Cancer of the prostate

It is a type of cancer that grows in the prostate gland. The prostate is a small structure as large as a nut than it is part of the masculine reproductive system and surrounds uretra, the conduit that removes the urine from the body.

Alternative names
Cancer of the prostate

Causes, incidence and factors of risk
The cause of the prostate cancer is not known, although some studies have shown to a relation between a high fat diet and the increase in the testosterone levels. When the testosterone levels fall, or because of the surgical extirpation of the testicles (castration, orquiectomía) or by medecines, the prostate cancer can improve slowly.

A well-known relation with hiperplasia does not exist prostate benign (HPB).

The prostate cancer is the third cause more common of death by cancer in men of all the ages and the cause most common of the deaths by cancer in men majors of 75 years of age. This type of cancer rarely is in smaller men of 40 years of age.

Between the men who have the highest risk to suffer this disease are those of black race majors of 60 years, the farmers, people who work in plants of rims, painters and the exposed ones to cadmium. The smaller number of cases happens in the Japaneses and in which they do not eat meat (vegetarian).

The prostate cancers are classified or organized in agreement with their aggressiveness and with the form in which they are different from the surrounding prostate weave, which denominates estadificación. There are different forms to classify the tumors, one of most common is the system of estadificación ABC, also known like the Whitmore-Jewett system.

Stage A: the tumor does not feel in the physical examination and it is detected generally by accident after a surgery of prostate that became for other reasons.
Stage B: the tumor is solely in the prostate and generally a physical examination or an examination of blood is detected by means of (test of the specific prostate antigen).
Stage C: the tumor has been scattered beyond the prostate, but he is not present in the lymphatic ganglia.
Stage D: the tumor has been scattered (it has made metastasis) to the lymphatic ganglia or to other parts of the body (for example to the bones and the lungs).

This system also has several substages.
Symptoms
With the coming of the test of the specific prostate antigen (PSA), the majority of the prostate cancers now detects before they cause symptoms.

In addition, although the majority of the symptoms down mentioned can be associate with the prostate cancer, have more probability of being associate with noncancerous affections.

Difficulty when tinkling (delay or slowness to begin to tinkle)
Urinary dripping, especially, immediately after finishing urination
Urinary retention
Pain when tinkling
Pain when eyacular
Backache in the part inferior
Pain with the defecation

Additional symptoms that can be associated with this disease:

Excess of urine at night
Incontinence
Pain or sensitivity in the bones
Hematuria (blood in the urine)
Abdominal pain
Anemia
Involuntary loss of weight
Lethargy

Signs and examinations
A rectal examination reveals the surface generally lasts and irregular of an enlarged prostate. Many examinations can be carried out to confirm the diagnosis of prostate cancer.

The examination of the specific prostate antigen (PSA) can be high, although the noncancerous enlargement of the prostate also can increase the PSA levels.
The PSA frees can help to differentiate between the HPB and the cancer from prostate.
The urine analysis can reveal blood in the urine.
The cytology of the prostate liquid or the urine can reveal atypical cells.
A biopsy of the prostate confirms the diagnosis.
A TC can be carried out to see if the cancer has been scattered.
A bony gammagraphy can be realized to see if the cancer has been scattered.
A x-ray can be taken from thorax to see if the cancer has been scattered.

A newer examination, call AMACR, are more sensible to determine the presence of the prostate cancer that the examination of specific prostate antigen.

Treatment
The appropriate treatment for the cancer of the prostate often is controverted and the treatment options vary following the stage of the tumor. In the first stages, the surgery and the x-ray can be used to extirpate or to destroy the tumor.

The prostate cancer that has been scattered can deal with medecines to reduce the testosterone levels, surgery to extirpate the testicles or with chemotherapy.

The surgery, the x-ray and the hormonal therapy can interfere with desire or the sexual performance, or on a temporary or permanent base, reason for which these preoccupations are due to discuss with the doctor.

SURGERY:

The surgery usually recommends only after one complete valuation and discussion of all the options of treatment. A man who is decided by this surgery must be conscious as much of the benefits as of the risks of the procedure.

The extirpation of the prostate gland (radical prostatectomía) is recommended generally for the treatment of prostate cancers in stage To and B. This is a prolonged procedure that is realized generally under general or rachidian anesthesia. An incision through abdomen or in the perineal area becomes. It is possible that the person remains in the hospital from five to seven to days. The possible complications are impotence and urinary incontinence, although the procedures to preserve the nerves can reduce the risk of these complications. This surgical procedure must be realized by an urologist with an ample experience in this specific procedure.
The orquiectomía alters the hormonal production and it is possible to be recommended in case of metastatic cancer. After the surgery it can appear something of equimosis and inflammation, but these will disappear gradually. The loss of the testosterone production can take to problems with the sexual function, osteoporosis (thinning of the bones) and loss of the muscular mass.

X-RAY:

It is used mainly to treat the classified cancers of the prostate like stage To, B and C. The subject if the radiation it is as good as the extirpation of prostate is debatable and the decision about which to choose can be difficult. In patients whose health causes that the risk of the surgery is unacceptably high, the best alternative generally is the x-ray. The x-ray of the prostate gland can be external or internal.

