The prostate is a walnut-sized gland that is present only in men. It is located deep in the pelvis, at the exit of the bladder. It surrounds the tube, known as the urethra (through which urine flows from the bladder to the outside of the body). The prostate size enlarges with age and causes obstruction to the urine flow.
The normal adult volume of prostate is around 20 mL. Although the prostate is small compared with other organs, it poses a potential source of disease and disability once a man passes middle age.
What is Function of the Prostate?
The fluid in the prostate contains large amounts of a protein known as prostate-specific antigen (PSA). This liquefies the semen, allowing the sperm to move freely in search of an ovum to fertilize.
The prostate surrounds the urethra, so any disease of the gland is likely to cause problems with urination.
There are three common diseases that may affect the prostate:
- BPH or Enlarged Prostate: This results in urinary problems, and affects almost 50% of men beyond middle age
- Prostate cancer, which is now the most common malignancy in men with a 1 in 14 lifetime risk, rising to 1 in 11 for men over 50 years of age
- Prostatitis, an inflammatory disease affecting about 1 in 15 mainly younger and middle-aged men, which is characterized by symptoms of pain and discomfort around the anus, scrotum and the area in between (the perineum).
Prostate Cancer develops as a result of a progressive series of faults occurring in the genes that control cell growth in the prostate. This results in uncontrolled growth of cells causing cancer.
Because of its capacity to invade surrounding areas, cancer can spread to sites around the prostate, in which case it is said to be ‘locally advanced’.
It can also spread to distant sites in a process known as metastasis, which occurs as the cancer becomes more advanced. Cancer cells can break off from the tumour in the prostate and enter the bloodstream and lymphatic system (the latter is a network of tiny vessels that drain fluid from all the organs in the body). In this way, cancer cells can spread to other parts of the body (for example, the lymph nodes or bones) and, secondary tumors develop.
How common is Prostate Cancer?
According to the National Cancer Institute, prostate cancer is the second most common form of cancer affecting men in the United States. An estimated 223,000 men were diagnosed with prostate cancer in 2007. More than seventy percent of men diagnosed with prostate cancer each year are over the age of 65. African American men have a higher risk of the disease than Caucasian men.
So, there is huge need for increasing the awareness of Prostate Cancer, because, men with Prostate Cancer can increase their chance of cure with a little knowledge and timely action.
Men, and their partners and family who love and support them, need to be aware of the Symptoms and Signs of Prostate Cancer, and about the simple blood test called PSA for early diagnosis of Prostate Cancer.
How you can help yourself
Rather than looking for cure after disease has occurred, Our aim should be to prevent the disease
I often tell my patients, the 6 healthy habits as advised by European cancer congress’14:
- Eating more tomatoes,more fruits and vegetables
- Less processed meat, less fatty food
- Not smoking
- Eating fish
- Staying slim
Stages Of Cancer:
The cancer can also be classified according to how far it has spread, that is its ‘stage’. The tumour–nodes–metastases (TNM) system is commonly used, and involves the doctor assessing how far your cancer (tumour) has spread in and around the prostate, whether it has spread to the nearby lymph nodes (nodes) and then whether it has spread (metastasized) to the distant lymph nodes and bones. Knowing the stage of your cancer helps you, your family and your urologist to decide on the most appropriate course of action.
Prostate cancer is the most common cancer in men. It is the second most common cause of death due to cancer in Men.
Total number of new cases diagnosed every year in USA = 2, 20,000 cases
Overall, the lifetime risk of a man developing prostate cancer is around 10%. Your chance of getting prostate cancer depends on your personal risk factors.
A risk factor is something that makes you more likely to develop a certain disease; for example, a high cholesterol level in the blood is a well-known risk factor for heart disease.
- Belonging to an older age group (usually 50+ years)
- Having a close family member or members who have had prostate cancer
- Having certain racial origins; for example, it is more common among men of Afro-Caribbean origin
- Following certain eating patterns, such as a diet high in saturated fats and red meat
- Low exposure to sunlight
The strongest risk factor for prostate cancer is increasing age. The disease rarely occurs in men under 40, but commonly affects men beyond this age. The average loss of life expectancy is about 9 years – precious retirement years for which most men have been working and eagerly anticipating all their lives.
The next most important risk factor for prostate cancer after age is family inheritance. Like breast cancer, prostate cancer runs in certain families and has been linked to a growing number of genes. A man whose any other closebfamily member had the disease has an increased risk of developing prostate cancer compared with one without an affected relative (and the risk is higher if multiple family members have been affected). Particularly in the cases if the disease developed in the close relative when he was under 60.
1 out of every 3 men whose fathers or brothers have had prostate cancer will be diagnosed with the disease.
Race is also a factor, with men of Afro-Caribbean extraction being at highest risk. These men seem to develop a more aggressive form of the disease and at a younger age than white men. Men of Far Eastern descent seem to be relatively less likely to be affected by the disease
When should you go?
According to the American Urology Association Guidelines,2013, for screening of Prostate Cancer ,All men should visit a Urologist after age of 55 years for the Prostate Check that includes Digital Rectal Examination and a simple Blood test called Serum PSA, after shared decision making .
Serum PSA should be tested at-least once in every 2 years.
You may have to ask for a PSA test as not all doctors will offer it routinely.
Specific symptoms to visit a doctor.
