Research on Prostate Cancer

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Introduction

Prostate cancer can be defined as the tumor that forms in the tissues of the prostate gland, found in the reproductive system of a man, in front of the rectum and below the bladder. It is characterized by tumors that are caused by an unregulated multiplication of cells, and sometimes, these cells spread to other body parts.

Incidence

The risk of developing prostate cancer becomes high as the person gets older. It is a common disease among the old men, normally over 65 years. According to the National Cancer Institute,(NCI) a third of all American men are who are over age 50 have microscopic symptoms of prostate cancer.  However, the disease has also been diagnosed in men who are 40 years. Recent research has shown that In America, Prostate cancer is the second most frequently diagnosed cancer in American men after lung cancer. It is the leading cause of death in America for men diagnosed with cancer, especially those over 85 years.  Among the African American men, it is said that one out of every seven has prostate cancer, while among the Caucasian men; one of every eight is diagnosed with the disease.

The exact reason for this difference has not yet been known. Prostate cancer is lowest among the Asian men, while European men are the second lowest people to be diagnosed with prostate cancer. The differences may be due to the environmental conditions and other risk factors or due to the differences in the various types of diagnosing methods. Studies have shown that if prostate cancer is diagnosed early enough, the patient can be expected to live even up to five years. However, most men are not diagnosed early, hence the high mortality rate of prostate cancer patients. Of late, the mortality rate has decreased, mainly due to increased screening of the disease.

Pathophysiology

This is the study of the various body parts that are affected by various functional problems or diseases.  The problems may be of a physical or biochemical nature. Pathophysiological studies on prostate cancer have shown that there are several steps in which it forms. Normal cells in the prostate are unable to control their multiplication. They increase abnormally and fail to respond to the factors controlling the division of the cells. They then turn in to cancer causing cells. Prostate cancer may start from the cells of the prostate gland. This type of prostate cancer is called adenocarcinoma. The other type is called the angular prostate cancer, and it starts at the cells that secrete semen in the prostate gland. Adenocarcinoma may begin at the minor arts of the prostate gland, and may not seem to be a malignant tumor at the start.

On the other hand, the angular prostate cancer starts at the cells that secrete the semen, especially during the mutation of these cells. This leads to the uncontrollable growth of the cancer cells. As the cancer progresses, the cancer cells change their role and start playing that which they are not programmed to perform. They turn in to malignant cells and start attacking the lymph nodes if the cancer is the spreading type. During the advanced stages of the prostate cancer, it can spread to other areas of the body like the liver, lungs or the blood. A cancer that spreads to other areas is called the metastatic cancer and is at its worst stage in the patient’s body. If diagnosis is done at this stage, the prostate cancer patient can not live for more than five years.  Pathophysiology is the only way in which the scientists can understand the causes of prostate cancer in a better way.

Although the causes for prostate cancer have not been well understood, scientists have identified environmental factors and the biochemical factors as the major causes of cancer. Others are the high intake of fat from warm blooded animals, since it causes an abnormal growth of the prostate cells. There has also been proof that if the level of testosterone in a man is high, then he is more prone to cancer than the man with a low testosterone level. Also, prostate cancer has been said to be hereditary, so a man from a family with a history of prostate cancer is in danger of inheriting the disease, especially in his old age. (Pathophysiology is the Key to Prostate Cancer’s Treatment 09/22/2007)

Signs and symptoms

Prostate cancer may not show or cause any signs and symptoms in the early stages of development. The symptoms may appear if the tumor makes the prostate gland to enlarge, to an extent that it starts to press the urethra. This makes it difficult to pass the urine, and the patient may want to pass the urine more frequently. The symptoms are often similar to those of benign prostaticn hyperplasia (BPH).

