Urologic Diseases

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Prostate Cancer

Overview:

The prostate is a part of the male reproductive system, which includes the penis, prostate, seminal vesicles, and testicles. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut and weighs approximately 20 gm. The prostate gland is composed of muscular tissue, glandular tissue, and a rough fibrous surface. The prostate gland secretes a thick, whitish fluid that helps transport sperm.

What is prostate cancer?

Prostate cancer occurs when prostate cells divide abnormally and cannot be controlled. As men get older, the prostate gland tends to increase in size, and this can lead to a narrowing of the urethra and a reduced flow of urine. This is called benign prostatic hyperplasia. It is not the same as prostate cancer.

Risk Factors:

Age: The risk of prostate cancer increases with age.
Family history: Your risk of developing prostate cancer increases if you have a family history of prostate cancer.
Obesity: Obese men diagnosed with prostate cancer are more likely to get advanced stages of it. These are often hard to treat.

Symptoms:

Symptoms can look different in each person. Some people may have no symptoms at all and other may observe some symptoms, such as:

Difficulty starting urination
Decreased force in the stream of urine
Frequent urination, especially at night
Difficulty emptying the bladder
Painful urination
Blood in the urine
Pain in the lower back, hips, or pelvis
Painful ejaculation

Noteworthy, these symptoms, or some of them, may be caused by diseases other than prostate cancer.

When to see a doctor?

If you notice any of the aforementioned symptoms, along with a risk factor.

Diagnosis:

A diagnosis aims to detect cancer before it causes symptoms, to quickly treat it before it spreads to other parts of the body. Several tests are used to diagnose prostate cancer. They include:

Digital rectal exam (DRE). Your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate.
Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than usual level is found, it may indicate prostate enlargement. High PSA levels may also be due to: prostate infection, inflammation, enlargement or cancer. Your doctor may not rely on this test alone to diagnose prostate cancer. Your doctor may also examine a sample of prostate tissue to confirm the diagnosis (biopsy).

A biopsy is the main tool for diagnosing prostate cancer, but your doctor may also use other tools to ensure the biopsy is done correctly. For example, he or she may perform an ultrasound on your rectum. Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.

Treatment:

Your doctor will discuss treatment plans with you to choose what suits you best.

Active surveillance: In active surveillance, regular follow-up blood tests, rectal exams and prostate biopsies may be performed to monitor progression of your cancer.
Surgery: Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes.
Radiation therapy: Radiation therapy uses high-powered energy to kill cancer cells. There are two types of prostate cancer radiation therapy treatments: Internal and external (topical)
Freezing or heating prostate tissue: Ablative therapies destroy prostate tissue with cold or heat.
Chemotherapy: Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.
Biological therapy: It works with the body's immune system to fight cancer, or control the side effects of other treatments.
High intensity ultrasound used to kill cancer cells.
Hormone therapy: Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow.