Download PROSTATE CANCER What is the prostate? The prostate is a series

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What is the prostate?
The prostate is a series of glands and smooth muscle encased together in muscular tissue.
It is located in men at the bottom of the bladder just above the anus. It junctions at the top of the
urethra, where the vas deferens and the urethra meet. (See figure 1-1, page 7). (WebMD,
Prostate gland). The prostate is about the size and shape of a walnut. It is part of two body
systems, the urinary system and reproductive system. The vas deferens and the seminal vesicles
from both testicles drain into the prostate. It aids in the process of adding seminal fluid to sperm
to create ejaculate. As well as maintain the amount of urine passing through the urethra as part
of the urination process. With prostate cancer the prostate will enlarge in size and can cause the
urethra to restrict the amount of urine passing through during the urination process. This can
cause discomfort to the patient and result in frequent and small urinations. In one study, 80
percent of respondents did not know the function of the prostate, and almost half did not know
that prostate cancer is the most common internal cancer in men (second only to skin cancer).
(Katz, 2012).
What is prostate cancer?
Prostate cancer is found in cells of the male prostate. It is a small or large amount of cells
that grow abnormally out of control. These cells can grow together and create what is called a
tumor. In early stages the tumor grows in the outer zone of the prostate and in later stages the
tumor can grow large enough to impact the inner zone. (See figure 1-2, page 7). (WebMD,
Difference between normal and cancerous prostate). Most tumors are generally slow growing
and take 5-15 years to spread to other parts of the body. Although, prostate cancer can be found
in men of any age it most often affects men over 50 years of age. There are two types of prostate
cancer, localized prostate cancer and metastic prostate cancer. Localized prostate cancer is
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localized to stay within the prostate. Metastic prostate cancer is originally within the prostate
then it metastasizes, moving through the lymphatic system and then spreads to other parts of the
body. In the early stages of prostate cancer there are usually no symptoms. Later stages there
can be fatigue, weakness, and pain in the back, bone or pelvic area due to the tumor growth or
spread of the cancer to other areas. In most men with prostate cancer 90% will have localized
prostate cancer and only 10% will have metastic prostate cancer. (Jamnicky & Nam, 2008). The
best way to ensure that you are cancer free is going regularly to your family doctor and examined
to determine if you are at risk.
How is prostate cancer diagnosed?
Prostate cancer can be diagnosed a few ways, the earlier the better for the patient. There
is a blood test called a prostate specific antigen blood test (PSA). It shows the level of an
enzyme that is present from the prostate cells. Healthy prostate cells give off a small amount of
this enzyme into the blood stream on a regular basis. With an increased production by abnormal
cells or a tumor doctors are able to gage if the prostate has turned cancerous, is damaged or
irritated by the levels that are currently present. The PSA test is the test used most often first
because, it can show high levels early and usually before the tumors can be felt by a manual
examination. The digital rectal exam (DRE) is another way of determining that there is a
problem or cancer. The doctor would insert a gloved, lubricated finger into the rectum and feel
the back wall of the prostate to feel for any tumors that may be present. The only problem with
this method is that only one side of the prostate can be felt from this position. Generally the PSA
and DRE are both used by the doctor in order to determine if there may in fact be an issue that
warrants further investigation. These two tests together are called prostate screening. Prostate
screening is readily available to anyone wishing to be screened. Most hospitals, doctor’s offices
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and clinics will do this screening at low or no cost. If the screening was to discover anything
abnormal the next step would to have an ultrasound and biopsy. With ultrasound the doctor is
able to insert an ultrasound probe into the rectum. This then enables the doctor to visualize the
prostate’s size, shape and view any possible tumors. Then the doctor inserts a long, thin biopsy
needle through the rectum into the prostate that once inserted would open up inside and obtain
small samples for testing. Usually the doctor would then take eight to fourteen biopsies of
different sections in order to test all the areas thoroughly. Most biopsies are done as an
outpatient procedure without general anesthetic and a minor amount of temporary discomfort
afterwards.
What are some of the treatments for prostate cancer?
