Prostate cancer is the uncontrolled growth of cells in the prostate gland. The prostate is a small gland in the male pelvis that is part of the reproductive system. The prostate is under the bladder in front of the rectum. The prostate gland surrounds the urethra, the channel that carries urine from the bladder to the penis. The prostate helps produce fluids that nourish and protect sperm. When ejaculation occurs, the prostate secretes this fluid to the urethra. The released fluid will flow along with the sperm as semen.
There is prostate cancer that is aggressive and able to spread rapidly. But in general, prostate cancer grows slowly and does not spread.
According to WHO data, prostate cancer is the second most common cancer cases in men. It is estimated that around 1.1 million men worldwide are diagnosed with prostate cancer and there are 307 thousand deaths in 2012. In Indonesia alone, prostate cancer ranks 5th as the most cancer, with the number of people 971 people in 2011. Men aged 70 to 79 years are the largest group who suffer from this disease.
Symptoms of Prostate Cancer
Prostate cancer may not cause any symptoms at an early stage. Symptoms of prostate cancer will appear when the prostate is too large or swollen and begins to affect the urethra. Some of the signs and symptoms that occur when this happens are:
- More frequent urination, especially at night
- Feel the pain or heat in the penis during urination or ejaculation
- Feeling the bladder is always full
- Blood in urine or semen
- Pressure when removing urine decreases
Usually, signs and symptoms of prostate cancer will appear when the cancer has spread out of the prostate. But the above symptoms are not always caused by prostate cancer. The condition above may be caused by a urinary tract infection.
Until now, the cause of the emergence of prostate cancer is still unknown. But heredity or genetic factors and a person's age can increase the risk of prostate cancer.
Diagnosis of Prostate Cancer
There are many tests and checks to determine the diagnosis of prostate cancer. The most common tests for detecting prostate cancer are:
- Physical examination or rectal examination . This check is performed to check the size of the prostate gland.
- Blood test . This blood test is better known as the PSA test ( prostate-specific antigen or prostate-specific antigen ). But this test is not only specific to detect prostate cancer because PSA levels can also rise due to other conditions such as urinary tract inflammation or the prostate.
- Biopsy . Prostate tissue samples will be taken for inspection in the laboratory.
It is recommended that men consult a doctor to screen for prostate cancer at the age of 40, 45 years, or 50 years. Screening is done by blood tests using prostate-specific antigen. Anal rectal examination will also be performed as part of screening.
Prostate Cancer Treatment
The earlier the prostate cancer is diagnosed, the greater the chances of the patient getting well. But if the cancer is still in its very early stages and does not cause any symptoms, the patient may choose to be alert to it. Treatment of prostate cancer is through surgical removal of the prostate and radiotherapy. But if the cancer is detected when it has spread, for example to the bone, then the cancer can not be cured. Treatment is done only to extend the age and also relieve symptoms that appear.
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Causes And Symptoms Of Prostate Cancer
In the early stages, prostate cancer generally does not cause any symptoms. But when the swelling of the prostate has affected the urethra or cancer begins to spread, here are some of the symptoms that usually appear:
- More frequent urination, especially at night
- Feeling painful or takes a long time to urinate
- There is blood in urine or semen
- The pressure of urine decreases
- Urine comes out when coughing or laughing
- Not able to urinate while standing
- Erectile dysfunction
Male prostate will generally grow larger as you get older. The above symptoms need to be aware, though not always means you have prostate cancer. The following are symptoms of prostate cancer when it has entered a more severe stage:
- Weight loss
- Loss of appetite
- Pain in the bone, especially the lower back, thighs and hips
- Nausea and vomiting
- Feeling sore or stiff at the pelvis, lower back, upper thighs, or on the bone around him
- Weakness or paralysis of the lower body
Causes and Risk Factors of Prostate Cancer
The exact cause of prostate cancer is still unknown. But at a basic level, prostate cancer is caused by changes in normal prostate cell DNA. However, prostate cancer affects mainly elderly men. About eight out of ten cases suffered by men aged over 65 years.
In addition to age, here are some factors that can increase the risk of prostate cancer:
- Family health history . If there is a family of men suffering from prostate cancer or women suffering from breast cancer , your risk for prostate cancer will increase.
- Food . Eating foods that contain high calcium too often can also increase your risk of getting prostate cancer.
- Obesity . Being overweight increases a man's risk of getting prostate cancer.
- Race. Prostate cancer is more risky to men from men of African-American and Caribbean races.
- Location. Prostate cancer cases are more prevalent in parts of North America, Northwest Europe, Australia and the Caribbean Islands.
- Gene changes. Some inherited gene changes can increase the risk of prostate cancer.
- Some types of food. Men who often eat red meat or high-fat dairy products will have a slightly higher risk of prostate cancer than men who consume only a few foods.
- Exposure to chemicals.
