The connection prostate gland and prostate cancer

 The connection prostate gland and prostat cancer.

The prostate gland is an organ that is located at the base or outlet (neck) of the urinary bladder. The gland surrounds the first part of the urethra. The urethra is the passage through which urine drains from the bladder to exit from the penis. One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds. The main function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar. Semen is the fluid that transports the sperm to assist with reproduction. A man can manage quite well, however, without his prostate gland.

In a young man, the normal prostate gland is the size of a walnut (<30g). During normal aging, however, the gland usually grows larger. This hormone-related enlargement with aging is called benign prostatic hyperplasia (BPH), but this condition is not associated with prostate cancer. Both BPH and prostate cancer, however, can cause similar problems in older men. For example, an enlarged prostate gland can squeeze or impinge on the outlet of the bladder or the urethra, leading to difficulty with urination. The resulting symptoms commonly include slowing of the urinary stream and urinating more frequently, particularly at night. Patients should seek medical advice from their urologist or primary-care physician if these symptoms are present. 

What is prostate cancer? 

Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. 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.

Genetics and other factors effect to prostate cancer

Genetics and other factors effect to prostate cancer.
The cause of prostate cancer is unknown, but the cancer is not thought to be related to benign prostatic hyperplasia (BPH). The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. The chances of developing prostate cancer increase with age. Thus, prostate cancer under age 40 is extremely rare, while it is common in men older than 80 years of age. 

The differences in diagnosis and death rates are, however, more likely to reflect a difference in factors such as environmental exposure, diet, lifestyle, and health-seeking behavior rather than any racial susceptibility to prostate cancer. Recent studies indicate that this disparity is progressively decreasing with chances of complete cure in men undergoing treatment for organ-confined prostate cancer (cancer that is limited to within the prostate without spread outside the confines of the prostate gland), irrespective of race.

Genetics (heredity), as just mentioned, plays a role in the risk of developing a prostate cancer. Prostate cancer is more common among family members of individuals with prostate cancer. This risk may be two to three times greater than the risk for men without a family history of the disease. Earlier age at diagnosis (<60 years) in a first-degree relative (father or brother) and disease affecting more than one relative also increases the risk for developing prostate cancer. 

Testosterone, the male hormone produced by the testicles, directly stimulates the growth of both normal prostate tissue and prostate cancer cells. Not surprisingly, therefore, this hormone is thought to be involved in the development and growth of prostate cancer. The important implication of the role of this hormone is that decreasing the level of testosterone should be (and usually is) effective in inhibiting the growth of prostate cancer. 

Although still unproven, environmental factors, such as cigarette smoking and diets that are high in saturated fat, seem to increase the risk of prostate cancer. There is also a suggestion that obesity leads to an increased risk of having more aggressive, larger prostate cancer, which results in a poorer outcome after treatment. Additional substances or toxins in the environment or from industrial sources might also promote the development of prostate cancer, but these have not yet been clearly identified

Radiation therapy for prostate cancer and effects

Radiation therapy for prostate cancer and effects.
The way of radiotherapy is to damage the cancer cells and stop their growth or kill them. This works because the rapidly dividing (reproducing) cancer cells are more vulnerable to destruction by the radiation than are the neighboring normal cells. Clinical trials have been conducted using radiation therapy for patients with organ-confined (localized) prostate cancer. These trials have shown that radiation therapy resulted in a rate of survival (being alive) at 10 years after treatment that is comparable to that for radical prostatectomy. Incontinence and impotence can occur as complications of radiation therapy, as with surgery, although perhaps less often than with surgery. More data are needed, however, on the risks and benefits of radiation therapy beyond 10 years, especially because late recurrences (reappearances) of the cancer can sometimes occur after radiation.

Choosing between radiation and surgery to treat organ-confined prostate cancer involves considerations of the patient's preference, age, and coexisting medical conditions (fitness for surgery), as well as of the extent of the cancer. Approximately 30% of patients with organ-confined prostate cancer are treated with radiation. Sometimes, oncologists combine radiation therapy with surgery or hormonal therapy in an effort to improve the long-term results of treatment in the early or later stages of prostate cancer.

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. Brachy, from the Greek language, means short. The term brachytherapy thus refers to placing the treatment (radiation therapy) directly into or a short distance away from the cancerous target tissue. The theoretical advantage of brachytherapy over external beam radiation is that delivering the radiation energy directly into the prostate tissue should minimize damage to the surrounding tissues and organs.

