Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
2 PROSTATE CANCER 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 3 PROSTATE CANCER 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 4 PROSTATE CANCER 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 5 PROSTATE CANCER 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 6 PROSTATE CANCER 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.