Prostate Cancer: What All Men Must Know
Prostate cancer is a malignant (cancerous) tumor
(growth) that consists of cells from the prostate gland.
Generally, the tumor usually grows slowly and remains
confined to the gland for many years. During this time,
the tumor produces little or no symptoms or outward
signs (abnormalities on physical examination). However,
all prostate cancers do not behave similarly. Some
aggressive types of prostate cancer grow and spread
more rapidly than others and can cause a significant
shortening of life expectancy in men affected by them. A
measure of prostate cancer aggressiveness is the Gleason
score (discussed in more detail later in this article),
which is calculated by a trained pathologist observing
prostate biopsy specimens under the microscope.
The prostate cancer is the most common type of cancer in men. Prostate cancer is the second
leading cause of cancer death in men, exceeded only by lung cancer. Adenocarcinoma of the
prostate is the clinical term for a cancerous tumor of the prostate gland. 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 (seminal vesicles), and to distant parts of the body (e.g.,
bones, liver, lungs). Prostate cancer confined to the gland often is treated successfully.
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 Having a hard
time starting or stopping the urine flow
Needing to urinate often, especially at night
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.
What Are the Most Important Things to Know About
Detection of Prostate Cancer
Every year, thousands of men receive the diagnosis of
prostate cancer. Because of the high number of men afflicted
with this disease, annual screening tests have been put into
place to hopefully catch prostate cancer in its early stages. A
number of tests also exist to confirm the presence of prostate
cancer after an abnormality is found through screening.
Blood test for prostate-specific antigen (PSA): A lab
checks the level of PSA in your blood sample. The prostate
makes PSA. A high PSA level is commonly caused by BPH or
prostatitis (inflammation of the prostate). Prostate cancer may
also cause a high PSA level. The digital rectal exam and PSA
test can detect a problem in the prostate. However, they can't
show whether the problem is cancer or a less serious
condition. If you have abnormal test results, your doctor may
suggest other tests to make a diagnosis.
Transrectal ultrasound: The doctor inserts a probe
into the rectum to check your prostate for abnormal
areas. It also measures the size of the prostate, which
can help to determine if the PSA level is elevated for
the size of the prostate. The probe sends out sound
waves that people cannot hear (ultrasound). The waves
bounce off the prostate. A computer uses the echoes to
create a picture called a sonogram.
Transrectal biopsy: A biopsy is the removal of tissue
to look for cancer cells. It's the only sure way to
diagnose prostate cancer. The doctor inserts needles
through the rectum into the prostate. The doctor
removes small tissue samples (called cores) from many
areas of the prostate. Transrectal ultrasound is usually
used to guide the insertion of the needles. A pathologist
checks the tissue samples for cancer cells.
Advanced Treatment of Prostate Cancer
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. Your doctor can describe your
treatment choices, the expected results of each, and the possible side
effects. You and your doctor can work together to develop a
treatment plan that meets your medical and personal needs.
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
Robotic laparoscopic surgery: 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
Laparoscopic prostatectomy: The surgeon removes the entire
prostate through small cuts (1/4" â€“ Â½" in size), 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
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. TURP may not remove all of the cancer,
but it can remove tissue that blocks the flow of urine. After
surgery, a catheter (flexible tube) is often left through the penis
into the bladder. This allows the area to heal where the bladder
and urethra are reconnected. Oftentimes patients only have to
stay in the hospital overnight and can go home the following day.
With newer surgical techniques, the complications from surgery
are significantly reduced.
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