- Inflammation of the prostate. Some studies suggest that prostate inflammation is associated with an increased risk of prostate cancer.
- Sexually transmitted diseases, such as gonorrhea or chlamydia, may increase the risk of catching type cancer
- Vasectomy. Men who undergo vasectomy procedures have a higher risk of prostate cancer.
There are several tests and also examinations that must be undertaken to diagnose prostate cancer, namely:
Anal rectal examination
In this procedure, the doctor will insert a gloved finger and smear the lubricant into the rectum to examine the prostate gland whose position is next to the rectum. If your doctor finds abnormalities in the texture, shape, or size of your prostate gland, you may need other advanced tests.
PSA test ( prostate-specific antigen or prostate-specific antigen )
The prostate gland produces a protein called the PSA. PSA levels in the blood of all men are quite small, but PSA levels will increase with the age of a man.
PSA blood test serves to measure PSA levels in the blood. The PSA test is not specific for detecting prostate cancer, because other conditions such as inflammation of the prostate also cause an increase in PSA in the blood. In addition, there are some patients with prostate cancer who did not experience increased levels of PSA. Only about 45% of patients with prostate cancer have high levels of PSA.
Transrectal ultrasound test (TRUS)
In this test, a small appliance will be lubricated and placed on the patient's anus. This small device will emit sound waves on the prostate and record the echoes of the sound waves. The echo will be processed so that it becomes the patient's prostate image.
The biopsy procedure is prostate tissue sampling to further investigate whether there are cancer cells. This is the most reliable step in diagnosing prostate cancer.
In addition to the above procedures, doctors may also perform imaging tests (bone detector, CT scan , and MRI) to evaluate the spread of cancer cells in other organs.
Patients may be suspected of having prostate cancer if the results indicate the presence of ASAP ( Atypical small acinar proliferation ) in prostate cells. ASAP is a condition in which prostate cells are suspected to develop into cancer when examined with a microscope.
Patients may also be suspected of prostate cancer if prostate cell examination results indicate PIA ( Proliferative inflammatory atrophy ). PIA is a condition in which prostate cells look smaller than normal size and there are signs of inflammation in the prostate area.
Stages of Prostate Cancer
To determine the proper way of handling prostate cancer, doctors need to know at what stage of cancer suffered. Thus, the right treatment can be given. Here is the stage of prostate cancer:
- Stage I. At this stage, the cancer is still very small and has not spread beyond the prostate gland.
- Stage II . At this stage, the cancer is larger and has not spread beyond the prostate gland.
- Stage III . The cancer has spread beyond the prostate gland, but is still in the surrounding tissue, such as the urethra.
- Stage IV . Cancer has spread further, for example into the bladder, rectum, or bone.
Determining the stage of prostate cancer is very important because it deals with the right treatment options to deal with cancer suffered.
Prostate Cancer Screening
The examination of PSA levels to confirm the diagnosis of prostate cancer is still debatable as well as controversy. PSA levels in the blood can be increased due to various causes, be it cancer or non-cancerous causes, such as inflammation and swelling of the prostate gland.
When a person's PSA level is high, he will need to undergo a prostate gland biopsy process to confirm the diagnosis of prostate cancer. This means, it is likely that the person is undergoing a generally painful and uncomfortable biopsy, and the result is not prostate cancer.
In addition, cancer detection through PSA levels also becomes controversial. Because there are some cases of prostate cancer that is still at a very early stage with minimal development, making the sufferer does not need to undergo treatment. Treatment of prostate cancer is considered to be more risky in such cases than if left unchecked, due to the very high post-treatment side effects, for example losing control to urination.
According to the study, there is a 20 percent reduction in prostate cancer deaths that perform early examination. But, only one more person can be saved from 48 people who receive prostate cancer treatment. Therefore, advocacy to perform prostate cancer examination is still a debate.
If you want to do an early examination, it is recommended that men at high risk consult a doctor to perform prostate cancer screening with PSA test and rectal examination. This consultation should be conducted on:
- Age 50 years for men who have a small risk of prostate cancer.
- Age 45 years for men who are at high risk of prostate cancer.
- Age 40 years for men who are at high risk of prostate cancer.
For people with prostate cancer, it may be confusing in choosing the best treatment procedure that can be done. Each treatment performed has its own risks and benefits. Treatment of prostate cancer depends on several factors:
- Stage of cancer
- The size of cancer
- Age and life expectancy of the patient
- How extensive the spread of cancer has occurred
- Patient health condition
For patients with prostate cancer at an early stage, they can choose to wait and monitor the development of cancer. There are some cases of prostate cancer that do not require treatment at all, and this needs to be considered because there are significant side effects of treatment.
When choosing to monitor prostate cancer, during the period of supervision, additional information may be collected to help determine the appropriate treatment.
