The prostate is an important part in men’s health. Majority of men who develop some degree of poor urine flow have this small walnut shaped gland to blame. Naturally the prostate gland increases in size with age. This swelling is called benign prostate hypertrophy or BPH. This swelling is non-cancerous and when troublesome, it can be removed through an open abdominal surgery or through the urethra in an operation called trans-urethral resection of the prostate – TURP. This gland may however, at times develop malignant changes which lead to cancer of the prostate.
Prostate cancer is a male hormone supported cancer which proliferates better in the presence of male hormones (androgens).
Types of prostate cancer
The commonest type is called adenocarcinoma. Other types are:
- Small cell carcinomas
- Transitional cell carcinomas
Symptoms of prostate cancer
There may be no symptoms at all and the cancer may be diagnosed on routine screening. Most of the early symptoms are related to passing urine. The patient may notice difficulties including blockage and a gradually weakening stream. Other symptoms may include:
- Erectile problems
- Pelvic pains
- Painful ejaculation
- Blood stained semen.
Causes of prostate cancer
What causes the initial cancerous changes in the prostate gland are not known. There is DNA mutation which leads to the abnormal proliferation of cells. There are however, factors that appear to increase chances of developing this type of cancer.
- Family history. There appears to be some genetic connection such that a person whose close relative has prostate cancer is more likely to develop the cancer unlike another with no family member affected.
- Obese men have a higher risk
- Black men are more prone than their Caucasian counterparts.
- Men who have mothers or sisters with breast cancer (another hormone regulated cancer).
- Older men are also at a higher risk of developing prostate cancer.
How is prostate cancer diagnosed?
Routine screening may reveal high levels of prostate-specific antigen (PSA). A direct rectal examination (DRE) may also reveal abnormalities of the prostate gland. If these initial tests are abnormal other tests to follow can include:
- A trans-rectal ultra-sound (TRUS)
- Prostate biopsy.
It is after this that the cancer if present can be staged. The next step is to determine if the cancer has spread. This is done by doing:
- Bone scan imaging tests to rule out cancer spread to the bones
- Computerized tomography and computerized axial tomography (CT and CAT scans) are also used in looking for cancer cells spread.
- Magnetic resonance imaging (MRI), lymph node biopsy and Prostascint scans can all be done depending on what the prostate cancer team are looking for.
Treatment of prostate cancer
The stage of the disease, the age of the patient and the general condition of the patient are a few of the many factors that doctors consider in determining the best treatment to adapt.
Treatment options available
Apart from the specific treatment directed at the cancer, other symptoms like pain, nausea and maybe vomiting must be addressed. Measures taken include:
- Doing nothing and monitoring the state of the patient
- Surgery which may involve therapeutic removal of the testes
- Hormone therapy
- Prostate cancer vaccine which is reserved for advanced prostate cancer that is poorly responding to other forms of therapy.
- For prostate cancer that has spread, more innovative therapy techniques can be used. One of these is radiopharmaceuticals. These are medications containing radioactive substances that settle in areas with malignant cells and kill them off.
Recurrence after prostate cancer treatment is possible and so follow-up is important.