Potential disadvantages of radiation therapy include a transient swelling of the prostate that may cause obstruction to the flow of urine and increase symptoms that may already be present because of an enlarged prostate. Side effects of external beam radiation include skin burning or irritation and hair loss at the area where the radiation beam goes through the skin. Both can cause severe fatigue, diarrhea, and discomfort on urination. These effects are almost always temporary. However, there are concerns about the long-term effects of radiation, and although still not proven, some studies have reported a higher chance of developing bladder or rectal cancer many years after undergoing radiation for prostate cancer. Although surgery can be done in case radiation therapy fails to cure prostate cancer (salvage radical prostatectomy), it is fraught with greater surgical difficulty and involves a significantly higher chances of complications like impotence and urinary incontinence.

Herbal or other medicine, treatment for prostate cancer

Herbal or other medicine, treatment for prostate cancer.
Alternative medicine, also called integrative or complementary medicine, includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. A major problem with most herbal treatments is that their composition is not standardized. Moreover, the way herbal treatments work and their long-term side effects usually are not known. Currently, there is no evidence to prove that these medications have any therapeutic benefit in prostate cancers that have become resistant to conventional treatments.

Active surveillance for slow-growing of prostate cancer .

Active surveillance is observing a patient while no immediate treatment is given. Such a patient usually has a less aggressive, small-sized, organ-confined tumor and no symptoms. This way is based on the premise that most early prostate cancers are slow-growing tumors and will remain confined to the prostate gland for a significant length of time. This implies that in selected patients it may be possible to defer definitive treatment for many years or avoid it altogether thereby preventing the side effects associated with treatments like surgery or radiation. Understand, however, that although active surveillance involves no actual treatment, the patient still needs close follow-up and monitoring. The follow-up involves frequent visits to the doctor, perhaps every three to six months. The visits include questions about new or worsening symptoms and digital rectal examinations for any change in the prostate gland. In addition, blood tests are done to watch for a rising PSA, and imaging studies can be conducted to detect the spread of the cancer. Most experts also recommend performing a confirmatory set of prostate biopsies to ensure that there is low-volume disease. Additional prostate biopsy is required every year to detect any increase in the volume and Gleason grade of the cancer. As mentioned before, Gleason grade is a measure of aggressiveness of the tumor and increase in this value may point toward a need to treat the cancer with other means. If the history, examinations, or any of the tests signal the possibility of an advancing cancer, the active surveillance usually is discontinued and active treatment is recommended, often with radiotherapy or surgery. 

Active surveillance is different from watchful waiting. Watchful waiting means the action for patients without any tests or biopsies and treating them only when symptoms arise. This is reserved for men who have a life expectancy of less than 10 years. Therefore, watchful waiting seems to make sense for organ-confined (localized) prostate cancers in men who are elderly.

Detect the spread of prostate cancer

Detect the spread of prostate cancer

It is very important to know how far the spread of cancer cells in the body, Once a prostate cancer is diagnosed on a biopsy, additional tests are done to assess whether the cancer has spread beyond the gland. 

Radionuclide bone scans can determine if there is a spread of the tumor to the bones. The radioactive substance highlights areas where the cancer has affected the bones. This test is usually reserved for men with prostate cancer who have deep bone pain or a fracture or who have biopsy findings and high PSA values (>10-20 ng/ml) suggestive of advanced or aggressive disease. 

Chest X-ray can be used to detect whether or not cancer has spread to the lungs. Ultrasound tests can be used to look for the effects of a urinary blockage on the kidneys. This study can also be used to assess the bladder for any sign of urinary obstruction due to prostate enlargement by looking at the thickness of the bladder wall as well as the amount of urine remaining within the bladder after an attempt at passing urine. 

Additionally, CT scans (coaxial tomography) and MRIs (magnetic resonance imaging) can determine if the cancer has spread to adjacent tissues or organs such as the bladder or rectum or to other parts of the body such as the liver or lungs. Newer scanning using a method called PET scan can sometimes help to detect hidden locations of cancer that has spread to various areas of the body. 

Cystoscopy is usually performed in selected situations. A thin, flexible, lighted tube with a tiny camera on the end is inserted through the urethra to the bladder. The camera transmits images to a video monitor. This may show whether the cancer has spread to the urethra or bladder and may be utilized to take a biopsy from these organs. 

