In this type of surgery, no external
incision is needed. After giving anesthesia, the surgeon reaches the prostate
by inserting an instrument through the urethra .A procedure called TURP
(transurethral resection of the prostate) is used for 90 percent of all
prostate surgeries done for BPH. With TURP, an instrument called a resects
is inserted through the penis. The resects, which is about 12 inches long
and 1/2 inch in diameter, contains a light, valves for controlling irrigating
fluid, and an electrical loop that cuts tissue and seals blood vessels.
During 45 - 90 minutes operation, the surgeon uses the
resects' wire loop to remove the obstructing tissue one piece at a time.
The pieces of tissue are carried by the fluid into the bladder and then
flushed out at the end of the operation.
Most doctors suggest using TURP whenever possible. Transurethral
procedures are less traumatic than open forms of surgery and require a
shorter recovery period.
Another surgical procedure is called transurethral incision
of the prostate (TUIP). Instead of removing tissue, as with TURP, this
procedure widens the urethra by making a few small cuts in the bladder
neck, where the urethra joins the bladder, and in the prostate gland itself.
Although some people believe that TUIP gives the same relief as TURP with
less risk of side effects such as retrograde ejaculation, its advantages
and long-term side effects have not been clearly established.
Each year, more than 120,000 new cases of prostate
cancer occurs in USA and more than 30,000 deaths are caused annually by
this disease. Approximately, one out of every 10 men will develop this
form of cancer - it is second only to lung cancer as the leading cause
of death in men - and the likelihood of developing it increases with age.
An estimated 232,090 cases of prostate cancer will be diagnosed in U.S.
men in 2005.
Every man over the age of 50 should know that
he is at risk for prostate cancer. African Americans have the highest
risk of developing this disease. Having a father or brother with prostate
cancer also greatly increases a man's likelihood of developing it. In
addition, studies have shown that a diet high in fat may contribute to
the development of this cancer.
Most prostate cancers begin in the outer
part of the prostate. The cancer must grow fairly large before it presses
on the urethra and interferes with the urination. In the early stages,
prostate cancer is curable. With prompt treatment the percentage of men
who survive longer than 10 years is roughly equal to that of men who have
never had prostate cancer.
If prostate cancer is allowed to develop without treatment,
it may spread to other organs, causing disability and sometimes death.
Advanced prostate cancer is more likely to cause symptoms, which may lead
a man to see a urologist for diagnosis. Unfortunately, by the time prostate
cancer has reached this stage, it is less responsive to treatment.
If the results of DRE suggest the presence
of cancer, your urologist may recommend that other test be performed which
help detect prostate cancer or indicate the extent of the cancer's growth.
To confirm the presence of cancer, the urologist may perform a biopsy
obtaining a small sample of the suspected cancer for examination under
a microscope by a pathologist.
If a diagnosis of prostate cancer is made,
the urologist will generally recommend treatment. How prostate cancer
is treated depends upon the stages of cancer, the aggressive nature of
the cancer, the age of the patient, the patient's overall health and side
effects of different treatments. Because so many different options exists,
the treatment of prostate cancer should be carefully weighed by you and
your urologist. One of the treatment options, no matte what the stage
is "watchful waiting".
Since the prostate cancer grows slowly, symptoms
may not appear for years. Men generally develop this disease late in life,
so a period of watchful waiting (period of observation) may be a choice.
But studies have shown that after the age of 40, there is no fixed rule
for cancer of prostate to develop.
Various treatment options are employed: these
include surgery, radiation therapy, hormonal therapy and occasionally
chemotherapy. The urologist will advise on the treatment most appropriate
for each particular case depending upon the stage of disease.
Prostate cancer occurs when cells within the prostate grow
uncontrollably, creating small tumors. Most cells in the body are constantly
dividing, maturing, and then dying in a tightly controlled process. Unlike
normal cells, the growth of cancer cells is no longer well regulated.
Instead of dying, as they should, cancers cells outlive normal cells and
continue to form new, abnormal cells. The term "primary tumor"
refers to the original tumor; secondary tumors are caused when the original
cancer spreads to other locations in the body. Prostate cancer typically
is comprised of multiple very small, primary tumors within the prostate.
At this stage, the disease is often curable (rates of 90% or better) with
standard interventions such as surgery or radiation that aim to remove
or kill all cancerous cells in the prostate. Unfortunately, at this stage
the cancer produces few or no symptoms and can be difficult to detect.
Metastatic prostate cancerIf untreated and allowed to grow,
the cells from these tumors can spread in a process called metastasis.
