Life Health Sciences – Science Rules it All

Prostate cancers are carcinomas that arise in peripheral (outer) part of prostate gland.

Incidence

Prostatic cancer is commonly found in United States (black population), UK and Northern Europe. In United Kingdom it is the third most common male cancer and second most common cause of cancer related death in males; and fifty males out of every one hundred thousand males suffer with it. It is less common in Asian countries like China and Japan. It is uncommon before 60 years of age and the mean age of prostate cancer is 70 years.

Symptoms

The main symptoms are due to outflow obstruction. Patient has weak and interrupted urinary stream.  There is hesitancy, terminal dribbling, feeling of incomplete emptying and straining to void. Patient also has symptoms of urinary tract infection including increased frequency, urgency, urge incontinence and increased frequency and urge to pass urine during night (nocturia).

The patients also have general symptoms of malignancy including loss of appetite, weight loss, anemia, weakness and cachexia and inability to perform.  There are symptoms due to local spread and metastasis. These may include pain due to obstruction of ureters, backache, cough and neurological symptoms when nerve roots are involved.

Investigations

A plain radiograph is taken to investigate pain in lower back that may be the first symptom. The metastasis from the primary carcinoma of prostate to the lumber vertebrae causes degenerative changes resulting in backache.

Endoscopic resection of patient’s prostatic tissue is done to provide relief from outflow obstruction. Tissue sample is taken for histology.

Transrectal ultrasound scan with needle biopsy of prostate is done to diagnosis cancer.

Radioisotope bone scan is done to see distant metastasis.

Blood investigations like blood complete examination is done to confirm anemia. Specific investigation like high serum level of Prostatic Specific Antigen (PSA more than 100 ng/ml) shows distant metastasis and its serum level is used to monitor response to treatment.

Management

When tumor is limited to prostate, it can be cured with surgery (radical prostatectomy) or radical radiotherapy of prostate. This treatment should be considered when patient has ten years or more live expectancy. A small tumor found and dissected out by endoscopic resection does not alter life expectancy even if removed. Prostatic cancer is sensitive to hormonal treatment.  Localized, with local spread or distant spread, the cancer can be treated by surgically removing testicles, or using medication to suppress androgens. The use of androgen suppressing drug is more common than surgery. The drugs act at receptor sites of tumor cells and block them for hormone dihydrtestosteron thus do not allow growth of tumor. A large number of patients respond to drug treatment for 1-2 yeas then cancer again shows up.

Chemotherapy with 5-fluorouracil, cyclophosphamide or nitrogen mustard is done to treat bone pain. For more widespread pains hemi body radiotherapy is used as palliative treatment. The pain is relieved with strong analgesia.

Prognosis

When carcinoma is found at its focal stage and removed the life expectancy is similar to general public. When tumor is localized to prostate, half of the patients have 10 years life expectancy. If metastasis is present then only 10% of patients have 10 year survival.

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