Cancers generally start when the cells in the body grow in an uncontrollable fashion. Cells in nearly any part of the body can become cancerous and spread to other body areas. We can therefore say prostate cancer begins when cells of the prostate grows uncontrollably. Briefly let’s discuss some basic anatomy.
Anatomy of the Prostate
Only in males will you find a prostate gland.
It is usually described as a gland, the size of a walnut in younger men, however it can be much larger in older men.
It is located right below the urinary bladder and in front of the rectum. A portion of the urethra, which is the conduit for urine, pass through the prostate and this relationship is noteworthy, as symptoms of prostate diseases are usually due to this anatomical relationship when the prostate enlarges.
What are the Risk factors?
1. Age: commoner in elderly men, mean age at diagnosis is 65years.
2. Ethnicity: commonest among Blacks and least common among Asians.
3. Family History: your risk of having prostate cancer is increased if a close relative i.e a brother or father has it.
4. Lifestyle: Smoking, obesity increases the risk.
5. Hormones: insulin like growth factor (IGF-1) has been linked.
There might be things you might have heard off but are not included in this list probably because of insufficient evidence to back it up.
How does it Manifest?
At the moment, majority of prostate cancers are identified in patients who are asymptomatic. In such cases, it could be due to abnormalities in a screening prostate specific antigen(PSA) which is a hormone secreted by the prostate or findings on digital rectal examination (DRE). It is important to note that symptoms of localized prostate cancer can also be caused by benign prostatic hyperplasia (BPH) another prostate pathology that causes enlarged prostate.
Symptoms of localized disease includes; difficulty passing urine, passing urine more often (frequency), getting up in the night to void more than normal(nocturia), straining to urinate, poor urinary stream, blood in urine(hematuria), blood in semen(hematospermia). Most of these symptoms are due to the relationship of the prostate to the bladder, remember the anatomy we discussed earlier. In advanced disease, there may be anemia, weight loss, it has a strong predilection for spreading to the bones which causes bone pain with or without pathological fracture.
How is Prostate Cancer Diagnosed?
Now this is where it gets interesting and a bit confusing and the reason is as we mentioned earlier that prostate cancer suspicion can arise due to an abnormal DRE or PSA level but just as DRE is examiner dependent and less than reliable, so also, an abnormal PSA level is not diagnostic because BPH and prostatitis can lead to a rise in PSA level.
When PSA testing was first developed, the upper limit of normal was thought to be 4ng/ml. However, subsequent studies have shown that no PSA level guarantees the absence of prostate cancer, cancer can be detected even at a PSA of 1ng/ml if a biopsy is performed. Although, as the PSA level increases, so does the risk of this disease.
If you are still following at this point, the next question will be how then is prostate cancer truly diagnosed? Simply you need a prostate biopsy! Although MRI scan can also detect abnormal areas of the prostate. Prostate biopsy is done under ultrasound guidance (TRUS). Complications that may arise from prostate biopsy includes fever, pain, hematuria, hematospermia.
It is important to know all the various treatment options available, the pros and cons. You should have a lengthy discussion with your doctor and possibly get a second opinion.
Some of the things to consider will include;
⦁ The stage and grade of your cancer
⦁ Your age at diagnosis and life span
⦁ Any other serious health conditions you have
⦁ Your feelings about getting treated right away together with your doctor’s opinion on that
⦁ Is the treatment likely to cure the disease
⦁ Your feelings about the possible side effects of treatment
Depending on the situation, treatment options of prostate cancer includes:
⦁ Active surveillance or watchful waiting
⦁ Radiation therapy
⦁ Hormone therapy
⦁ Bone directed treatment
These treatments can be used one at a time or in various combinations.
Dr. Aransiola S.A