Prostate cancer generally affects men over 50 and is rare in younger men. It’s the most common type of cancer in men. It differs from most other cancers in the body, in that small areas of cancer within the prostate are very common and may stay dormant (inactive) for many years. Most of these cancers grow very slowly and so, particularly in elderly men, are unlikely to cause any problems. In a small proportion of men, prostate cancer can grow more quickly and in some cases may spread to other parts of the body, particularly the bones.
Symptoms of Prostate Cancer
A man with prostate cancer may not have any symptoms. Symptoms of prostate
cancer are often similar to those of benign prostatic hyperplasia (BPH). Men
observing the following signs and/or symptoms should see their physician for a
thorough examination:
- Urinary problems - Not being able
to pass urine รข€¢ Having a hard time starting or stopping the urine flow
- Needing to urinate often,
especially at night
- Weak flow of urine
- Urine flow that starts and stops
- Pain or burning during urination
- Blood in the urine or semen
- Frequent pain in the lower back,
hips, or upper thighs If you have any of these symptoms, you should tell
your doctor so that problems can be diagnosed and treated.
PDigital rectal
exam (DRE) : The doctor inserts a lubricated, gloved finger into the
rectum and feels the prostate through the rectal wall for lumps or abnormal
areas.
Prostate-specific
antigen (PSA) test:A test that measures the level of PSA in the blood. PSA is a
substance made by the prostate that may be found in an increased amount in the
blood of men who have prostate cancer. PSA levels may also be high in men who
have an infection or inflammation of the prostate or BPH (an enlarged, but
noncancerous, prostate).
Transrectal
ultrasound : A procedure in which a probe that is about the size of a
finger is inserted into the rectum to check the prostate. The probe is used to
bounce high-energy sound waves (ultrasound) off internal tissues or organs and
make echoes. Transrectal ultrasound may be used during a biopsy procedure.
Biopsy :The removal
of cells or tissues so they can be viewed under a microscope by a pathologist.
The pathologist will examine the biopsy sample to check for cancer cells and
determine the Gleason score. The Gleason score ranges from 2-10 and describes
how likely it is that a tumor will spread. The lower the number, the less
likely the tumor is to spread.
There are 2 types of biopsy procedures used to
diagnose prostate cancer:
Transrectal biopsy: The
removal of tissue from the prostate by inserting a thin needle through the
rectum and into the prostate. This procedure is usually done using transrectal
ultrasound to help guide the needle.
Transperineal
biopsy: The removal of tissue from the prostate by inserting a thin needle
through the skin between the scrotum and rectum and into the prostate.
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Staging of Prostate Cancer
If the biopsy shows that you have cancer, your doctor needs to learn the extent
(stage) of the disease to help you choose the best treatment. Staging is a
careful attempt to find out whether the tumor has invaded nearby tissues,
whether the cancer has spread and, if so, to what parts of the body. Some men
may need tests that make pictures of the body:
Bone scan: The doctor injects a small amount of a radioactive substance
into a blood vessel. It travels through the bloodstream and collects in the
bones. A machine called a scanner detects and measures the radiation. The
scanner makes pictures of the bones on a computer screen or on film.
CT scan: An x-ray machine linked to a computer takes a series of
detailed pictures of your pelvis or other parts of the body. Doctors use CT
scans to look for prostate cancer that has spread to lymph nodes and other
areas. You may receive contrast material by injection into a blood vessel in
your arm or hand, or by enema. The contrast material makes abnormal areas
easier to see.
MRI: A strong magnet linked to a computer is used to make
detailed pictures of areas inside your body. The doctor can view these pictures
on a monitor and can print them on film. An MRI can show whether cancer has
spread to lymph nodes or other areas.
Stage I The cancer can't be felt during a digital rectal exam, and
it can't be seen on an imaging study, such as ultrasound.
Stage II: o The tumor is more advanced or a higher grade than
Stage I, but the tumor doesn't extend beyond the prostate. It may be felt
during a digital rectal exam, or it may be seen on a sonogram. It is detected
either after a needle biopsy or surgery done for other reasons, i.e. resection
of the prostate for benign enlargement.
Stage III: o The tumor extends beyond the capsule (outer covering)
of the prostate. The tumor may have invaded the seminal vesicles, but cancer
cells haven't spread to the lymph nodes, bones or other organs.
Stage IV: o The tumor may have invaded the bladder, rectum, or
nearby structures (beyond the seminal vesicles).
Men with prostate
cancer have many treatment options. The treatment that's best for one man may
not be best for another. Your doctor will make recommendations that are best
for each individual. The options include active surveillance (also called
watchful waiting), surgery, radiation therapy, cryotherapy, hormone therapy,
and chemotherapy. You may have a combination of treatments. The treatment that's
right for you depends mainly on your age, the grade of the tumor (the Gleason
score), the number of biopsy tissue samples that contain cancer cells, the
stage of the cancer, your symptoms, and your general health.
Surgery: Surgery is an option for men with
early (Stage I or II) prostate cancer. It's sometimes an option for men with
Stage III or IV prostate cancer. Before the surgeon removes the prostate, the
lymph nodes in the pelvis may be removed. If prostate cancer cells are found in
the lymph nodes, the disease may have spread to other parts of the body. If
cancer has spread to the lymph nodes, the surgeon does not always remove the
prostate and may suggest other types of treatment. After removing the prostate,
the bladder is reconnected to the urethra (tube that men urinate through).
Robotic laparoscopicsurgery: The surgeon removes
the entire prostate through small cuts . A
laparoscope and a robot are used to help remove the prostate. Instruments are
passed through the small cuts and are used to remove the prostate. The surgeon
uses handles below a computer display to control the robot's arms.
Open surgery: The surgeon makes a large incision (cut) into your body to
remove the tumor. There are two approaches:
- Through the abdomen: The surgeon removes the entire
prostate through a cut in the abdomen. The incision typically is from the
umbilicus (belly button) down to the pelvic bone. This is called a radical
retropubic prostatectomy.
- Between the scrotum and anus: The surgeon removes the entire
prostate through a cut between the scrotum and the anus. This is called a
radical perineal prostatectomy.
Laparoscopic
prostatectomy: The surgeon removes
the entire prostate through small cuts , rather
than a single long cut in the abdomen. A thin, lighted tube (a laparoscope)
helps the surgeon see. Other instruments are passed through the small cuts.
These instruments are used to remove the prostate.
TURP: A man with advanced prostate cancer may choose TURP (transurethral
resection of the prostate) to relieve symptoms. The surgeon inserts a long,
thin scope through the urethra. A cutting tool at the end of the scope removes
tissue from the inside of the prostate.
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