treatment, high energy rays kill the cancer cells. This will help destroy the original tumour and also reduces the pain caused by tumour cells which have spread to the bones.
  • Brachytherapy - this is a newer type of radiotherapy in which small radioactive pellets or wires are inserted directly into the prostate tumour, killing it from the inside. This is at least as effective as the other treatments and sometimes more so. There are also usually fewer side-effects with brachytherapy.
  • Hormone therapy - since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour and sometimes shrink it. However, after about five years, most prostate cancers go on to develop the ability to grow without androgens and the hormone therapy stops working.
  • Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.

Side-effects of prostate cancer treatment

There are normally no side-effects from surgery, although there is a risk of impotence as an after-effect. Radiotherapy causes general side-effects such as tiredness, diarrhoea and nausea. These will all go away after the treatment has finished. The only long- term effect is impotence, which happens in about half of patients having long-term radiotherapy. Almost all patients receiving hormone therapy experience impotence while the treatment is being taken. Hot flushes, tiredness and weight gain are also common, but will cease when the treatment stops.

The good news is prostate cancer need not be a death sentence. Early diagnosis is so important and there is a great deal all men can do to safeguard their health.

If you found these FAQs helpful and would like to assist AICR in funding further research and education, please consider donating here.

Reference : emedicine.com & aicr.org


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