To summarize, doctors do the staging of prostate cancer based primarily on the results of the prostate biopsy, possibly other biopsies, and imaging tests. In staging a cancer, doctors assign various letters and numbers to the cancer, depending on which of the classifications for staging they use. The numbers and letters in the different classifications define the volume or amount of the tumor and the spread of the cancer. The stage of the prostate cancer, therefore, helps to predict the expected course of the disease and determine the choice of treatment. 

The stages of prostate cancer are categorized as follows: 

• Stage I (or A): The cancer cannot be felt on a digital rectal exam, and there is no evidence that it has spread outside the prostate. These are often found incidentally after surgery for an enlarged prostate. 
• Stage II (or B): The tumor is larger than a stage I and can be felt on a digital rectal exam. There is no evidence that the cancer has spread outside the prostate. These are usually found on a biopsy when a man has an elevated PSA level. 
• Stage III (or C): The cancer has invaded other tissues neighboring the prostate.
• Stage IV (or D): The cancer has spread to lymph nodes or to other organs.

The symptoms and signs of prostate cancer.

The symptoms and signs of prostate cancer.
In the early stages, prostate cancer often causes no symptoms for many years. As a matter of fact, these cancers frequently are first detected by an abnormality on a blood test (the PSA, discussed below) or as a hard nodule (lump) in the prostate gland. Occasionally, the doctor may first feel a hard nodule during a routine digital (done with the finger) rectal examination. The prostate gland is located immediately in front of the rectum. Rarely, in more advanced cases, the cancer may enlarge and press on the urethra. As a result, the flow of urine diminishes and urination becomes more difficult. Patients may also experience burning with urination or blood in the urine. As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder. These symptoms by themselves, however, do not confirm the presence of prostate cancer. Most of these symptoms can occur in men with non-cancerous (benign) enlargement of the prostate (the most common form of prostate enlargement). However, the occurrence of these symptoms should prompt an evaluation by the doctor to rule out cancer and provide appropriate treatment. 

Furthermore, in the later stages, prostate cancer can spread locally into the surrounding tissue or the nearby lymph nodes, called the pelvic nodes. The cancer then can spread even farther (metastasize) to other areas of the body. Symptoms of metastatic disease include fatigue, malaise, and weight loss. The doctor during a rectal examination can sometimes detect local spread into the surrounding tissues. That is, the physician can feel a hard, fixed (not moveable) tumor extending from and beyond the gland. Prostate cancer usually metastasizes first to the lower spine or the pelvic bones (the bones connecting the lower spine to the hips), thereby causing back or pelvic pain. The cancer can then spread to the liver and lungs. Metastases (areas to which the cancer has spread) to the liver can cause pain in the abdomen and jaundice (yellow color of the skin) in rare instances. Metastases to the lungs can cause chest pain and coughing.

The fastest action to prevent prostate cancer

The fastest action to prevent prostate cancer.
There’s no standart measurement to know the result of prevent development of prostate cancer. We can prevent progression of the cancer by making early diagnoses and then attempting to cure the disease. Early diagnoses can be made by screening men for prostate cancer with PSA and digital rectal examination The purpose of the screening is to detect early, tiny, or even microscopic cancers that are confined to the prostate gland. Early treatment of these malignancies (cancers) can stop the growth, prevent the spread, and possibly cure the cancer.

Based on some research in animals and people, certain dietary measures have been suggested to prevent the progression of prostate cancer. For example, low-fat diets, particularly avoiding red meats, have been suggested because they are thought to slow down the growth of prostate tumors in a manner not yet known. Soybean products, which work by decreasing the amount of testosterone circulating in the blood, also reportedly can inhibit the growth of prostate tumors. Finally, other studies show that tomato products (lycopenes), the mineral selenium, and vitamin E might slow the growth of prostate tumors in ways that are not yet understood. 

Recently, studies have shown that certain medications (finasteride [Propecia] and dutasteride [Avodart]) decrease the chances of getting prostate cancer when taken over the long term. These medications are currently used for shrinking the size of the prostate and relieving symptoms associated with benign (non-cancerous) enlargement of the prostate. However, they may have a future role for decreasing the chances of development of prostate cancer in men who are at high risk for the disease. 

What will be the future treatments for prostate cancer? 

