Prostate cancer is most common visceral malignant neoplasm in US men since 1984.The estimated life time risk of disease is 17.6% for whites and 20.6% for African Americans with the lifetime risk of death of 2.8% and 4.7% respectively.
The lowest yearly incidence occurs in asia (1.9 cases per 100,000 in Tianjin,China) and the highest in north America and Scandanavia (272 cases per 100,000)Mortality varies widely among countries, being highest in Sweden and lowest in Asia.
A family history of prostate cancer increases the risk. Other possible risk factors include the following:
- 55 years old and older
- Diet high in saturated fat
- Exposure to heavy metals (e.g., cadmium)
- Race (African American)
- Sedentary lifestyle
Signs and Symptoms
Early prostate cancer usually is discovered during a routine digital rectal examination (DRE).
Symptoms are often mimic to those of benign prostatic hyperplasia.
- Blood in the urine or semen
- Frequent urination, especially at night
- Inability to urinate
- Nagging pain or stiffness in the back, hips, upper thighs, or pelvis
- Painful ejaculation
- Pain or burning during urination (dysuria)
- Weak or interrupted urinary flow
- Acute retention of urine
Following tests are used to diagnose prostate cancer.
1,Digital rectal examination (DRE)
2,Transrectal ultrasound (TRUS) Insertion of an ultrasound probe approximately the size of an adult man’s thumb into patient’s rectum. The ultrasound probe allows the physician to inspect the prostate visually.. The doctor also can measure the prostate and accurately determine its size.
TRUS and the digital rectal examination are most important prostate-cancer screening tools.
3, PSA Test. PSA is currently the most important blood marker for prostate diseases. It is elevated in men with prostate cancer, but can also be elevated in men with BPH depending on the size of their prostate. In fact, there is a pretty good relationship between the size of the benignly enlarged prostate and the serum PSA. The PSA values also increase with advancing age. Urologist doctor will make careful assessment of your age, your prostate size, and the PSA value. If he thinks that your PSA value is too high for the prostate size, and/or for your age, he may recommend to you a transrectal ultrasound guided biopsy also abbreviated as TRUS biopsy.
The test measures the amount of PSA in the blood in nanograms per milliliter (ng/mL). A PSA of 4 ng/mL or lower is considered normal; 4 – 10 ng/mL, slightly elevated; 10 – 20, moderately elevated; and 20 – 35, highly elevated. Most men with slightly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal PSA levels. A highly elevated level may indicate the presence of cancer.
The PSA test can produce false results. A false positive result occurs when the PSA level is elevated and there is no cancer. A false negative result occurs when the PSA level is normal and there is cancer. Because of this, a biopsy is usually performed to confirm or rule out cancer when the PSA level is high.
Percent-Free PSA – A Relatively New Concept
Basically, the absolute PSA level does not always tell the whole story.
Doctors have now started using alternative PSA measurements such as the PSA density and the percent-free PSA to make better decisions about a man’s risk for prostate cancer.
Age-specific PSA Evidence suggests that the PSA level increases with age. A PSA of up to 2.5 ng/mL for men age 40–49 is considered normal, as is 3.5 ng/mL for men age 50–59, 4.5 ng/mL for men age 60–69, and 6.5 ng/mL for men 70 and older.
4,Prostate Biopsy. If a tumor is suspected, a biopsy is performed to determine the type of cancer, its location, and stage of development.
Beform performing biopsy patient is instructed to discontinue antiplatelet medication( blood thinner).he is instructed to statr antibiotics one day prior to the procedure.
procedure is an outdoor procedure. Usually no anaesthesia is used during the procedure but in some patients it can be done under peri prostatic block or short general anaesthsia.
5,Computed tomography (CT scan)/MRI
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.
Hormone therapy for prostate cancer involves the use of antiandrogens to block production of testosterone, which prostate cancer cells use to grow. Drugs used for hormone therapy include leuprolid acetate Goserelin acetate implant ,bicalutamide and flutamide
Treatment for Bone Metastases
Zoledronic acid is a bisphosphonate prescribed to treat hypercalcemia—excess calcium in the blood—in prostate cancer patients who have bone metastases (secondary tumors in bone).
Doses are given intravenously for 15 minutes, every 3 to 4 weeks. A blood sample is taken before each treatment to monitor kidney function.
Two types of radiation therapy are used to treat prostate cancer: brachytherapy and external radiation therapy (XRT).
This treatment involves implanting tiny, radioactive capsules (called “seeds”) into the cancerous prostate gland. The seeds emit radiation that kills the malignant tumor. Men with small tumors confined to the prostate (stage T1 or T2) are candidates for brachytherapy.
External Radiation Treatment (XRT)
XRT is recommended when the tumor has spread through the prostate capsule to surrounding tissues. XRT usually is given on an outpatient basis for 7 to 8 weeks. High-energy x-rays are projected onto prostate tissue from a machine outside the body. The radiation destroys cancer cells and shrinks tumors.
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
- High Intensity Focused Ultrasound (HIFU)
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).
Typically, patients remain in the hospital for 3 to 7 days after surgery and are catheterized for 2 to 3 weeks.
1,Urinary leakage (incontinence) is common after surgery, but most men eventually regain urinary controlwithin 3 to 6 months time.
2,impotance:with the advent of anatomical(nerve sparing)radical prostatectomy incidence has gone down significantly.
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 done by select centre in world.here at shyam urosurgical hospital we perform this procedure.
laparoscopic radical prostatectomy has all the advantages of minimal access surgery it causes less bleeding and less postoperative pain and results in a shorter hospital stay and recovery period. this is a preffred method at the advance centres in the world.
Robotic radical prostatectomy:
Most advance centres in usa,europe offers this treatment option.in india because of cost related to it this has not been very popular method .
When cancer is ORGAN CONFINED, the disease is usually curable. Once cancer has spread to distant organs, life expectancy is usually less than 3 years.
It is said that prevention is better then cure.prostate cancer is consider patient friendly cancer if it is picked up in its early stage as it is very slow growing cancer.While prostate cancer cannot be prevented, measures can be taken to prevent progression of the disease. It is important for men over 50 to have an annual prostate examination. we at shyam urosurgical hospital run prostate disease awareness clinic.we also have annual prostate screening camps