In this process, prostate cancer cells are transported through the lymphatic
system and the bloodstream to other parts of the body, where they lodge
and grow secondary tumors. Once the cancer has spread beyond the prostate,
cure rates drop dramaticallyCauses & Risk Factors The
major known risk factors for prostate cancer are
The chance of having prostate cancer increases rapidly after age 50.
In fact, about 80% of all prostate cancers are diagnosed in men over
the age of 65.
More African-American men develop prostate cancer than Caucasian-American
men. Asian men living in Asia have the lowest incidence.
Approximately 25% of men with prostate cancer have a history of the
disease within their family.
· It is believed that only 9% of all prostate cancers
are purely hereditary.
Recent studies have shown that men who are overweight or obese are
at significantly higher risk for developing prostate cancer.
Prevention Some risk factors – such as race,
family history or age -cannot be modified, while others, especially
diet and weight, can be controlled.
The prostate cancer Foundation suggests that men wanting to reduce
their risk of prostate cancer
Eat fewer red meats and high-fat dairy products,
Eat five or more servings of vegetables and fruits each
Exercise regularly and
Maintain a normal weight.
Screening & DiagnosisScreening
for prostate cancer can be performed quickly and easily in a physician’s
office using two simple tests:
The Prostate Specific Antigen (PSA) blood test, and the
Digital Rectal Exam (DRE).
PSAA PSA level above 4.0 ng per milliliter of serum may
trigger a prostate biopsy to search for cancer.
The Digital Rectal Exam
||Symmetrical Enlargement (BPH)
The digital rectal exam should be performed along with the
PSA test. A physician who will insert a gloved finger into the rectum
to feel the peripheral zone of the prostate where most prostate cancers
occur performs the DRE. The physician will be checking for hardness
of the prostate or for irregular shapes or bumps extending from the prostate
– all of which may indicate a problem. The DRE is particularly
useful because the PSA test may miss up to 25% of cancers, and the DRE
may catch some of these.SymptomsOften, early stages of prostate cancer
do not cause symptoms. However, in some cases, men with prostate
cancer may experience any of these problems:
A need to urinate frequently, especially at night;
Difficulty starting urination or holding back urine;
Weak or interrupted flow of urine;
Painful or burning urination;
Difficulty in having an erection;
Blood in urine or semen; or
Frequent pain or stiffness in the lower back, hips,
or upper thighs.
Digital Rectal Examination (DRE)
Prostate Specific Antigen (PSA) Test
Transrectal Ultrasonograpy (TRUS) of the
Prostate Needle Biopsy (PNB)
X-ray chest P.A.view
After a bone is damaged by tumor, new bone
tissues grows. A bone scan can detect this new growth may show that cancer
has spread into the bone. Bone scan is done to see for the spread of the
cancer to the bone.
Learning about prostate cancer
Your treatment about will depend on:
Your age, lifestyle, general health will also
help you and your doctor to choose the best treatment.
The pathologist grade cancer cell removed during
Low grade look more like normal cells
High grade, cell may vary in size and shape
Cell from two biopsy site are graded using Gleason score of between 2
–10. The higher the score, the more likely cancer cells will grow
faster and spread. The pathologist will give your doctor a report about
Base on results from your test, your urologist
will stage the cancer. This shows how much the cancer has grown and spread.
Lower stage tumors are likely to be confined to prostate.
Higher stage tumor may have spread from prostate to the seminal vesicles,
lymph nodes, bones, lungs and other part of body.
You should speak with your doctor immediately if you have experienced
any of the above symptoms or if you are a man over 50 who have not had
a recent prostate cancer screening. If you have a family history
of prostate cancer, or are an African-American male, you should consider
screening at age 45.
Bone scan is done to see for the spread of
the cancer to the bone.
Treatment for prostate cancer.
Various treatment options are employed:
Treatment of prostate cancer in early stage:
In early stages, when the prostate
cancer is localized (confined to prostate), treatment options generally
This is surgical removal of the prostate gland. The idea is to remove
the cancerous growth of the prostate by removing the entire prostate gland.
This therapy helps to shrink the tumor by:
Radiation has its own complication but with
proper planning and linear accelerator, side effects can be minimized.
Radical retropubic prostatectomy and
radical perineal prostatectomy are the two most common types
of radical prostatectomy procedures. The entire prostate gland, attached
seminal vesicles, and some nearby tissue are removed during these surgeries.
A radical retropubic prostatectomy
involves a surgical cut in the lower abdomen. The surgeon can then
remove the cancer through this skin incision. The entire prostate
and attached seminal vesicles are removed, along with a small part
of the bladder next to the prostate.