Problems with urinating are the most common symptoms of prostate disease. You should visit your doctor if you regularly experience one of the following:
- A weak flow of urine
- Difficulty starting to urinate
- A need to urinate frequently
- A need to urinate urgently
- Having to go to the toilet several times during the night
- A feeling that your bladder is not completely empty after you have finished urinating
- Pain or burning when passing urine
- Blood in your urine (this is particularly important).
Treatment for prostate cancer that has not spread
The most appropriate treatment for you will depend on several factors:
- how aggressive and advanced your cancer is (the grade and stage)
- your age
- your general health
- you and your family’s own informed treatment preferences.
For example, for older men with small tumours and those with other severe illnesses, often the best option is either active surveillance or ‘watchful waiting’
What is the PSA test?
PSA, prostate-specific antigen, is a protein-like substance that occurs in abundance in the fluid within the prostate. Its function is to liquefy the semen. It is tested by a simple Blood test. The normal values for Serum PSA are 0-4 ng/ml. If PSA is higher than 4, you should definitely consult your doctor.
When should I have a PSA test?
Currently, the American Urological Association recommends that most men only need a PSA every 2 years, and that men between the ages of 55 and 69 should consider the pros and cons of PSA testing before making their own decision about a testing schedule.
Based on his experience with prostate cancer, Dr. Sabharwal strongly encourages men to commit to annual PSA screenings and to get a baseline test at age 40.
He believes all men over the age of 40 should have a PSA (prostate-specific antigen) blood test and digital rectal exam as part of their annual physical specially, for those with prostate cancer risk factors – a family history of the disease or African American men.
Through monitoring PSA levels, men who are at risk for developing of the disease can be closely and easily monitored.
If an elevated PSA level is detected, a prostate biopsy can be done to confirm the presence of cancer.
For men who have not yet started their PSA screening, but are experiencing difficulties urinating, a constant urge to urinate, the feeling that you can’t fully empty your bladder, or blood in your urine: please see your doctor immediately. These could be signs of BPH or prostate cancer. Never ignore your health.
It’s not always cancer
It is worth re-emphasizing that a PSA level that is higher than normal does not necessarily mean that you actually have prostate cancer. Conversely, a normal PSA value does not conclusively exclude the presence of the disease. Both BPH and prostatitis can result in elevated PSA levels in the blood, and your doctor will cross-check your PSA result with your symptoms, the result of a digital rectal examination and probably the results from a biopsy to make the diagnosis. If you have a raised PSA, but a negative result on biopsy, your doctor will probably monitor your PSA level over time. Depending on further results, he may suggest that you have another biopsy at a later date. The value of sequential PSA testing lies in its ability to provide a baseline. A sudden or progressive rise above this level may act as an early warning of either prostate cancer development or another disease process within the gland. Urinary infection, for example, or sudden retention of urine requiring a catheter, can both cause the PSA level in the blood to rise sharply.
Raised PSA – What Next?
If your doctor finds that you have a raised or rising PSA level (usually above 4 ng/mL ), or a reduced percentage of free PSA (less than 18%) you will probably be referred to a Urologist – a Prostate Specialist
If cancer is suspected
If cancer is suspected, your urologist will first need to check whether you do in fact have cancer by performing a biopsy, which involves taking some tiny samples from the prostate under a local anesthesia. If you have, he will then need to determine how aggressive it is and how far it has progressed. You may hear a reference to the grade and stage of your cancer. These are important in selecting the best treatment option for you.
The grade is a measure of how aggressive the cancer is. The cancer cells in the prostate start out looking very similar to normal prostate cells, but start to change their appearance and de-differentiate (i.e. become more aggressive) as the cancer progresses . Grading is a means of assessing this process in a standardized way, and is performed in a laboratory by specialist pathologists.
The standard grading system is the Gleason score.
The cancerous areas in the prostate may vary and have different grades, so the grades of the two most prominent areas are added together to give a Gleason score (for example, 3 + 4); the maximum is 10 (5 + 5). This figure then gives your doctor an idea of how quickly your cancer is likely to progress and therefore helps him advise you about treatment.
|Gleason score and the risk of Prostate Cancer progressing|
Robotic Prostatectomy or Robotic Radical Prostatectomy
Earlier, the only option to treat prostate cancer was Open prostatectomy, involving large incisions and side effects like risk of excessive blood loss, post-op infections, long hospital stays, and considerable pain. Following open prostatectomy, patient activity was limited and often resulted in a loss of bladder control and sexual dysfunction due to severance of the delicate plexus of nerves around the prostate gland.
Over the last two decades there has been revolutionary improvement in medical surgical technology with great impact on prostate cancer treatment and prostatectomy. This device three-dimensional visualization at 10 times magnification and very precise control of movement, which may reduce blood loss and enable better preservation of the nerve bundles that are important for erections.
Robotic prostatectomy using the da Vinci surgical system manufactured by Intuitive Surgical is gaining popularity as a less traumatic and minimally invasive prostate cancer treatment.
Recent technological developments have enabled the prostate to be removed using telescopes and 4–6 small incisions (‘minimally invasive’ or ‘keyhole’ surgery). The advantages of this technique include reduced blood loss and a quicker recovery time, but the disadvantages may be a longer operating time and the difficulty in training surgeons to perform what is a technically demanding procedure. The abdominal wall is punctured and the abdominal cavity is distended with gas (carbon dioxide). The surgery is then performed by a surgeon who is guided by the magnified image on a television monitor.
For More Details see page Robotic Surgery