The signs and the symptoms are;

a) Hesitancy, this is difficulty in starting the urine stream.

b) The steam of urine is weak, meaning that it is not as the normal stream.

c) Some patients are not able to urinate at all, while others have a frequent urination.

d) The feeling that even after urination, the bladder does not empty completely.

e) Dyssuria, which is feeling a burning or pain during urination.

f) Hematuria, the presence of blood in urine.

g) Hematospermia, having blood in the semen.

h) Deep pain in the hip, abdomen, pelvis and the lower back.

These symptoms may be caused by benign prostatic hyperplasia (BPH), an occurrence in the older men where the prostate enlarges. As the man grows, the prostate also grows, and starts to press against the urethra when it gets big enough, causing problems to the bladder. They may also be caused by prostatitis, an infection of the prostate. If the urinary tract is infected, it may cause problems with the prostate gland. If the cancer has spread to the other body parts, the patient shows weight loss, swelling of the feet and pain in the bones, especially those at the lower back, the hips and the pelvis. (Godoy G, 2009)

Diagnosis

It is important for all men to regularly see the general practitioner for the regular check of their health. Several tests can be run in order to diagnose the prostate cancer.

The blood test

In this method, the doctor needs to check the Prostate Specific Antigen (PSA) of the patient. To do this, he takes a sample of the patient’s blood. Prostate Specific Antigen is a type of protein that is produced by both the cancerous prostate cells and the normal cells. If the PSA level is high, then the person is said to be cancer positive. However, a person can have a high level of the PSA, in a condition that is not cancerous, if he has an infection. The doctor has to be careful not to pronounce the possibility of a urine infection before carrying out the PSI test. It is therefore important that the person be tested for the PSA at least a month after the urine infection treatment finishes. PSA is normally measured in nanograms, per milliliter of blood. No PSA reading is considered normal. It varies from one man to another, but normal PSA increases as the man gets older.

The PSA readings are interpreted as follows:

a) 3 nanograms per milliliter or less – the normal reading for a person below 60 years.

b) 4 nanograms per liter or less – normal reading for men between 60 to 69 years of age.

c) 5 nanograms per liter or less is considered to be for a man over the age of 70.

If a reading is higher than these values, it may be because the prostate is enlarged, but the higher the values are from the above values, then the more likely that the person has prostate cancer. Also, the higher the PSA reading, then the more likely it is that the cancer will spread faster. If the person is diagnosed with prostate cancer, then the doctor places a gloved finger in to the rectum to feel the prostate gland and to check for the normal signs. This is called the digital rectal examination (DRE).

Rectal ultra sound

Rectal ultra sound is the examination of the prostate gland. The patient is required to have a bowel movement before the examination, so that during the appointment, the bowels are empty. In order to diagnose the cancer, a small microphone is inserted at the rectum, to enable a clear view of the prostate gland. This type of scanning does not take long. It should also not hurt, although it might be uncomfortable.

Needle biopsy

During the rectal examination, if a lump or any kind of hardening is found on your prostate, the doctor takes a sample of the cells for further examination through a microscope. The biopsy can also be done through the skin behind the testicles, but the most common way is through the rectum using the Trans rectal ultrasound scanner. Biopsy can be done even to the out patients. The patient has to be explained to what is to be done to him, so that he is not met by surprise. He is also given antibiotics before the biopsy to stop any infection to spread after the examination. The antibiotics can be taken by injection directly in to the vein, through the mouth or through the rectum in a suppository. Another PSA test may be run to ensure that the readings really indicate any cancer symptoms.

In order to have the biopsy, the patient lies down on the left side. The doctor then inserts the rectal ultrasound probe in to the back passage to examine prostate. The needle is then put into the prostate and in to the ultrasound probe to get a sample of the prostate tissue. This may feel a little painful and uncomfortable, but anesthetics are used to make the area numb so that the examination is painless. The patients are advised to drink a lot after the examination. Effects of the examination may be bleeding from the prostate and urine infection. That is why the patients are advised to drink a lot to prevent the infection from spreading by flushing the blood. There may also be blood in the urine and the semen but only for a few weeks after the examination. However, in case of an infection, the patient should consult the doctor as soon as possible. The signs and symptoms of the infection may include high temperatures, shaking or shivering, presence of a lot of blood in the urine or irregular urination.