The treatment of organ-confined prostate cancer to date has involved cutting out, radiating, or freezing the gland in trying to cure the disease. In more advanced cases, the goal has been to control the cancer for at least some time by using hormonal treatment or chemotherapy. Earlier diagnosis and improved treatment techniques in recent years have certainly led to better results.

The key to curing prostate cancer, however, ultimately will come from an understanding of the genetic basis of this disease. Genes, which are chemical compounds located on the chromosomes, determine the characteristics of individuals. Accordingly, investigators at research centers have focused on identifying and isolating the gene or genes responsible for prostate cancer. For example, studies are being conducted in men who have a family history of prostate cancer to try to uncover the genetic links of the disease. The investigators ultimately will try to block or modify the offending genes so as to prevent or alter the disease. 

Recently, the FDA approved a prostate cancer vaccine called sipuleucel-T (Provenge) that has been made for people who are at an advanced stage of prostate cancer. Although clinical experience with this vaccine is limited, it has been shown to improve survival in patients whose cancer has become resistant to hormones. This treatment involves taking a patient's own white blood cells and using a drug that trains them to more actively attack cancer cells. Once these cells are removed from the patient, they are treated with the drug and placed back into the patient. After the treatment of these cells, it kills cancer cells while leaving normal cells unharmed.

Another area of research is focal therapy for prostate cancer that attempts to mirror the evolution of breast cancer treatment, which often involves "lumpectomy" as part of the initial management of the disease. It involves treatment of only that part of the prostate that is affected by cancer and uses methods like cryotherapy (freezing), HIFU (heating), and brachytherapy (seed implantation) to treat the cancer. Focal therapy is still at its infancy and its role is unclear because of unresolved problems related to lack of a proper method for complete evaluation of cancer location within the prostate and the potential coexistence of many different cancerous areas within the same prostate. 

There is also a great interest in inventing better methods to image prostate cancer to detect its location and spread in the body. Newer techniques like MRS (magnetic resonance spectroscopy), PET (positron emission tomography) and certain molecular imaging techniques hold promise in this regard. 

Prostate Cancer conclusions :

• Prostate cancer is the leading cause of deaths from cancer.
• While the causes of prostate cancer are still unknown, some risk factors for the disease, such as advancing age and a family history of prostate cancer, have been identified. 
• Prostate cancer is often initially suspected because of an abnormal PSA blood test or a hard nodule (lump) felt on the prostate gland during a routine digital (done with a finger) rectal examination. * Refinements in the PSA test, including the PSA ratio, age-specific PSA, and PSA velocity or slope have improved the accuracy of the test. 
• If one of the screening tests is abnormal, the diagnosis of prostate cancer should be suspected and a biopsy of the prostate gland is usually done.
• The diagnosis of prostate cancer is made when cancerous prostatic cells are identified in the biopsy tissue under a microscope.
• In some men, prostate cancer is life threatening, while in many others, it can exist for many years without causing health problems.
• The choice of treatment for prostate cancer depends on the size, aggressiveness, and extent or spread of the tumor, as well as on the age, general health, and preference of the patient.
• The many options for treating prostate cancer include surgery, radiation therapy, hormonal treatment, cryotherapy, chemotherapy, combinations of some of these treatments, and watchful waiting/active surveillance. 
• Research is under way to identify the genes that cause prostate cancer. 

REFERENCES: 

Chang, S.S., M.C. Benson, S.C. Campbell, J. Crook, R. Dreicer, C.P. Evans, et al. "Society of Urologic Oncology Position Statement: Redefining the Management of Hormone-Refractory Prostate Carcinoma." Cancer 103.1 Jan. 1, 2005: 11-21.

Kataja, V.V., and J. Bergh. "ESMO Minimum Clinical Recommendations for Diagnosis, Treatment and Follow-up of Prostate Cancer." Ann Oncol 16.1 (2005): i34-6. 

Loblaw, D.A., D.S. Mendelson, J.A. Talcott, K.S. Virgo, M.R. Somerfield, E. Ben-Josef, et al. "Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2006 Update of an American Society of Clinical Oncology Practice Guideline." J Clin Oncol 22.14 July 15, 2004: 2927-2941.

Zaheer, A., S.Y. Cho, and M.G. Pomper. "New Agents and Techniques for Imaging Prostate Cancer." J Nucl Med 50.9 Sept. 2009: 1387-1390.