There are five basic treatments for prostate cancer. The first one would be active
surveillance where the doctor would regularly monitor your PSA levels and perform a DRE to
keep track of any progression. The second treatment would be classed as a curative option such
as radiation therapy. With radiation therapy there are two types. One is called intensity
modulated radiation therapy (IMRT). This is when an external beam of radiation is used to
destroy the cancerous cells. The second is interstitial radiotherapy also known as radioactive
seed therapy or brachytherapy. This is where radioactive pellets are placed surgically within the
prostate to destroy the cancerous cells. The third would also be a curative option such as a
surgery called a radical prostatectomy. This is where the prostate and surrounding glands are
removed surgically in order to totally remove all cancerous cells. The fourth would be a
destructive therapy option there are two currently used. With cryotherapy the prostate is frozen
with probes inserted directly into it and the cancerous cells are destroyed. At the same time a
warming catheter is inserted into the urethra to circulate warm fluid so the urethra does not
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freeze and an ultrasound probe inserted in to the rectum so the doctor can make sure that they are
not freezing the rectal wall. Another destructive therapy option is high intensity focused
ultrasound (HIFU). With this treatment a rectal probe is placed into the rectum and high
intensity ultrasound waves penetrate through the rectal wall to the prostate. These high intensity
ultrasound waves actually do the opposite of the cryotherapy, instead of freezing the cancerous
cells it actually heats them up and cooks and kills the cancerous cells. The fifth treatment would
be hormone therapy such as removal of one or both testes or hormone injections in order to
lower or eliminate testosterone. Testosterone is the major hormone that stimulates cancerous
cells to grow. As well as the final fight against this cancer would be chemotherapy.
Chemotherapy is usually used together with one or more of the other treatments. It is a certain
mixture of drugs that kill or affect your healthy and cancerous cells in the entire body.
What are the stages of prostate cancer?
There are three basic stages to prostate cancer. The first stage is called localized, which
means that it is confined to the primary site, the prostate. At this stage there would be very few
if any symptoms. The second stage is called regional, meaning it has spread to the regional
lymph nodes. At this stage it’s possible to have some tenderness or pain in the surrounding
tissues. The third stage is called distant, meaning that the cancer has now metastasized and
spread to other tissues and parts of the body. At this stage there could be pain from anywhere in
the body to where the cancer has spread also, possible lethargy and overall not feeling well.
Depending on what stage the patient is at will depend on the suggested course of treatment.
How to cope with a prostate cancer diagnosis?
When someone is handed the diagnosis of prostate cancer there are in many ways
overwhelmed and distressed. Most men worry about their sex lives and will they be able to have
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sex again. They tend to feel alone, afraid, angry and quite often depressed. Mild to moderate to
severe depression is not uncommon. Depression can be aided by medication, exercise or
counseling. Some ways that men might help themselves is to ask the doctor questions, be well
informed about what is going on with their bodies. Take an active role in their treatment options
and treatment and that will remove some of the fears that they have after diagnosis. There are
many support groups that can aid in understanding the disease and treatments. Support groups
also supply a comfortable and safe atmosphere for patients and their families to share their worst
fears with others who are going through or have gone through the same disease and treatment.
Even if someone is too shy to share with a group sometimes just listening to others can be very
helpful. Communication with family members or friends is an important part of dealing with this
diagnosis in a healthy way. Alternate sources of information are The Canadian Cancer Society
and The Canadian Red Cross. A helpful website is http://prostatcancerinfolink.net/ (Marks,
2009). You could even go to a local public library and find a good book that will help.
What is the prognosis?
Many advances in prostate cancer have been made and with early diagnosis the outcome
is usually in favor of the patient. (Centeno & Onik, 2004). The five-year survival rate for men
with localized prostate cancer is 100%, for regional that have spread to the lymph nodes is 100%,
for distant that has metastasized is 27.9% and unstaged is 72.9%. (See charts on page 8).
(National cancer institute, Percent of cases & 5-year relative survival by stage at diagnosis:
Prostate cancer). The key to survival is early detection and regular examinations to ensure that
the prostate is healthy and cancer free.