PROSTATE CANCER

What is Prostate Cancer?
The prostate is a gland found only in men that produces the liquid component of semen. Prostate cancer is the second most common cancer in men (after lung cancer), though it mainly affects older men.

Changes to the Prostate-

Normally, cells grow and multiply only when the body needs them to. Cancer develops as a result of a breakdown in this process, leading to cells growing in an uncontrolled way. The mass of excess cells forms a tumour (growth), which may be benign or malignant. The tumour is described as malignant if it is able to invade other healthy tissue. The peripheral (outer) zone of the prostate is the area most susceptible to developing cancer.

Symptoms

> a difficulty in starting to pass urine
> a weak, sometimes intermittent flow of urine
> dribbling of urine before and after urinating
> a frequent or urgent need to pass urine
> a need to get up several times in the night to urinate
> a feeling that the bladder is not completely empty
> rarely, blood in the urine

Diagnosis

Urine test - A simple urine test will be carried out to look for blood or infection.

PSA blood test - Prostate-specific antigen (PSA) is a glycoprotein in the cytoplasm of prostatic epithelial cells. It can be detected in the blood of all adult men. The PSA level is increased in men with prostate cancer but can also be increased somewhat in other disorders of the prostate.

Digital rectal examination - The urologist will carry out an examination of your prostate by inserting a finger into your rectum. Although this can be uncomfortable, it is not painful, and tumours can often be felt by this method

Biopsy - The urologist may do a prostatic biopsy (removal of a small piece of tissue). A biopsy involves passing an ultrasound probe into the rectum to give an accurate view of the prostate. Samples of the prostate are collected using a needle. Biopsies can be uncomfortable and you may be given a mild sedative or local anaesthetic.
A pathologist will examine the prostate sample under a microscope and check whether or not it is cancerous. If cancer is found, the pathologist will "grade" it

Scans - To establish whether the cancer has spread (metastasised) to the bones, you may have a bone scan - a form of X-ray picture.

Another technique is an MRI scan which can look at the body in sections using a strong magnetic field and radio signals. CT scanning is similar to an MRI scan but uses X-rays to build up a picture.

Treatment

The most appropriate treatment for you will depend on several factors including:

" the size and location of the tumour within the prostate
" whether it is contained within the prostate, spread to the lymph nodes or spread to other more distant sites
" your age and your general health

Watchful waiting

Sometimes, particularly for slow-growing tumours, no treatment is the best course of action. Your condition will be monitored closely with routine check-ups.

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Surgery Surgery is the main treatment for most prostate cancer. The most common technique is a "radical prostatectomy", which involves removing the prostate gland, seminal vesicles and nearby lymph nodes. It is a major operation, so it is most suitable for otherwise healthy men (usually, those under 70) whose cancer appears not to have spread. About 80% of men who have this operation are still alive after 10 years. Possible side-effects of the procedure include some urinary incontinence, sterility and erectile dysfunction (impotence), although modern surgical techniques can minimise the risks of this to some extent.

Prostatectomy There are two main surgical methods used for removing the prostate gland. The first method is called the "perineal" method. An incision is made in the perineum, which is the area between the base of the scrotum and the anus

The second surgical method of prostatectomy is called the "suprapubic" approach. An incision is made in the abdomen, just below the umbilicus, which extends downward to the pubic bone

Patients with prostate cancer might require radiation therapy after their surgery. Results depend on the extent of their disease, and the response of the tumor to resection (removal) and radiotherapy.

Hormone therapy

Hormone therapy successfully reduces the size of prostate tumours in 80% of men, but it does not kill cancer cells. For many men, it will be recommended as well as surgery. It is sometimes used before radiotherapy (see below) to reduce the size of the tumour

Radiotherapy

Radiotherapy is an alternative to radical prostatectomy. Currently there is no conclusive evidence to show that one method is more effective than the other. The treatment involves radiation being applied to the affected areas to destroy the cancer cells. This is usually done as an out-patient procedure. The main side-effects are bladder irritation and diarrhoea. Some men also become impotent as a result.

Brachytherapy

Brachytherapy is a relatively new procedure which involves implanting radioactive pellets into the prostate, where they gradually lose their radioactivity over a period of months. The pellets are inserted under general or spinal anaesthetic. Brachytherapy is not recommended for men whose cancer has spread to other parts of the body.