This prostate control requires that you undergo a PSA test as well as biopsy procedures regularly. This is done to ensure as early as possible whether there is growth of cancer cells. This series of procedures is performed to determine treatment in accordance with the stage of cancer suffered, especially when prostate cancer has spread out from the prostate gland.
Here are some of the recommended ways to treat prostate cancer:
Prostate Cancer Surgery
Here are some ways and also surgical procedures that can be done to overcome prostate cancer.
TURP or trans-urethral resection
TURP is a surgical procedure in cutting parts of the prostate gland. TURP is done by means of general anesthesia or spinal anesthesia, so you do not feel pain during surgery. The goal of surgery is to relieve or eliminate symptoms of urination that is disrupted due to prostate cancer
The surgeon will insert an iron wire with a circular section at the end into the urethra toward the prostate. Electric current is used to heat a circular section that serves to cut prostate cancer.
Radical prostatectomy is an operating procedure to remove the prostate gland and surrounding tissue. Radical prostatectomy can cure prostate cancer in men if the cancer has not spread beyond the prostate gland. But there is a small chance that not all cancer cells can be lifted. There is a possibility the cancer cells will return postoperatively.
Some potential complications of radical prostatectomy procedures are:
- Urinary incontinence, which is the inability to control urination.
- Erectile dysfunction. Better known as impotence . Inability to achieve and maintain an erection.
- Can not ejaculate so can not have children through intercourse.
Kryotherapy is sometimes done to deal with early-stage prostate cancer. However, most doctors will not choose this treatment as a first step treatment.
In this procedure, the doctor will use a very cold temperature breeze to freeze and kill the prostate cancer cells. Some of the side effects of this action are:
- Most patients will have blood mixed in the urine for a day to two days after the action of cryotherapy.
- Kryotherapy affects the anus and bladder, which makes the appearance of pain, tenderness, and frequent urge to urinate.
- Erectile dysfunction or impotence, because kryoterapi risk of damaging the nerves around the prostate that controls erection.
- Difficulty controlling urination.
Radiotherapy uses radiation energy to kill cancer cells in cases where the cancer has not spread beyond the prostate. Radiotherapy can also be used after surgery to kill the remaining cancer cells. In addition, radiotherapy is also done to relieve symptoms or pain and slow the rate of cancer development in advanced cancer cases.
Patients do not need to undergo hospitalization for radiotherapy procedures. Here are some of the side effects of radiotherapy on prostate cancer:
- Pubic hair fall out
- Feeling tired
- Feeling uncomfortable around the anus and rectum
- Inflammation of the bladder
- Inability to erect
- Urinary incontinence
- Problems with bowel movements, such as diarrhea and bleeding
In this treatment step, the patient will be prescribed anti-cancer drugs by the doctor. This action is very appropriate if the cancer has spread to organs outside the prostate gland. Some of the side effects of chemotherapy are:
- Hair loss.
- Nausea and vomiting.
- Increased risk of infection, due to reduced number of white blood cells.
- Easily bruised or bleeding.
Hormone therapy is usually combined with radiotherapy procedures. Hormone therapy performed before radiotherapy aims to improve treatment success. While hormone therapy given after radiotherapy is intended to reduce the likelihood of the return of cancer cells.
In addition to the above functions, hormone therapy can also be used to slow the development of end-stage prostate cancer and relieve symptoms or pain that appears.
Side effects of hormone therapy in prostate cancer are:
- Loss of sexual passion
- Erectile dysfunction or impotence
- Weight gain
- Swelling of the chest
- Hot flush or a condition in which the body suddenly feels too hot to cause excessive sweating and body shivering.
Steroid tablets can be used if hormone therapy is no longer successful because cancer is resistant to hormones. Steroids can be used to shrink tumors and inhibit tumor growth.
Doctors can provide cancer vaccine for people with prostate cancer. This cancer vaccine works by encouraging the immune system to attack prostate cancer cells.
Cancer vaccine for each patient can vary, because the vaccine is based on the patient's white blood cells. However, this vaccine is not consumed to prevent cancer developing, but extend the life of patients several months.
Treatment of bone
If prostate cancer spreads to other body parts, it will most likely spread to the bone first. Spread to the bone will make the patient feel pain, bone fractures, or high calcium levels in the blood.
This action aims to prevent or slow the spread of cancer to the bone. There are several steps that doctors usually do for treatment procedures on the bone, namely:
- Provide drugs such as bisphosphonates and denosumab, to inhibit the spread of cancer.
- Administering corticosteroids or painkillers to relieve bone pain.
- External radiation therapy that serves to relieve the pain of bone.
- Radioactive drugs. It is a drug that contains radioactive elements that serve to kill cancer cells.
Treating End Stage Cancer
If prostate cancer has entered the final stage, then this condition can no longer be cured. Treatment is performed only to slow down progression, prolong life, and relieve symptoms.
To treat end-stage prostate cancer, treatment that can be done is radiotherapy, hormone therapy, chemotherapy.