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What is prostate cancer?
The incidence of prostatic cancer increases with advancing age to the extent that if one were to live long enough without any other disease, one would eventually die of prostate cancer. It rarely occurs in men below 45 years.
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What is the cause?
The exact cause is unknown. It may run in some families or may be related to diet. It may arise due to an imbalance of certain body chemicals or growth factors that control the growth and division of cells in the prostate gland. It develops in the outer part of the gland as distinct from Benign Prostatic Hyperplasia (BPH), which develops in the centre of the gland. Therefore, it is possible to get prostatic cancer even after one has had a prostatectomy for BPH.
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What are the symptoms?
The symptoms are quite similar to those with BPH (i.e. poor urinary stream, frequent urination and obstruction to urine flow), as in this condition also the gland enlarges and presses on the urethra. There may be, in addition, loss of appetite and loss of weight. If the cancer has spread, there may be pain in the spine or back or in advanced cases, in the lower abdomen or even around the rectum.
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How is it diagnosed?
The doctor will usually be able to feel the large prostate gland with a finger inserted into the rectum. The prostate will feel nodular and hard, unlike the smooth enlargement in BPH. Blood tests may show a raised value of prostate-specific antigen (PSA). X-rays, ultrasound scan, CT, MRI or bone scans may be done to determine the spread of the disease.
The diagnosis needs to be confirmed by taking a piece of the prostate gland (biopsy) for examination. This is usually done by inserting a biopsy needle into the rectum and guiding it into the prostate gland. There may be some pain during this procedure and the patient may pass a small quantity of blood in the urine, semen or stools afterwards. -
What is the treatment?
If the disease is localized to the prostate gland, the entire prostate can be removed surgically (radical prostatectomy). This is a major operation performed under general anaesthesia and the recovery period is prolonged. Blood transfusions are required and in some cases there may be loss of control over urination or even impotence.
The other form of treatment is radiotherapy, in which deep penetrating X-rays are used to burn the cancer cells of the prostate. This treatment is given over several weeks and may be associated with side effects like pain, diarrhoea, bleeding from the rectum or in the urine, lower abdominal discomfort and, rarely, impotence.
If the disease is advanced or comes back after initial treatment (recurrence) then hormonal control of the disease is attempted. The aim is to deprive the tumour cells of the male sex hormone, testosterone. This is achieved by using medicines like goserelin or by removing both the testes of the patient (orchidectomy).
