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prostate cancer - Symptoms, Causes, Diagnosis & treatment

Prostate cancer is cancer that develops in the prostate gland, a malignant tumor that can grow into cancerous cells and spread via the seminal vesicles branch of the ejaculatory duct and/or seminal vesicles, urethra, and bladder. If left untreated it can lead to death.

 

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There are three (3) main types of prostate cancer:

1. Localized prostate cancer, that is cancer that has not spread from the prostate,

2. Locally advanced prostate cancer, in which the cancer has spread from the prostate to nearby lymph nodes but not to distant sites, and

3. Advanced or metastatic prostate cancer (spread of the disease) where the tumor may have spread (metastasized) to other parts of the body.

Cancer can occur in one or both sides: right side and left side. Another classification is Prostate Cancer T1-T2 and Prostate Cancer T3-T4. T1 is localized to the prostate and has not spread to other parts of the body while T2 has spread to nearby areas, such as the seminal vesicles. T3 is when cancer has spread to more distant areas, like lymph nodes and may be stage IV.

Symptoms of Prostate cancer:

1. Pain during urination, can be lower back and perineum pain

2. Hemorrhaging and blood in urine (hematuria)

3. Bone pain, especially when walking

4. Pelvic pressure on the bladder ( bladder obstruction)

5. Pouching of the skin, sometimes swelling under the breast/armpit area

6. Nausea and vomiting due to bile secretion in the abdomen (abdominal pain) or rectal emptying often leads to diarrhea including nausea and vomiting, abdominal cramps, bloating or flatulence (excess gas) that may lead to loss of appetite. In many cases all these symptoms may indicate cancer of the prostate or metastasis and should be checked immediately.

When to see a doctor?

If you have any of the above symptoms you might be suffering from prostate cancer. A cancer is a group of cells that grows in an abnormal way. Your prostate is a small gland in the male reproductive system that makes some of the components that are part of semen, such as zinc and acid phosphatase. The prostate, along with the seminal vesicles, the two glands that sit on either side of the urethra, combine with fluids from your testicles to produce semen or ejaculate in males.

Causes:

Causes for Prostate cancer: There is no exact cause for prostate cancer but there are factors that may increase your risk of developing the disease. Some of them are:

1. Age: It is common for men older than 50 years old to develop prostate cancer.

2. Family history of prostate cancer

3. Race: African Americans have a higher chance of getting the disease than any other race in the US and they are more likely to develop an aggressive form of the disease.

4. Sexual Activity: This is the most common risk factor for prostate cancer. Men who have sex more than once a week are more likely to get the disease.

5. Diet: Too much red meat, processed meats, and saturated fats may increase your chance of getting prostate cancer.

6. Obesity: It is associated with higher levels of fat in the blood in men  whose diet contains excessive amounts of red meat, eggs, and cheese.

7. Alcohol consumption: Drinking alcohol increases risks for this disease. The more you drink, the higher your chances of developing prostate cancer.

8. Foreign objects: The cause is not clear, but it may be linked to an infection with a sexually transmitted infection.

Complications:

Complications of Prostate cancer: There are several possible complications of prostate cancer that may include:

1. Urinary obstruction: The prostate gland is very close to the urethra and in advanced cases it may lead to urinary obstruction. This affects the patient's ability to urinate and restrict urine outflow.

2. Bone fractures: Usually, cancers that have spread to bones will lead to pain in such site. 

3. Leukemia has a 10-20% chance of developing it, which may occur because of the exposure to chemotherapy  for cancer treatment.

4. Difficulty breathing due to compression on the lungs (pneumonia)

5. Heart failure due to septal myocardial infarction or coronary artery disease( Coronary artery disease)

6. Dehydration

7. Infection of the blood or lymphatic system

8. Poor quality of life

Diagnosis:

Diagnosis of Prostate Cancer: A prostate exam and rectal exam are done to determine if a prostate cancer is present. An ultrasound scan can be done to see the extent of a tumor or to see whether it has spread outside the prostate gland. A biopsy may then be taken from the prostate and testicles or using MRI scans, X-rays or CT scans may show blood flow pattern in the body (circulation) is not affected by tumors under the skin (skin metastases). 

Treatment:

1. Watchful Waiting: In this treatment the prostate is monitored using Prostate specific antigen fingerstick tests and a digital rectal exam (DRE). If the tumor grows or symptoms develop, treatment is started immediately. Treatment may include radiation therapy and hormone therapy. 

2. Hormone Therapy: This is a process that reduces your body's level of male hormones (androgens) to slow the growth of cancer cells or reduce symptoms caused by the cancer. Anti-androgen hormone pills can be taken that reduce testosterone levels in the body by blocking their production, decreasing how much of these hormones reach prostate cells, or stopping testosterone from working properly on prostate cells. 

3. Radiation Therapy: Radiation therapy is a treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing.  Radiation therapy can be used before surgery to shrink the tumor so it's easier to remove or after surgery to destroy any remaining cancer cells.

4. Surgery: This is a process in which the surgeon removes the tumor with some tissue from around it (called the surgical margin). The tissue is examined under a microscope by a pathologist, who checks for cancer cells, and sends this information with the surgical report.

5. Targeted Therapy: This is a new type of therapy which targets and destroys prostate cancer cells. This is not currently available in the US, so patients usually travel abroad for treatment.

6. Chemotherapy: This is a process that uses certain medications to kill cancer cells or stop them from growing. Doctors will start with the first of these three main types of chemotherapy using pills or intravenously (into the bloodstream). These medications are given in cycles over several weeks and carried out under a doctor's supervision, as they can be toxic to other parts of the body if used in excess. 'Biological modifier therapy' is a type of chemotherapy that uses man-made treatments to increase your body's ability to kill cancer cells.

prevention:

1. Reduce the amount of animal fat in your diet.

2. Try to maintain a healthy weight.

3. Avoid drinking alcohol to excess

4. Do regular exercises, such as running and swimming, which are known to strengthen the muscles of the pelvic floor and surrounding muscles.

5. Have regular prostate exams starting at age 40–50 years old

6. Know your family history: If you have a relative that has prostate cancer or get tested for the disease at an early age  ( below 50 years ).

7. Know the risk factors of prostate cancer

Smoking and Prostate cancer

Prostate Cancer Survival Rate  : According to a study, of about 1.268 million men received medical treatment for prostate cancer, 709,000 have died from this disease in the US in 2005-2011.  Prostate cancer is the second most common cause of death for men after lung cancer. The 5-year relative survival rate is higher for white men than black men in America [81%] and [70%], respectively.  The patients who are diagnosed with very early stages of prostate cancer (stage I or II) have a better prognosis than those diagnosed with advanced stage (III or IV).  The survival rate of men with metastatic prostate cancer is much lower.

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