PROSTATE CANCER

PROSTATE CANCER

Introduction:- 

The prostate is a glandular organ present only in males. It surrounds the neck of the bladder & the fipart that the ofth urethra and contributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter. It has got five lobes anterior, posterior, two lateral, and median lobe.  Since the first part of the urethra pass through it, any lesion in the prostate will produce difficulty in passing urine.

Diseases of the prostate gland:- 

1) Prostatitis:-

This is iininflammationthe prostate gland due to bacterial infection. 

2) Benign enlargement of the prostate:-

This is a noncancerous tumor of the prostate seen after the age of 50. 3,  Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males. 

Cancer of the prostate.

Cancer of the prostate is directly linked with the male sex hormones(androgens). If the levels of sex hormone increase the growth rate of cancer also increases. It is found that after the removal of testes there is a marked reduction in the size of the tumor.

Site of tumor:-

Prostate cancer is seen mainly in the posterior lobe    .ononcancerous enlargement is seen in other lobes. 

Changes in the gland in cancer:-

The gland becomes hard with the irregular surface with loss of normal lobulation. Histologically prostate cancer is an adenocarcinoma cancer of the epithelial cells in the gland) 

Growth:-

The growth rate is very fast in prostate cancer The tumor compresses the urethra and produces difficulty in urination. 

Spread of tumor:-

Metastasis in cancer of the prostate is very early. 

1) Local spread:-

From the posterior lobe, the cancer cells go to the lateral lobes and semvesivesiclesumor cells also move to the neck and base of the urinary bladder. 

2) Lymphatic spread:-

Through the lymph vessels, cancer cells reach the internal and external iliacgroupsp of lymph nodes.  From there cells move to retroperitoneal(Behind the peritoneum) and mediastinal lymph nodes(in the chest) 

3) Spread through the blood:-

The spread of cancer celltttakesske place through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae. 

Signs and symptoms of prostate cancer:-- 

Signs and symptoms depend upon the stage of cancer. The following symptoms may be seen. 

1) no symptoms:-

Tumour is small and only in the posterior lobe. This is diagnosed accidentally. 

2) Slight difficulty in urination:-

Here the tumor is enlarged and the urethra is slightly compressed. Shortly there will be a frequent urge for urination with difficult urination.

3) When the tumor spreads to all nearby areas including the neck of the bladder and urethra there will be painful urination withinnhini n   g. The urine comes to drop by drop.

4) Retention of urine:-

When the urethra is completely compressed there will be retention of urine. This can lead to hydronephrosis, renal failure ect.In this condition, the patient may get convulsions due to renal failure and find a final coma. 

5) Signs of metastasis:-

Some patients come with the signs and symptoms of metastasis.

a)Lumbosacral pain due to the spread of cancer cells to lumbar and sacral vertebrae.

b) Fracture of the spine due to cancerous growth in the spine.

c) Swelling, pain, and fluid collection in the abdomen due to lesion in the abdomen.

d) Respiratory complaints due to cancer of mediastinal lymph nodes and lungs.

e) General weakness due to the spread of cancer to different parts of the body.

f) Anaemia due to the involment of bone marrow and increased destruction of RBCs.

Clinical examination:-

Includes per rectal examination to feel the prostate gland,  palpation of the abdomen to feel the swelling in kidneys, and anytumorsatient is examined from head to foot to find out any lesions.

Investigations:- 

1) Complete blood investigations;-

RBC,  WBC, Platlets, ESR, bleeding time, clotting time ect.

2) Urine analysis:-

Microscopic examination to detect pus cells, occult blood, casts, Crystals ect.

3) Renal function tests:-

Blood urea level, serum creatinine level, electrolyte level ect.

4) Serum acid phosphatase:-

Increased in cancer of prostate.

5) x-ray of the spine:-

To detect any tumor or fracture.

6) Ultrasonography;-

Gives an ann about the thee rththeprostateteetetatestateteadder, kidney ect.

7) C T scan:-

More detailed information about organs and tumors.

8) MRI of the spine:-

Gives detailed information about the pine, disc, and nearby soft tissues.

9) Lymphangiography:-

Gives an idea ideal the spread of cancer.

10) Biopsy to confirm cancer:-

A biopsy is taken from the tumor and is sent for histopathological examination under the microscope. This will detect the presence of cancer cells.

Treatment:-

1) If there is a retention of urine catheterization is needed.

2) Dialysis if kidney failure.

3) If there is coma monitoring of all vital functions along with parenteral nutrition and electrolyte supply.

4) Specific treatment is prostatectomy(removal of the prostate)

Partial prostatectomy:-

Here only the affected lobe is removed.

Radical prostatectomy:-

Total removal of the prostate along with nearby lymph nodes.

5, Hormone therapy:-

Stilbestrol is given to reduce tumor growth. Since this treatment increases the chance for cardiovascular disease phosphorylated diethyl stilbesterol is used nowadays.

6) Chemotherapy:-Drugs like cyclophosphamide, cisplatin ect are given.

7) Radiotherapy is also done in some cases.

8) Homoeopathy:-

Homeopathic drugs like carcinogen, conium, sabal, Crotalus, thuja, sodium, selenium, staphysagria, sulfur ect can be given according to symptoms. Constitutional homeopathic medicine will give great relief and can increase the life span. 

9) Yoga and meditation are also helpful.