The prostate: what is it?
The prostate is a gland involved in the male reproductive system. It is located just below the bladder, surrounding the tube leading from the bladder (called the urethra) like a doughnut. The prostate is composed mostly of muscular and glandular tissue. Its primary job is to produce fluid for semen.
What is prostate cancer?
Prostate cancer is a disease in which cancerous cells are found in the prostate, most often starting in the outer part of the prostate. The tumor may grow and spread into the inner part of the gland. Cancer that remains confined to the prostate gland itself, and has not spread to outside tissues, is called localized prostate cancer. The cancer may spread outside the gland, most often to surrounding tissues or seminal vesicles (sac-like structures attached to the prostate). Further spreading would include the lymph nodes, and eventually other organs throughout the body. As with other cancers, its ability to spread beyond the prostate is what makes prostate cancer such a dangerous threat.
The most common risk factor for developing prostate cancer is age. More than 75% of men who are diagnosed with prostate cancer are over the age of 65. Fortunately, in most men it is slow growing, and if found early is very treatable.
What are the symptoms?
Unfortunately, prostate cancer rarely produces symptoms until late in the disease. That is why prostate check-ups are extremely important in order to spot the disease when it is still “silent” and curable. Your physician will do a digital (finger) rectal exam (DRE), which can reveal an enlarged gland, and may also give you a simple blood test to check the level of prostate specific antigen (PSA). An elevated PSA can be a sign of prostate cancer, and indicate that further evaluation is called for.
If either the DRE or PSA test reveal problems, your physician may want to perform a tissue biopsy, which is usually performed in the doctor’s office. Tissue is taken from several areas of the prostate gland and closely examined. The pathologist will “grade” the tissue, describing it as low-grade, medium-grade, or high-grade cancer. With prostate cancer, pathologists often use the Gleason system, which gives a score of 2 to 10, and a grading system that uses G1 through G4. The higher the score, the higher the grade of tumor; high-grade tumors are more likely to spread. The tumor is also staged, which means determining the site and location of the disease. Early cancer, stages 1 and 2, is localized to the gland; stage 3 cancer is present just outside the gland; and stage 4 has spread to other tissues or organs.
What there treatment options?
There are generally three treatment options, depending on the grade and stage of cancer: radical prostatectomy, radiation therapy, or “watchful waiting.”
Radical prostatectomy removes the whole prostate gland and nearby tissues, sometimes including lymph nodes in the pelvis. “Nerve-sparing” prostatectomy can sometimes be done to avoid damaging the nerves needed for an erection and for urinary continence. Radiation therapy delivers radiation energy to the prostate and is usually done in multiple sessions in an outpatient setting. The energy can also be delivered by “seed implants,” which are radioactive pellets surgically implanted in the prostate. Radiation seed implants are a significant treatment advance that offers an effective option to surgery, with less impact on patient lifestyle. “Watchful waiting,” or surveillance, is sometimes recommended for older patients, who generally have slow-growing cancer. These patients are followed regularly by their doctor and treated more aggressively is there is evidence of cancer growth.
Choosing the best treatment can be a difficult decision, since there are risks and benefits to each approach. The decision should involve careful discussions among the patient, his family, and his doctor, and it should not be made in haste.
What about early diagnosis?
While prostate cancer cannot be prevented, it CAN be diagnosed early, in most cases. The American Cancer Society recommends that men age 50 and older should talk to their physician about having a digital rectal exam and a PSA blood test every year. Men at high risk (African Americans and men with a family history of prostate cancer) should consider beginning these tests annually at age 40.
Of course, you should see your doctor if you have symptoms related to urination, such as weak urine flow, inability to urinate or stop the flow, or painful urination, or frequent pain or stiffness in the lower back, hips, or upper thighs. These may also be signs of an enlarged prostate, which is a non-cancerous condition.
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