PROSTATE CANCER
Prostate cancer begins when cells in the prostate gland start to grow out of control. The prostate is a gland found only in males. It makes some of the fluid that is part of semen.
The prostate is below the bladder (the hollow organ where urine is stored) and in front of the rectum (the last part of the intestines). Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the centre of the prostate.
Prostate cancer begins most often in the outer part of the prostate. It is the most common cancer in men older than age 50. In most men, the cancer grows very slowly. In fact, many men with the disease will never know they have the condition. Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland.
Types of prostate cancer
Almost all prostate cancers are Adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen).
Other types of cancer that can start in the prostate include:
- Small cell carcinomas
- Neuroendocrine tumors (other than small cell carcinomas)
- Transitional cell carcinomas
- Sarcomas
These other types of prostate cancer are rare. If you are told you have prostate cancer, it is almost certain to be an Adenocarcinoma.
Generally, the tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs (abnormalities on physical examination). However, all prostate cancers do not behave similarly. Some aggressive types of prostate cancer grow and spread more rapidly than others and can cause a significant shortening of life expectancy in men affected by them. A measure of prostate cancer aggressiveness is the Gleason score (discussed in more detail later in this article), which is calculated by a trained pathologist observing prostate biopsy specimens under the microscope.
As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.
In a normal situation, prostate become bigger when patient become older. It's a common evolution called benign prostatic hyperplasia. It can cause urinary troubles and may be confused with prostate cancer.
Treatments and Procedures
The kind of prostate cancer treatment is decided functions of the PSA blood level, results of rectal examination and complementary exams, and Gleason score. The treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery, radiation therapy, hormonal therapy, cryotherapy, combinations of some of these treatments, and watchful waiting. A cure for metastatic prostate cancer is, unfortunately, unattainable at the present time. The treatments for metastatic prostate cancer, which include hormonal therapy and chemotherapy, therefore, are considered palliative.
The surgical treatment for prostate cancer is commonly referred to as a radical prostatectomy, which is the removal of the entire prostate gland.
Transurethral resection of the prostate (TURP) involves the removal of a part of the prostate by an instrument inserted through the urethra. It is used as an alternative to prostatectomy in patients with extensive disease or those who are not fit enough to undergo radical prostatectomy to remove tissue that is blocking urine flow.
The goal of radiotherapy is to damage the cancer cells and stop their growth or kill them. Radiation therapy can be given either as external beam radiation over perhaps six or seven weeks or as an implant of radioactive seeds (brachytherapy) directly into the prostate. In external beam radiation, high energy X-rays are aimed at the tumor and the area immediately surrounding it. In brachytherapy, radioactive seeds are inserted through needles into the prostate gland under the guidance of transrectally taken ultrasound pictures.
Cryotherapy is a new kind of treatment that consists in an internal radiation exposure. Small spheres of a radioactive element are introduced into the prostate under general anesthesia. They emit during approximately 6 months but the rays are too weak to be dangerous for persons around.
Hormone therapy is also a part of the treatment. The growth of the tumor is partly controlled by the testosterone. In the case of a metastatic cancer, treatment consists in an administration of substances that will block the action of testosterone (hormonotherapy), and so stop the growth of the tumor. It can be associated to chemotherapy if need be. Treatments available for hormonotherapy are:
- Testicles Ablation: Testosterone is secreted by the testicles and their removal leads to a decrease in testosterone blood level.
- Estrogens: These hormones decrease testosterone blood level. The most used is the diethylstilbestrol, but this drug can lead to cardiovascular disorders.
- Luteinizing Hormone-Releasing Hormone (LH-RH): It blocks he testicles' testosterone secretion.
- Anti-Androgen Drugs: These drugs block the action of all male hormones (not only testosterone), that also have a little action on the tumor growth. Adverse effects can be a loss of sexual desire and erectile dysfunction.
After the end of treatment, a dosage of the PSA is administered regularly and the patient is kept under observation to asses for an eventual relapse.
Technologies for detection of cancer:
- Computerized Tomography (CT)
- Nuclear Medicine PSMA PET CT.
- MRI
- Ultrasound
New cutting-edge equipment include the Cyberknife® robotic radiosurgery, which are at the cutting edge of this technology – both offering pain-free non-invasive treatment with far greater accuracy and speed. Other leading-edge treatment technologies available include:
- Robotic Surgical System
- Adaptive Intelligence Guided Radiation Therapy System (AI POWERED)
- Trilogy Image Guided Radiation Therapy System (IGRT)
- Intensity Modulated Radiation Therapy System (IMRT).