Prostate cancer :

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body. 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.  The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes.

Causes, incidence, and risk factors

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.Rates of detection of prostate cancers vary widely across the world, with South and East Asia detecting less frequently than in Europe, and especially the United States. The estimated lifetime risk of being diagnosed with the disease is 17.6% for Caucasians and 20.6% for African Americans. The lifetime risk of death from prostate cancer similarly is 2.8% and 4.7% respectively. As reflected in these numbers, prostate cancer is likely to impact the lives of a significant proportion of men that are alive today. The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. Prostate cancer is more common among family members of individuals with prostate cancer. This risk may be two to three times greater than the risk for men without a family history of the disease.

People who are at higher risk include:

·           African-American men, who are also likely to develop cancer at every age

·           Men who are older than 60

·           Men who have a father or brother with prostate cancer

Other people at risk include:

·           Men who have been around agent orange

·           Men who use too much alcohol

·           Farmers

·           Men who eat a diet high in fat, especially animal fat

·           Tire plant workers  

·           Men who have been around cadmium

·           There is also a suggestion that obesity leads to an increased risk of having more aggressive, larger prostate cancer

Prostate cancer is less common in people who do not eat meat (vegetarians).

A common problem in almost all men as they grow older is an enlarged prostate. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk of prostate cancer. However, it can increase your PSA blood test results.

Symptoms

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms.

The symptoms listed below can occur with prostate cancer, usually at a late stage. These symptoms can also be caused by other prostate problems:

·           Delayed or slowed start of urinary stream

·            flow of urine diminishes and urination becomes more difficult

·           Dribbling or leakage of urine, most often after urinating

·           Slow urinary stream

·           Straining when urinating, or not being able to empty out all of the urine

·           Blood in the urine or  burning with urination

·           Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)

·           As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder

 Most of these symptoms can occur in men with non-cancerous (benign) enlargement of the prostate (the most common form of prostate enlargement). However, the occurrence of these symptoms should prompt an evaluation by the doctor to rule out cancer and provide appropriate treatment.

Metastasized Cancer

Furthermore, in the later stages, prostate cancer can spread locally into the surrounding tissue or the nearby lymph nodes, called the pelvic nodes. The cancer then can spread even farther (metastasize) to other areas of the body.

Symptoms:

·        fatigue

·         malaise

·         weight loss.

           ·         back or pelvic pain

Signs and tests

Screening tests

 If a screening test is abnormal, the disease is then suspected to be present, and further tests usually are needed to confirm the suspicion (that is, to make the diagnosis definitively). Prostate cancer usually is suspected initially because of an abnormality of one or both of the two screening tests that are used to detect prostate cancer.

These screening tests are 

Digital Rectal Exam

·        digital rectal examination 

·        blood test called the prostate specific antigen (PSA).

A biopsy is needed to tell if you have prostate cancer. A sample of tissue is removed from the prostate and sent to a lab.

Your doctor may recommend a prostate biopsy if:

·           You have high PSA level

·           A rectal exam shows a large prostate or a hard, uneven surface

The results are reported using what is called a Gleason grade and a Gleason score.

The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 - 5. You may have different grades of cancer in one biopsy sample. The two main grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer is to have spread past the prostate:

·           Scores 2 - 5: Low-grade prostate cancer

·           Scores 6 - 7: Intermediate- (or in the middle-) grade cancer. Most prostate cancers fall into this group.

·           Scores 8 - 10: High-grade cancer

The following tests may be done to determine whether the cancer has spread:

·           CT scan

·           Bone scan

The PSA blood test will also be used to monitor your cancer after treatment. Often, PSA levels will begin to rise before there are any symptoms. An abnormal digital rectal exam may be the only sign of prostate cancer (even if the PSA is normal).

Treatment

Treatment depends on many things, including your Gleason score and your overall health. Your doctor will discuss your treatment options.

For early-stage prostate cancer, this may include:

·           Surgery (radical prostatectomy)

·           Radiation therapy, including brachytherapy and proton therapy

If you are older, your doctor may recommend simply monitoring the cancer with PSA tests and biopsies.

If the prostate cancer has spread, treatment may include:

·           Hormone therapy (medicines to reduce testosterone levels)

·           Surgery

·           Chemotherapy

Surgery, radiation therapy, and hormone therapy can affect your sexual desire or performance. Problems with urine control are common after surgery and radiation therapy. Discuss your concerns with your health care provider.

After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including PSA blood tests (usually every 3 months to 1 year).