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11 years, 3 months ago
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Prostate cancer develops in the walnut-sized gland underneath the male bladder. It is the most common cancer, other than skin cancer and is the second leading cause of cancer-related death in men.
The disease, which often develops slowly, is different to most other cancers because small areas of cancer within the prostate are common, especially in older men and may not grow or cause any problems. This presents men diagnosed with prostate cancer with some extremely difficult choices. The statistics Prostate cancer is the second most frequently diagnosed cancer in men and the fifth most common cancer overall. One in six men will be diagnosed with the disease in their lifetime and the overwhelming majority of cases occur in wealthy countries. Each year, about 37,000 men in the UK and some 210,000 men in the US are diagnosed with prostate cancer and more than 10,000 and 28,000 respectively die each year of the disease. In the US there are over two million men living with the disease and African American men have a higher incidence of prostate cancer and double the mortality rate compared with other racial and ethnic groups. In the US about US$10 billion is spent annually on treatments for the disease. Standard treatments Traditional treatments to stop the spread of prostate cancer involve surgery and radiotherapy, which has significant side effects. Following such treatments 50% of patients experience impotence, up to 20% suffer incontinence and between one and five percent who receive radiotherapy experience pain and bleeding. |
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Prostate cancer usually doesn't produce any noticeable symptoms in its early stages, so many cases of prostate cancer aren't detected until the cancer has spread beyond the prostate. For most men, prostate cancer is first detected during a routine screening such as a prostate-specific antigen (PSA) test or a digital rectal exam (DRE).
When signs and symptoms do occur, they depend on how advanced the cancer is and how far the cancer has spread.
Less than 5 percent of cases of prostate cancer have urinary problems as the initial symptom. These problems are caused when the prostate tumour presses on the bladder or on the tube that carries urine from the bladder (urethra). However, urinary symptoms are much more commonly caused by benign prostate problems, such as an enlarged prostate (benign prostatic hyperplasia) or prostate infections.
When urinary signs and symptoms do occur, they can include:
- Trouble urinating
- Starting and stopping while urinating
- Decreased force in the stream of urine
Cancer in your prostate or the area around the prostate can cause:
- Blood in your urine
- Blood in your semen
Prostate cancer that has spread to the lymph nodes in your pelvis may cause:
- Swelling in your legs
- Discomfort in the pelvic area
Advanced prostate cancer that has spread to your bones can cause:
- Bone pain that doesn't go away
- Bone fractures
- Compression of the spine
While with most cancers, early detection increases the chance of a cure; it is unclear whether screening for prostate cancer reduces the number of deaths from this disease. Despite the controversy, it is still recommended that men undergo annual screening for this disease utilizing digital rectal examination (DRE), PSA blood test or transrectal ultrasonography. Currently, it is recommended that men begin annual screening with PSA and DRE at age 50 and that men from Afro Caribbean origin and men with a strong family history of prostate cancer begin annual screening at age 45.
The combination of detail gained by the PSA and DRE together improves the chance of identifying prostate cancer at an early stage.
- Digital Rectal Exam (DRE): During a digital rectal exam (DRE), a physician inserts a gloved finger into the rectum to assess the texture and size of the prostate. If there are any abnormalities in the texture, shape or size of your gland, you may need more tests.
- PSA Blood Test: A simple blood test allows laboratory technicians to determine PSA levels. PSA is a protein that is normally secreted and disposed of by the prostate gland. Its function is involved in liquefying sperm.
It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, benign prostate enlargement, or cancer. In patients with a known diagnosis of prostate cancer, the PSA level roughly reflects the total amount of cancer. The higher the PSA level , the more likely that the cancer is advanced. - Transrectal Ultrasonography: During transrectal ultrasonography, a small probe is inserted into the rectum. The probe emits high frequency sound waves that bounce off the prostate and produce echoes. A computer uses these echoes to create a picture called a sonogram that can show abnormal areas.
- Prostate biopsy: If initial test results suggest prostate cancer, a biopsy may be recommended. To do a prostate biopsy, a small ultrasound probe is inserted into the rectum. Guided by images from the probe, a fine, spring-propelled needle retrieves several very thin sections of tissue from the prostate gland. This is done under local anaesthetic.
A pathologist who specializes in diagnosing cancer and other tissue abnormalities evaluates the samples. From those, the pathologist can tell if the tissue removed is cancerous and estimate how aggressive the cancer is.
Cancer that is removed by surgical resection or needle biopsy will be classified according to the Gleason Grading System for prostate cancer. This grading system, on a scale of 2-10, helps physicians predict how rapidly the cancer is likely to spread. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly.
The pathologist identifies the two most aggressive types of cancer cells when assigning a grade. The most common scale used to evaluate prostate cancer cells is called a Gleason score. Based on the microscopic appearance of cells, individual ratings from 1 to 5 are assigned to the two most common cancer patterns identified. These two numbers are then added together to determine your overall score. Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).
Generally, higher Gleason scores are associated with more advanced and more rapidly growing cancers than lower scores.
