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Prostate Cancer


Prostate carcinoma is the most  common malignancy in men in the United States and is one of the most common cause of cancer related deaths in men above 55 years old. Although the cause is unknown, it is more common  and also associated with higher mortality in African American men for unclear reasons. It has also been associated with sexual activity and testosterone level. Dietary fat , occupational exposure to carcinogens (cadmium oxide dust), religion ( commoner in protestants and Catholics than in Jews) and marital status ( commoner in married men) have been suggested to play a role, but have not been fully understood. Family history plays a significant role; there is a twofold increased risk of developing the neoplasia in patients with affected 1st degree relative.
Benign Prostatic Hyperplasia
Prostatic Carcinoma

Prostatitis

Digital Rectal Exam

Prostate Specific Antigen
Prostate Cancer - Most Common Tumor in Men

The risk of developing prostate cancer also increases with age. Some prostate carcinomas are slow growing and may persist for a long period of time without any significant symptoms, while some are quite aggressive. More than 75 percent prostate cancers are adenocarcinomas and often begins in the peripherial zones of the prostate. The most poorly differentiated (histoligically) part of the tumor determines its biological behavior. The remaining types tumors are mainly divided between squamous and transitional cells carcinomas.

Screening For Prostate Carcinoma

Routine testing for prostate carcinoma by digital rectal examination, transrectal ultrasonography and measurement of prostate specific antigen levels has been suggested, but there is a great debate as to the cost of screening, reliability of the test results and possible over-diagnosis of the condition.  Another screening method is measurement of the serum acid phosphatase levels in conjunction with the above screening modalities. The target population for screening for prostate cancer includes men over the age of 55.

Symptoms Of Prostate Cancer

Both early and advanced stage prostate cancer may be asymptomatic at the time that it is diagnosed. In the past, close to 80 percent of diagnosed prostate carcinoma cases had advanced local disease or the tumor had spread to other parts of the body. This is why regular screening for prostate cancer cannot be over-emphasized. Sometimes prostate cancer may present with symptoms that are quite similar to diseases such as benign prostatic hyperplasia such as : increased frequency of urination, increased urination at night, pain during urination, difficulty starting and maintaining steady stream of urine flow and in some cases blood in the urine. Because the prostate gland may surround the urethra and the growth can obstruct the urinary passage, some patients can present with symptoms of urinary obstruction such as: urinary retention and overall kidney failure. Patients may be prone to recurrent urinary tract infections and some may present with erectile dysfunction or hip pain. Additional complications of prostatic carcinoma may include: spinal cord compression from spread of the tumor, pain in remote areas of the body due to distant metastasis (spread). The relevance of digital rectal examination in men over 40 years of age, as part of routine physical examination cannot be stressed too strongly. Palpation of the prostate during this routine examination is essential for optimal detection of almost all stages of the tumor.

Management Of Prostate Cancer

Localized prostatic carcinoma may be treated with radiation therapy, watchful waiting or radical prostatectomy. In experienced hand, radical prostatectomy carries lower risk of urinary incontinence as a complication. Radical prostatectomy is not required is all cases of the early stages of the disease, since some of the earlier stages can be cured by simple prostatectomy. The effectiveness of radical prostatectomy is not very clear in cases where the tumor is locally advanced.

Radiation therapy was developed as the primary treatment for prostate cancer in an attempt to reduce the sexual dysfunction and urinary incontinence that sometimes complicates radical prostatectomy. However radiation therap carries the risk of proctitis and urethritis. Prolonged radiation therapy may also result in impotence in about 30-60 percent of cases.

Hormonal therapy such as androgen deprivation have also be implement with varying degrees of success. The growth of the prostate is dependent on testicular androgens, hence it was logical that deprivation of androgens could reduce the prostatic tumor size. Some success have been achieved by removal of the testicles since 95 % of the androgens are produced by the the testicular secretions. Your doctors will determine the most appropriate treatment modalities. Please consult your doctor promptly regarding any suspicion about your health.


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