The x-ray of external beam is carried out in a center of oncology of radiation on the part of oncólogos with special training in radiation, generally in ambulatory form. Previous the treatment, the therapist marks the area that is going away to deal with a special pencil-holder. The radiation goes to the prostate gland using an apparatus that is looked like the machine of normal X-rays. The treatment in himself is generally painless, nevertheless, are several associate indirect effect with the x-ray, like loss of the appetite, tire, reactions of the skin like reddening and irritation, injury or burn of the rectum, diarrhea, cystitis (inflamed bladder) and blood in the urine. The x-ray of external beam is generally realized five days to the week, during a period of six to eight weeks.
With the internal x-ray, radioactive seeds within the person in or near the tumor are placed directly, which denominates brachytherapy. A surgeon makes a small incision in the area to inject the seeds, which are so small that the person does not feel them, and can be temporary or permanent. Because the internal x-ray is directed to the prostate, this one reduces the damage to the weaves that this gland surrounds. The indirect effect can include pain, swelling or hematomas in the penis or escroto, urine or semen of red-brown color, impotence, incontinence and diarrhea.
The radiation is used some times to alleviate the pain when the cancer has been scattered to the bone.

MEDECINES:

Medecines can be used to fit the testosterone levels, which denominates hormonal manipulation. Since the prostate tumors require of testosterone to grow, the reduction of its levels works generally very well to avoid the growth and later propagation of the cancer. The hormonal manipulation is used mainly to alleviate the symptoms in those men whose cancer has been scattered and also it is possible to be practiced extirpating the testicles surgically.

In order to treat the advanced cancer of prostate also the drugs Lupron or Zoladex are being used, which block the testosterone production. The procedure usually denominates chemical castration, because it throws the same results that the surgical extirpation of the testicles, although unlike the surgery, this one is reversible. Medecines must inject, usually every 3 months. The possible indirect effect include nauseas and vomits, sofocos, anemia, lethargy, osteoporosis, diminution of sexual desire and eréctil dysfunction (impotence).

Other medecines used for the hormonal therapy are the blocking drugs of the androgens (like the flutamida one), which avoid that the testosterone one to the prostate cells. The possible indirect effect include eréctil dysfunction, hepatic loss of sexual desire, problems, diarrhea and enlargement of the breasts.

The chemotherapy is used frequently to deal with the symptoms prostate cancer that are resistant to hormonal treatments. Generally, the specialized oncólogo recommends a single medicine or a medecine combination. Chemotherapy medecines that can be used to treat the prostate cancer, are:

Mitoxantrona
Prednisona
Paclitaxel
Docetaxel
Estramustina
Adriamicina

After the first round of chemotherapy, the majority of the men receives added doses of ambulatory way in a clinic or a doctor’s office. The indirect effect depend on the administered drug, as well as on the frequency and time during which it has been taken. Some of the indirect effect for quimioterapéuticos drugs more commonly used to deal with the cancer prostate include/understand:

Clots of blood
Hematomas
Resequedad of the skin
Fatigue
Retention of liquids
Loss of the hair
Diminution of white blood cells, red blood cells and plaquetas
Buccal ulcers
Nauseas
Creeps or numbness in hands and feet
Upset stomach
Increase of weight

SUPERVISION:

The person will be supervised carefully to make sure that the cancer is not scattered, which implies controls of routine on the part of the doctor. The supervision will include:

Examination of blood for PSA seriado, generally every 3 months to a year.
Bony gammagraphy or a computerized tomography to verify the dissemination of the cancers.
Complete sanguineous count (CSC) to review the signs and symptoms of anemia.
To other signs and symptoms are supervised that indicate the progress of the disease like: fatigue, loss of weight, increase of the pain, diminution of the functions of the bladder and the internal and weakness.

Support battalions
The stress caused by the disease can generally be surpassed tying support battalions, in which the members share common experiences and problems. To see support battalions for the prostate cancer.

Expectations (prognosis)
Results vary much, mainly because the disease is in men majors that possibly have other complications and conditions, like cardiac or respiratory diseases, or incapacity immobilize that them or diminish their activities enormously.

Complications
The impotence is a possible complication that arises after a prostatectomía or x-ray. The last advances in surgical procedures have caused that these complications happen with less frequency. Urinary incontinence is another possible complication. Medecines can have indirect effect that include sofocos and loss of sexual desire.

Situations that require medical aid
Medical aid is due to look for if he is a greater man of 50 years than:

It has been examined never to detect prostate cancer (by means of a rectal examination and determination of the level of the PSA).
One has not become regular examinations annual.
It has familiar antecedents of prostate cancer.

The advantages and disadvantages of the examination of the specific prostate antigen (PSA) are due to discuss with the doctor.

Prevention
Preventive measures are not known. To adopt a vegetarian, low diet in fat or a similar to the traditional Japanese diet can diminish the risks. The early identification (different from the prevention) is now possible by means of the annual examination in the men of more than forty or fifty years, through digital rectal tact and of an examination of blood of the PSA (antigen prostate specific).

Nevertheless, a debate exists about if the examination is due to do or not of the PSA in all the men, since several potential disadvantages of the same exist. First it is that high levels PSA not always indicate that a patient has prostate cancer. Second it is that the doctors are detecting and treating some cancers about prostate in very preliminary stages that never would have caused no damage to him to the patient. The decision about carrying out an examination of the PSA is due to base on a dialog between the patient and the doctor.