Prostate Cancer
Adenocarcinoma of the prostate is the clinical term for a prostate cancer. As prostate cancer grows, it may spread to the interior of the gland, to tissues near the prostate, to sac-like structures attached to the prostate, and to distant parts of the body. Prostate cancer confined to the gland often is treated successfully.
According to the American Cancer Society (ACS), prostate cancer is the most common type of cancer in men in the United States, other than skin cancer. The ACS estimates that about 218,890 new cases will be diagnosed in 2007 and about 27,050 men will die of the disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer.
Prostate cancer occurs in 1 out of 6 men. Reports of diagnosed cases have risen rapidly in recent years and mortality rates are declining, which may be due to increased screening.
The risk for developing prostate cancer rises significantly with age, and 60% of newly diagnosed cases occur in men over the age of 70. A family history of prostate cancer increases the risk. Other possible risk factors include, 55 years old and older, Diet high in saturated fat, Exposure to heavy metals,Race, Sedentary lifestyle, Smoking and African American Males.
Early prostate cancer usually is discovered by a simple blood test called PSA.
Symptoms 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.
- Blood in the urine or semen
- Frequent urination, especially at night
- Inability to urinate
- Painful ejaculation
- Pain or burning during urination (dysuria)
- Weak or interrupted urinary flow
Several tests are used to diagnose prostate cancer. In a DRE, the physician inserts a lubricated, gloved finger into the rectum to feel the surface of the prostate gland. A prostate ultrasound is used to measure the size of the prostate and visually identify tumors. Blood tests taken to check the levels of prostate specific antigen (PSA) in a patient who may have benign prostatic hyperplasia help the physician eliminate or confirm a diagnosis of prostate cancer.
Prostate-specific antigen (PSA) is produced by the cells of the prostate capsule and periurethral glands. Patients with benign prostatic hyperplasia (BPH) or prostatitis produce greater amounts of PSA. The PSA level also is determined in part by the size and weight of the prostate.
If a tumor is found, a biopsy is performed to determine the type of cancer, its location, and stage of development. The biopsy is performed with the patient lying on his side with his knees brought up to his chest. A biopsy needle, similar to one used to draw blood or administer injections, is inserted through the perineum into the tumor. A probe, guided by transrectal ultrasound (TRUS), is inserted into the rectum to help the physician properly place the needle, which is projected through the tip of the probe. A cell sample is extracted from one or several areas of the tumor into the syringe. The sample(s) is analyzed by a pathologist to confirm the diagnosis of a cancerous tumor and determine its type. The results are obtained within 5–10 working days.
The biopsy sample(s) is examined under a microscope for cells or groups of cells that are markedly different from healthy tissue. The greater the disparity between the healthy cells and those that are malignant, the more likely the tumor is aggressive and will spread.
After a biopsy, blood in the urine (hematuria) and stool is common and usually diminishes within 1–2 weeks. Patients also experience a dull ache in the perineum for several days. Blood may appear in the semen. If the patient develops a large number of blood clots or cannot urinate, the physician should be contacted or the patient should go to the emergency room.
Treatment for prostate cancer depends on the stage of the disease and the patient's age and overall health. Elderly patients with minor symptoms, early stage cancer, or coexisting illness may be treated conservatively.
Watchful waiting is a reasonable course of action for patients who are elderly, in poor health, or with early stage cancer. Untreated prostate cancer may take years to become problematic. During this time, the physician monitors the patient's condition for any marked or sudden progression of the disease, which may signal the need for more aggressive treatment.
Good candidates for surgery to treat prostate cancer have one or more of the following characteristics:
- Good health
- No spread of cancer to bone
- Tumor confined to the prostate gland (stage T1 and T2)
- Under the age of 70
- Expected to live another 10 years or longer
Depending on the extent of the disease, there are several surgical options for prostate cancer.
This minimally invasive outpatient procedure, also called cryoablation, destroys cancer cells by twice rapidly freezing and thawing cancerous tissue.
Radical prostatectomy is the surgical removal of the prostate gland and surrounding tissues, including the seminal vesicles and the pelvic lymph nodes. Surgeons use one of two surgical techniques, retropubic prostatectomy or perineal prostatectomy. General anesthesia is used in both procedures.
In retropubic prostatectomy, an incision is made in the lower abdomen. This gives the surgeon access to the prostate gland, seminal vesicles, and the pelvic lymph nodes. In perineal prostatectomy, the incision is made in the perineum, the space between the scrotum and the rectum. With perineal prostatectomy, a second procedure is required to remove the pelvic lymph nodes (lymphadenectomy).
Laparoscopic radical prostatectomy is performed through several small incisions. A device consisting of a tube and an optical system (laparoscope) is inserted into one incision and is used to guide the procedure. Surgical instruments are inserted through the other incisions. This procedure is not available in all areas, and not all surgical patients are good candidates for the laparoscopic approach.
In some cases, a computer-enhanced robotic surgical system is used to perform laparoscopic radical prostatectomy. In this procedure, a robotic surgical system is used to perform laparoscopic radical prostatectomy.
The robotic surgical system is comprised of 3 major components, including a vision system to provide the surgeon with a high magnification and high resolution view of the operative field, robotic arms and instruments used by the surgeon to perform the procedure, and a console to allow the surgeon to view the operative field and control the instruments.
Laparoscopic radical prostatectomy causes less bleeding and less postoperative pain and results in a shorter hospital stay and recovery period.
When cancer is confined to the prostate gland, the disease is usually curable. A number of patients with locally spread cancer die within 5 years. Once cancer has spread to distant organs, life expectancy is usually less than 3 years.
While prostate cancer cannot be prevented, measures can be taken to prevent progression of the disease. It is important for men over 40 to have an annual prostate examination. When identified and treated early, prostate cancer has a high cure rate.
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