The prostate gland is an organ that is located at the base or outlet (neck) of the urinary bladder.(See the diagram.) The gland surrounds the first part of the urethra. The urethra is the passage through which urine drains from the bladder to exit from the penis.
One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds.
Another function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar. Semen is the fluid that transports the sperm.
In a young man, the normal prostate gland is the size of a walnut. During normal aging, however, the gland usually grows larger.
PROSTATE CANCER AT A GLANCE
Prostate cancer is the second leading cause of deaths from cancer among US men.
While the causes of prostate cancer are still unknown, some risk factors for the disease, such as advancing age and a family history of prostate cancer, have been identified.
Prostate cancer is often initially suspected because of an abnormal PSA blood test or a hard nodule (lump) felt on the prostate gland during a routine digital (done with a finger) rectal examination.
The digital rectal examination (starting at age 40) and the PSA blood test (starting at age 50) should be done at yearly intervals to screen men for prostate cancer.
If one of the screening tests is abnormal, the diagnosis of prostate cancer should be suspected and a biopsy of the prostate gland is usually done.
The diagnosis of prostate cancer is made when cancerous prostatic cells are identified in the biopsy tissue under a microscope.
In some men, prostate cancer is life threatening, while in many others, it can exist for many years without causing health problems.
The choice of treatment for prostate cancer depends on the size, aggressiveness, and extent or spread of the tumor, as well as on the age, general health, and preference of the patient.
The many options for treating prostate cancer include surgery, radiation therapy, hormonal treatment, cryotherapy, chemotherapy, combinations of some of these treatments
What is prostate cancer?
Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. 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). As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.
Why is prostate cancer important?
Prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer. Most experts in this field, therefore, recommend that beginning at age 40, all men should undergo yearly screening for prostate cancer.
What causes prostate cancer?
The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. The chances of developing prostate cancer increase with age. Thus, prostate cancer under age 40 is extremely rare, while it is common in men older than 80 years of age. As a matter of fact, some studies have suggested that among men over 80, between 50 and 80% of them may have prostate cancer!
Prostate cancer is also more common among family members of individuals with prostate cancer. Thus, a person whose father, grandfather, or even uncle has prostate cancer is at an increased risk for also developing prostate cancer.
Testosterone, the male hormone, directly stimulates the growth of both normal prostate tissue and prostate cancer cells.
Environmental factors, such as cigarette smoking and diets that are high in saturated fat, seem to increase the risk of prostate cancer. Additional substances or toxins in the environment or from industrial sources might also promote the development of prostate cancer,
General symptoms of prostate cancer?
In the early stages, prostate cancer often causes no symptoms for many years. These cancers frequently are first detected by an abnormality on a blood test (the PSA) or as a hard nodule (lump) in the prostate gland. Usually, the doctor first feels the nodule during a routine digital (done with the finger) rectal examination. The prostate gland is located immediately in front of the rectum. As the cancer enlarges and presses on the urethra, the flow of urine diminishes and urination becomes more difficult. Patients may also experience burning with urination or blood in the urine. As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder.
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. The cancer can then spread to the liver and lungs. Metastases (areas to which the cancer has spread) to the liver can cause pain in the abdomen and jaundice (yellow color of the skin) in rare instances. Metastases to the lungs can cause chest pain and coughing.
Screening tests for prostate cancer?
Screening tests are to detect a disease such as prostate cancer at an early stage. 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). These screening tests are a digital rectal examination and a blood test called the prostate specific antigen (PSA).Doctors usually recommend doing a PSA annually in men age 50 and over.
Furthermore, for men who have high risks for prostate cancer as discussed above, most doctors recommend starting the PSA screening at an even younger age (for example, at age 40).
How is prostate cancer diagnosed?
If the PSA blood test is abnormal, a prostate cancer is suspected. A biopsy of the prostate is usually then recommended. A pathologist then examines the tissue under a microscope for signs of cancer in the cells of the tissue.
How is the staging of prostate cancer done?
The staging of a cancer refers to determining the extent of the disease. Once a prostate cancer is diagnosed on a biopsy, additional tests are done to assess whether the cancer has spread beyond the gland.
The stage of the prostate cancer, therefore, helps to predict the expected course of the disease and determine the choice of treatment.
Treatment options for prostate cancer?
To decide on treatment for an individual patient, doctors categorize prostate cancers as organ-confined (localized to the gland), locally advanced (a large prostate tumor or one that has spread only locally), or metastatic (spread distantly or widely).
The treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery, radiation therapy, hormonal therapy, cryotherapy combinations of some of these treatments, and watchful waiting.
Surgical treatment for prostate cancer?
The surgical treatment for prostate cancer is commonly referred to as a radical or total prostatectomy, which is the removal of the entire prostate gland. Since 1990, the radical prostatectomy has been the most common treatment for prostate cancer in the United States. This operation is done in about 36% of patients with organ-confined (localized) prostate cancer. The American Cancer Society estimates a 90% cure rate nationwide when the disease is confined to the prostate and the entire gland is removed.
Incontinence after treatment often improves with time, special exercises, and medications to improve the control of urination.
Radiation therapy for prostate cancer?
The goal of radiation therapy is to damage the cancer cells and stop their growth or kill them. This works because the rapidly dividing (reproducing) cancer cells are more vulnerable to destruction by the radiation than are the neighboring normal cells..
Choosing between radiation and surgery to treat organ-confined prostate cancer involves considerations of the patient's preference, age, and co-existing medical conditions (fitness for surgery), as well as of the extent of the cancer.
Hormonal treatment for prostate cancer?
The male (androgenic) hormone is called testosterone. It stimulates the growth of cancerous prostatic cells and, therefore, is the primary fuel for the growth of prostate cancer. The idea of all of the hormonal treatments (medical and surgical), in short, is to decrease the stimulation by testosterone of the cancerous prostatic cells.
Hormonal treatment usually effectively eliminates stimulation of the cancer cells by testosterone.
Cryotherapy for prostate cancer?
Cryotherapy is one of the newer treatments that is being evaluated for use in the early stage of prostate cancer. This treatment kills the cancer cells by freezing them. The freezing is accomplished by inserting a freezing liquid (for example, liquid nitrogen or argon) through needles directly into the prostate gland. The procedure is accomplished under the guidance of ultrasound images.
Chemotherapy for prostate cancer?
Chemotherapeutic agents, or chemotherapy, are anti-cancer drugs. They are used (for hormone resistant prostate cancer) as a palliative treatment (palliation to relieve symptoms) in patients with advanced cancer for whom a cure is unattainable.
The more common side effects of chemotherapy include weakness, nausea, hair loss, and suppression of the bone marrow.
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