Prostate Cancer : Tests & Treatment

Prostate is a reproductive gland found in males and is an androgen (or testosterone) dependent sex gland that provides the bulk of seminal fluid during ejaculation. The prostatic fluid is excreted in the semen and helps nourish the sperms and keep it in the fluid state in the vagina.

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man’s reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Tests & Diagnostics

A rectal exam will often show an enlarged prostate with a hard, irregular surface.
A number of tests may be done to diagnose prostate cancer:

  1. PSA test (may be high, although noncancerous enlargement of the prostate can also increase PSA levels)
  2. Free PSA (may help tell the difference between BPH and prostate cancer)
  3. AMACR (a newer test that is more sensitive than the PSA test for determining prostate cancer)
  4. Urinalysis (may show blood in the urine)
  5. Urine or prostatic fluid testing (may reveal unusual cells)

Prostate biopsy is the only test that can confirm the diagnosis.
The following tests may be done to determine whether the cancer has spread:
(a) CT scan
(b) Bone scan
(c ) Chest x-ray
Health care providers use a system called staging to describe how far the cancer has grown. Tumor size, and how far the cancer has spread outside of the prostate determine the stage. Identifying the correct stage may help the doctor recommend the best treatment.
There are several different ways to stage tumors, including:

  1. The TNM staging system (most common)
  2. The A-B-C-D staging system, also known as the Whitmore-Jewett system

The grade of a tumor describes how aggressive a cancer might be. The more tumor cells differ from normal tissue, the faster these cells are likely to grow. The grading system for prostate cancer is called the Gleason grade or score. Higher scores are usually faster growing cancers.

Treatments
The appropriate treatment for prostate cancer is not clear. Treatment options vary based on the stage of the tumor. In the early stages several options are available including surgery, radiation therapy, or, in older patients, monitoring the cancer without active treatment.

Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis.

Surgery
Surgery is usually only recommended after a thorough evaluation and discussion of all treatment options. A person considering surgery should be aware of the benefits and risks of the procedure.
(A) Surgery to remove the prostate gland is often recommended for treating stages A and B prostate cancers. This is a lengthy procedure and complications are possible. There are many different surgery options like Radical prostatectomy and Robotic surgery.
(B) Orchiectomy alters hormone production and may be recommended for cancer that has spread to other areas of the body. There may be some bruising and swelling right after surgery, but this will gradually go away. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.

Radiation therapy
Radiation therapy is used primarily to treat stage A, B, or C prostate cancers. Whether radiation is as good as prostate removal is unclear. The decision about which treatment to choose can be difficult. In patients whose health makes surgery too risky, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:

  1. External beam radiation therapy is done in a radiation oncology center by specially trained radiation oncologists, usually on an outpatient basis. The treatment itself is generally painless. Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, inflamed bladder (cystitis), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 – 8 weeks.
  2. Prostate brachytherapy or internal radiation involves placing radioactive seeds inside you, directly into the prostate. A surgeon inserts small needles through the skin behind your scrotum to inject the seeds. The seeds are so small that you don’t feel them. They can be temporary or permanent. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues around the prostate. Prostate brachytherapy may be given for early, slow-growing prostate cancers. It also may be given with external beam radiation therapy for some patients with more advanced cancer. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.
  3. Radiation is sometimes used for pain relief when cancer has spread to the bone.

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