The prostate gland is a small walnut shaped gland in the male reproductive system and secretions of which constitutes thirty percent of seminal fluid volume which helps to nourish and transport spermatozoa. Unlike other carcinomas prostate cancer tends to run a more silent and indolent course, often being a common incidental finding at autopsy.

It is thought to be present in 20-30% of men over fifty years and over 70% in men over ninety years of age, in a vast majority it remains occult during life. That being said some forms can spread aggressively and it is in that thought that we must have it investigated if any presence of the disease is suspected. Daily Mirror Life spoke with Dr.K.K.W. Perera regarding the disease,

 

What are the symptoms of prostate cancer?

prostate cancer may not show any signs and symptoms in its’ early stages but in its’ advanced stage it may cause signs and symptoms such as:

Trouble during urination where there is a poor stream of urine/ hesitancy to pass urine.

As a result of hesitancy to pass urine there is straining in an effort to evacuate the bladder.

Towards the latter stages blood may be seen with urine or semen.

Discomfort in the pelvic area.

Swelling in the legs- seen in advanced form of the disease

Bone pain and lower back pain specially in an elderly male should be thought of as prostate cancer until proven otherwise.

 

What are the risk factors of prostate cancer?

Age –The risk increases with age and it’s common in men over 65 years of age.

Ethnicity-It is commoner amongst the white male population than the asian men.

Family history-This has a strong familial tendency, a man with a father or brother with prostate cancer has a double the risk of getting it than someone with a negative family history.

Obesity-Obese men are likely to have the advanced form of the disease that’s more difficult to treat.

Environmental factors-A study in to the geographic distribution  of the disease showed that the low incidence amongst the Japanese men increased to approach that of the American white men when they migrated to America.

 

What are the complications of the disease?  

The complications due to prostate cancer and its’ treatment include:

Metastasis or spread of the cancer- It can extend to the local structures such as bladder base and ureters and block urine flow. It can spread via the lymphatics to the regional lymph nodes and it can spread by blood to the bones. Once the spread has been established it may be controlled but not cured.                                                

Incontinence- Prostate cancer as well as its’ treatment can cause urinary incontinence.

Erectile dysfunction- This too is a result of the cancer as well as its’ treatment.

 

What are the tests available to arrive at a diagnosis?

The prostate screening tests include:

Digital rectal examination- Your doctor will insert a lubricated gloved finger in to the rectum and asses the abnormalities in the texture, shape, and size of the gland.

Prostate-specific antigen (PSA)test- A blood sample is drawn from a vein and analyzed for PSA which is higher than normal in conditions like infection, inflammation and cancer of the gland.

These two tests help to identify prostate cancer at its’ earliest stages.

Diagnosing prostate cancer If an abnormality is detected in the above mentioned two tests then the doctor may recommend some more tests to arrive at a definitive diagnosis.

Ultrasound- If other tests raise concern then a small probe will inserted in to your rectum and using sound waves will take pictures of the gland.

Prostate biopsy- A thin needle is used to collect a core tissue sample and this is analyzed in a laboratory for cancer cells.

Once the biopsy confirms cancer cells the next step is to grade the tumor based on its level of differentiation and to determine the extent of the cancer spread by a bone scan, chest x-ray, ultrasound, CT scan or MRI to determine the stage.

 

What are the different modalities of treatment?

The treatment depends on several factors such as how fast your cancer is growing, the extent of spread, overall health and potential side effects of the treatment. Immediate treatment may not be necessary right away for men who are diagnosed to be in an early stage.

Doctors recommend watchful waiting which is also called active surveillance. In watchful waiting regular follow-up blood tests, rectal exams, and biopsies are performed to monitor the progression of the disease. If tests show progressing cancer then surgery or radiation can be opted for. In advanced disease hormone therapy can be used with radio therapy to shrink the tumor and if that is refractory then chemotherapy can be used.

 

 

By Samurddhi Tillekeratne