What is Prostate Cancer?
Prostate is a glandular organ present only in males. It surrounds the neck of the bladder and the first part of urethra. It contributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter. It has got five lobes anterior, posterior, two lateral and a median lobe. Since the first part of the urethra passes through it, any lesion in the prostate will produce difficulty in passing urine.
Diseases of the prostate gland
This is the inflammation of the prostate gland due to bacterial infection.
2) Benign enlargement of the prostate
This is a non cancerous tumor of the prostate usually seen after the age of 50.
3,Cancer of the prostate
This is the 4th most common cause of death from malignant diseases in males.
Cancer of the prostate
Cancer of the prostate is directly linked with the male sex hormones (androgens). If the levels of sex hormones increase, the growth rate of cancer also increases. It is found that after the removal of testes there is marked reduction in the size of a tumor.
Site of the tumor
Prostate cancer is seen mainly in the posterior lobe. Non cancerous enlargement is seen in other lobes.
Changes in the gland in cancer
The gland becomes hard with irregular surfaces with loss of normal lobulation. Histologically prostate cancer is an adeno carcinoma (cancer of the epithelial cells in the gland)
Growth rate is very fast in prostate cancer .The tumor compresses the urethra and produce difficulty in urination.
Spread of the tumor
Metastasis in cancer of the prostate is very early
1) Local spread
From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles. Tumor cells also move to the neck and base of the urinary bladder.
2) Lymphatic spread
Through the lymph vessels, cancer cells reach the internal and external illiac group of lymph nodes. From there cells move to retroperitonial (Behind the peritonium) and mediastinal lymph nodes (in the chest).
3) Spread through the blood
Spread of cancer cells takes place through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enters the vertebral bodies of the lumbar vertebrae.
Signs and symptoms of prostate cancer
Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.
1) No symptoms
Tumor is small and only in the posterior lobe. This is diagnosed accidently.
2) Slight difficulty in urination
Here the tumor is enlarged and urethra is slightly compressed. Shortly there will be frequent urge for urination with difficult urination.
3) Tumor spread
When the tumor has spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding. Urine comes drop by drop.
4) Retention of urine
When the urethra is completely compressed there will be retention of urine. This can lead to hydronephrosis, renal failure etc. In this condition patient may get convulsions due to renal failure and finally coma.
5) Signs of metastasis
Some patients come with the signs and symptoms of metastasis.
a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.
b) Fracture of spine due to cancerous growth in the spine.
c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.
d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.
e) General weakness due to spread of cancer to different parts of the body.
f) Anaemia due to involvment of bone marrow and increased destruction of RBCs.
Includes per rectal examination to feel the prostate gland, palpation of abdomen to feel the swelling in kidneys and any tumors. Patient is examined from head to foot to find out any lesions.
1) Complete blood investigations
RBC, WBC, Platlets, ESR, bleeding time ,clotting time etc.
2) Urine analysis
Microscopic examination to detect pus cells, occult blood, casts, Crystals etc.
3) Renal function tests
Blood urea level, serum creatinine level, electrolyte level etc.
4) Serum acid phosphatase
Increased in cancer of prostate.
5) x-ray of the spine
To detect any tumor or fracture.
6) Ultra sonography
Gives idea about prostate, bladder, kidney etc.
7) C T scan
More detailed information about organs and tumor.
8) MRI of the spine
Gives detailed information about spine, disc and nearby soft tissues.
Gives idea about lymphatic spread of cancer.
10) Biopsy to confirm cancer
Biopsy is taken from the tumor and is sent for histopathological examination under the microscope. This will detect the presence of cancer cells.
1) If there is retention of urine catherisation is needed.
2) Dialysis if kidney failure.
3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.
4) Specific treatment is prostatectomy (removal of prostate)
Here only the affected lobe is removed.
Total removal of prostate along with nearby lymph nodes.
5, Hormone therapy
Stilbestrol is given to reduce tumor growth. Since this treatment increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.
Drugs like cyclophosphamide, cisoplatim etc. are given.
7) Radiotherapy is also done for some cases.
Homoopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur etc can be given according to symptoms. Constitutional homeopathic medicine will give great relief and can increase the life span.
9) Yoga and meditation is also helpful.