If necessary, a pelvic lymphadenectomy
is performed to remove nearby pelvic lymph nodes
Recent developments in surgery have
led to a newer version of this technique, called nerve-sparing radical
retropubic prostatectomy. This allows the surgeon to identify the
nerves on either side of the prostate so that they can be left alone,
if possible. In general, there is a lower risk of certain adverse
effects if the nerve-sparing technique can be used.
Radical perineal prostatectomy is
similar to radical retro pubic prostatectomy except that the cancer
is removed through an incision in the perineum. A surgical cut is
made in the area between the scrotum and the anus. The entire prostate
is removed along with any nearby cancer.
Prostatectomy is a one-time procedure
that may optimally treat prostate cancer in its early stages and may help
extend life in the later stages. Surgery avoids some of the problems seen
with radiation therapy. These problems are discussed in the next section.
Prostatectomy is a major operation that requires
hospitalization and can produce side effects. The possible side effects
include impotence, urinary incontinence, and narrowing of the urethra
that can make urination difficult.
Although impotence can occur in a large number of patients, the chance
of impotence is lower with the newer nerve-sparing technique. Urinary
incontinence occurs in only a small percentage of patients.
Radiation therapy uses high-energy x-ray to kill cancer cells. There are
two methods of radiotherapy
Radiation may come from out side the prostate (external
As treatment begins cancer cells are damaged and later die. Some
normal cells are damaged too. More cancer cells die with more treatment.
Cells continue to die for 12-18 months after treatment.
During each dose of external beam radiotherapy, radiation
comes from a machine outside your body is beamed into the cancer.
Each dose damages more and more cancerous cells.
Risk and complications:
- Mild to moderate diarrhea.
- Darkening and drying of skin in the treatment area.
- Some loss of pubic hair.
- Bloating / Gas pain.
- Frequent urination, possibly with burning.
- Irritation or inflammation of rectum with diarrhea Urgent
needs to pass stool or rectal discomfort.
- Erectile dysfunction
- Bleeding or scaring of the bladder and or rectum.
Radiation comes from material placed inside the prostate
targeting cells from inside the prostate. During interstitial brachytherapy,
“seeds” (tiny plastic tubes containing radioactive material)
are implanted into your prostate through needles using the perineal
approach. This occurs when you are under anesthesia. The seeds releases
decreasing amount of radiation for about a year. The implant can be
temporary or permanent. Healthy tissue near the seeds may also be
affected. This may cause some side effect
Frequent urination, possibly with
a burning feeling.
Bleeding and inflammation of bladder
Treatment of advanced prostate cancer:
Advanced cancer of the prostate may not be present with
the symptoms. The aim of treating advanced prostate cancer is to slow
further growth of the disease, even before the symptoms begin.
Hormonal therapy is usually used for the slowing the spread
All male hormones “feed” prostate cancer. Hence,
the idea is to shut off the supply of testosterone to prostate. This
would prevent or slow down the spread of prostate cancer. This testosterone
is manufactured in testis.
Estrogen (DES), a female hormone is used in the treatment
of prostate cancer. In men, intake of estrogen leads to fall of testosterone.
However, its use is not widely accepted due to many side effects.
It is usually prescribed as a single dose per day but it may cause
nausea, vomiting, breast tenderness or enlargement, serious heart
or blood vessel problems (such as stroke, clots, and fluid retention)
and lower sex drive.
- It means surgical removal of testicles, it is also known
as surgical castration. In the absence of testis, the main source of
male hormones, testosterone, is absent. This slows the growth of the
tumor. Side effects may include impotence and hot flashes. The surgery
can be performed as a day care.
- Medical Castration: Testosterone production from testicles
can also be blocked by medicines. Medical castration shuts off the supply
of testosterone by the testicle and achieves almost the same results
as surgical castration. Medical castration involves monthly injection
of Lupron Depot (Leuprolide) or Zoladex (Goserelin). These medications
are also known as LHRH agonists. A LHRH agonist help reduce the amout
of testosterone similar to surgical procedure. Side effects usually
include hot flashes, impotence, breast enlargement and tenderness, loss
of sex drive and nausea.
- Complete Hormonal Therapy
- Although testicles are the main source of male hormones,
they are not the only one. The adrenal glands also make male hormones.
- While castration stops the testicles from making testosterone,
a drug called Flutamide can help prevent the male hormone produced by
the adrenal glands from reaching the prostate. Flutamide is referred
to as an antiandrogen.
- The combination of LHRH agonist (Lupron or Zoladex), or
castration plus Flutamide are called complete hormonal therapy. Complete
hormonal theapy virtually shuts off the body’s supply of male
hormones and slows the growth of the tumor.