Urosurgery and Endourology


Prostate Cancer Treatment

The prostate is a glandular organ, about size of a walnut, present in males. The prostate is normally about 3 cm long and it lies at the neck of the bladder and in front of the rectum. The prostate gland produces fluid that makes up part of the semen.

Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer. Prostate cancer is often a very slow-growing disease. It can take 10 years or more for a small tumor to spread beyond the gland and pose a serious threat to health.

Cancer occurs when normal cells undergo a transformation in which they grow and multiply without any control. There are four stages of prostate cancer:

  • Stage I - In stage I, cancer is found in the prostate only. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia.
  • Stage II- In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate.
  • Stage III- In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles.
  • Stage IV- In stage IV, cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones.

Stages Of Prostate Cancer

The cause of prostate cancer is unknown, but hormonal, genetic, environmental, and dietary factors are thought to play roles. The following risk factors have been linked with development of this condition:

  • Age: There is a strong correlation between increasing age and developing prostate cancer. Autopsy records indicate that 70% of men older than 90 years have at least one region of cancer in their prostate.
  • Race: African American men are 1.5-2 times more likely than white men to develop prostate cancer.
  • Genetic factors: Men, who have a history of prostate cancer in their family, are at an increased risk.
  • Diet: A diet high in fat has been associated with an increased risk of prostate cancer.
  • Chemical agents: Exposure to chemicals such as cadmium has been implicated in the development of prostate cancer.

Prostate cancer can produce many symptoms. Some of them have been listed below. But presence of these symptoms does not necessarily indicate prostate cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur. Some of the symptoms are:

  • Weak or interrupted flow of urine.
  • Frequent urination (especially at night).
  • Trouble urinating.
  • Pain or burning during urination.
  • Blood in the urine or semen.
  • A pain in the back, hips, or pelvis that doesn't go away.
  • Painful ejaculation.

The doctor may perform necessary test to detect and diagnose prostate cancer. The following procedures may be used:

  • Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.
  • Digital rectal exam (DRE)

  • Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate).
  • Transrectal ultrasound: A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure.
  • Transrectal ultrasound showing a series of prostate ultrasound images used to construct a 3-dimesnsional image of the prostate (volume study) and treatment plan. Key: Red line = prostate; Blue line = limit of radiation to be delivered

  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will examine the biopsy sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread. There are 2 types of biopsy procedures used to diagnose prostate cancer:
    • Transrectal biopsy: The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide the needle. A pathologist views the tissue under a microscope to look for cancer cells.
    • Transperineal biopsy: The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate. A pathologist views the tissue under a microscope to look for cancer cells.

If prostate cancer is diagnosed, the other tests( e.g Radionuclide bone scan, MRI. Pelvic lymphadenectomy, Seminal vesicle biopsy) are done to find out if cancer cells have spread within the prostate or to other parts of the body.