Treatment

Prostate Cancer

Introduction

 

 

As the name suggests, prostate cancer develops from cells of the prostate gland. The prostate gland is about the size of a walnut and is located in front of the rectum, behind the base of the penis, under the bladder. It is found only in men, and produces same of the seminal fluid, which protects and nourishes sperm cells. The prostate surrounds the upper part of the urethra, the tube that carries urine and semen out of the penis. Nerves located next to the prostate take part in causing an erection of the penis. When a person is affected by prostate cancer, the cancer cells may spread outside the gland to other parts of the body. Most prostate cancers grow very slowly and never cause symptoms or spread. Autopsy studies show that many elderly men who died of other disease also had a prostate
cancer which neither they nor their doctor were aware of. But some prostate cancers can grow and spread quickly. The people most likely to get prostate cancer are men over age 50.
Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. It accounts for about 13 per cent of male cancer-related deaths. The cause of prostate cancer is not known. In the early stagers of prostate cancer usually there are no symptoms. Most prostate cancers are discovered during a routine rectal examination. In the later stages urinary obstruction may be observed accompanied by pain in the low back or pelvis from spread of cancer. Eighty-nine percent of men diagnosed with prostate cancer survive at least 5 years, and 63 per cent survive at least 10 years. Fifty-eight per cent of all prostate cancers are found while they are still confirmed to the prostate. Thirty-one per cent of prostate cancers have already spread locally (to tissues near the prostate) at the time of diagnosis. Treatments that remove or damage nerves located next to the prostate nerves can cause erectile dysfunction, also known as impotence. Although early diagnosis and treatment of prostate cancer may help some men to live longer, it has no impact on the life span of other men.

Prevention and risk factors

Although some factors increase a person’s risk of getting cancer, they do not always cause the disease. Many people with one or more risk factors never develop cancer, while others with this disease have no known risk factors.

While the causes of prostate cancer are not yet completely understood, researchers have found several factors that are consistently associated with an increased risk of developing this disease. Prostate cancer seems to run in some families, suggesting an inherited or genetic factor. Having a father or brother with prostate cancer usually doubles a man’s risk of developing this disease. The risk is even higher for men with several affected relatives, particularly if they were young at the time of diagnosis.

The chance of having prostate cancer increases rapidly after age 50. More than 80 per cent of all prostate cancers are diagnosed in men over the age of 65.

Some studies suggest that men who eat a lot of fat have a greater chance of developing prostate cancer. Other research indicates that men with a high-fat diet ten to cat fewer fruits and vegetables and more dairy products, and that these factors may be responsible for increasing risk rather than the amount of fat itself. Lycopenes, which are found in especially high levels in some fruits and vegetables (such as cooked or raw tomatoes and watermelon) also seem to lower prostate cancer risk. These vitamin-like substances are antioxidants that help prevent damage to DNA and may help lower prostate cancer risk. The mineral selenium also seems to lower the risk of prostate cancer.
Recent research also suggests that a diet high in calcium and low in fructose (fruit sugar) increases the risk of prostate cancer.

Regular physical activity and maintaining a healthy weight may help reduce prostate cancer risk.

Men who have had a vasectomy may have an increased risk for prostate cancer. Some studies have found that prostate cancer develops one to two times more often in these men, but other studies found no difference in prostate cancer risk. Some studies that noticed an increase in risk found that this risk is highest in men who were younger than 35 when they has a vasectomy.

The role of vitamin supplements in reducing prostate cancer risk is not entirely certain, but some studies suggest that taking 50 mg of vitamin E daily can lower risk by 32 per cent. Although other studies found vitamin E to be of no benefit, reasonable doses of this vitamin have no significant side effects.

Some other studies suggest that taking vitamin A supplements may actually increase prostate cancer risk. As always, vitamin supplements should be used with the consent of a doctor.

What causes prostate cancer

What causes prostate cancer is still not known exactly but, researchers have found some risk factors and are making progress toward understanding how these factors cause cells in the prostate gland to become cancerous.

During the past few years, scientists have made great progress in understanding how certain changes in DNA can cause normal prostate cells to grow abnormally and form cancers. DNA is the chemical that carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance. Some genes (parts of our DNA) contain instructions for controlling when cells grow and divide.

Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the appropriate time are called tumour suppressor genes. It is known that cancers can be caused by DNA mutations (defects) that turn on oncogenes or turn off tumour suppressor genes. Some people with certain types of cancer have DNA mutations they inherited from a parent. Researchers have recently found that inherited DNA changes in certain genes make them more likely to develop prostate cancer. These genetic changes appear to be responsible for about 10 per of prostate cancers.

DNA mutations related to prostate caner usually develop during a man’s life rather than having been inherited before birth.

There is evidence that development of prostate cancer is linked to increased levels of certain hormones. High levels of androgens (male hormones) may contribute to prostate cancer risk in some men. Researchers have recently noted that men with high levels of another hormone, insulin-like growth factor-1 (IGF1), are more likely to develop prostate cancer.

Detection and symptoms

Some prostate cancers may be found because of symptoms such as slowing or weakening of the urinary stream or the need to urinate more often. These symptoms, however, can also be caused by benign diseases of the prostate. Symptoms of advanced prostate cancer include blood in the urine, impotence, and pain in the pelvis, spine, hips, or ribs. These symptoms, again, may also be present with other diseases.

 

SOME TESTS FOR PROSTATE CANCER

	1. CONSERVATIVE MANAGEMENT It is usually the treatment of choice for small stones in the kidney and ureter. Most of such stones pass spontaneously in the urine without any need for intervention. The probability of a stone passing down spontaneously will depend upon the size of a stone, it�s location, shape etc. Such patients can be treated with anti-biotics and analgesics to feel symptomatically better. Oral dissolution agents can also be given for a considerable length of time. The patient is generally instructed to maintain a high fluid intake ranging from 2 to 3.5 litres/day. If a patient has severe abdominal pain associated with vomiting and fever, then admission is usually required and intra-venous fluids may have to be given. If this does not help, then the stone may have to be removed by endoscopy. Some cases where the stone causes severe obstruction and infection then a procedure called DJ stenting has to be done to receiver obstruction. DJ stenting ie the process of inserting a synthetic tube between the kidney and the ureter. If this does not help a tube has to be passed directly into the kidney to drain the infected urine.
	2. EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY Extracorporeal Shock Wave Lithotripsy Advanced technique in stone removal Extracorporeal shock wave lithotripsy is recognized world wide as the most effective mode of treatment for kidney and ureteric stones.It is a highly scientific technique employing focused shock waves for breaking urinary stones into fine particles.This technique was introduced in 1980 by a German company. Ever since the introduction,of this technique,it has been successfully used by Doctors in USA,Europe and other areas of the world ,for the treatment of urinary stones. It is a non operative technique with no necessity for anaesthesia and involves minimal pain.Unlike the earlier open operation treatment, ESWL does not involve any cutting of tissues and no scars are left after the procedure. The ESWL procedure usually lasts for about 40 minutes.But depending on the size and number of stones,more than one session may be required for proper breaking of the stones. Patients may be required to remain in the hospital for a day for observation. After the procedure the patient is advised to drink plenty of fluids.This helps in the passage of stone fragments in the urine.In some cases, certain other procedures may have to be adopted to facilitate full removal of the stone fragments.
	3. URETEROSCOPIC STONE REMOVAL It is ideally suited for stones in the lower portion of the ureter. It involves the passage of an instrument namely ureteroscope through your urinary passage. The instrument is as thick as a pen and is about 40 cm long. You may have to be admitted in the hospital for a few days (2-3 days) for this procedure and it has to be done under anesthesia. A variety of other instruments can be passed in through the scope which can be used to break the stones and remove them. Very rarely it may so happen that the stone cannot be removed by this method in which case open surgery may be needed.
	4. PERCUTANEOUS NEPHROLITHOTRIPSY This procedure is ideally suited for very large calculi within the kidney and the upper ureter. In this procedure, a puncture is directly made on to the kidney, the stone is seen with a telescope, broken into fragments and the fragments removed. In some cases, it may not be possible to remove the entire stone. So a combination of other procedures like ESWL has to be done to ensure that the stone is completely removed.
	5. OPEN SURGERY With the advent of new technologies to treat stone disease, the need for open surgery has been drastically reduced. But in some cases it might be required. The type of open surgery will depend upon the site and size of the stone within the urinary tract.