Urine test, (PCA3)

PCA3 stands for Prostate CAncer gene 3.This test is new to the doctors to help them determine patients with prostate cancer and who should have biopsy.  PCA3 genes are found in the cancer cells, and they ensure the cells produce a certain type of protein. The PCA3 protein leaks in to urine if it is high, thus making it possible for it to be measured by a urine test. This test may be the most commonly used in the future. (Godoy G, Sankin A, et al. 2009)

Advanced practice management

It is important to treat the prostate cancer as early as it is detected. Deciding on the treatment of the prostate cancer is dependant on various factors. These include;

a) How far the cancer has spread and grown. It is important for the doctor to know the stage of the tumor so that he can know the treatment to use on the patient. A cancer that has been detected at a very early stage will not be treated the same as the one at an advanced stage.

b) How the cancer cells of the patient look when viewed under a microscope. If the cancerous cells of a patient are similar to the normal prostate cells, then the cancer will be said to be at a lower grade. However, if the cells seem abnormal, then the cancer is a high grade cancer. A low grade cancer grows and develops slowly than the high grade cancer.

c) The patient’s gleason score. A gleason score is important in describing the grade of the cancer. After a biopsy is performed, each area that shows the cancer cells is classified from 1 to 5, depending on the look of the cells. Those closer to 1 are more normal compared to those closer to 5. The doctor identifies the two areas with the highest grades, adds the scores to get the gleason score. The grade is used to determine the behavior of a cancer.

d) The age and the general health of the person. The age factor is considered because some prostate cancer cells grow very slowly. A patient, who is old, has the cancerous cells and does not show the cancer symptoms may live long without the aid of the treatment. In other patients, the cancer may be growing slowly, such that even if the patient is old, his life expectancy is high. Some of the patients whose cancer cells grow slowly are advised to wait and se what happens, instead of experiencing the side effects of the treatment.

e) The PSA blood test. This test is important because it shows the speed at which the cancer is growing. It helps to determine the progress of the cancer.

f) The patient’s choice and decision about the treatment. The patient in most cases determines which treatment will be used on him. The method of treatment chosen should be beneficial, affordable, and the side effects that the patient can be able to deal with. (Thomadaki H

2009, pages 373-80)

Treatment for prostate cancer

a) Treatment for prostate cancer that hasn’t spread

This is the kind of cancer that is contained in the prostate gland, the localized prostate cancer. Patients in this category are classified according to the speed in which the cancer grows, that is, quickly, slowly or if it will spread at all.

1) Low risk localized prostate cancer

This type is unlikely to develop for many years. Patients with this type are given an active monitoring, so that the doctor will observe the cancer for some time to see if it will grow. In some cases, this type is so slow that it doesn’t show any symptoms. The doctors also should monitor the cancer first to avoid treatments and their side effects. Radio therapy and surgery to remove the cancer are the treatments that are offered to the patient incase the cancer spreads during the observation period.  Normally, surgery to remove the cancer is done to young people, since the risk of the cancer spreading is higher, while in older men, radiotherapy to the prostate is preferred. High frequency ultra sound therapy and cryotherapy are some of the treatments that may also be tried.

2) Intermediate risk localized prostate cancer

This cancer spreads or grows within a few years. The doctor will perform surgery on the patient to remove the prostate gland, or external radiotherapy to the patient. The two treatments work equally well, but the benefits, the risks and the side effects of the treatments are very different. Active monitoring and radio therapy are other forms of treatment that may be administered to the patient.

3) High risk localized prostate cancer

This also spreads within a few years after diagnosis. Therefore, surgery to remove the tumor will be a good option for the treatment. External radiotherapy to the tumor is also an option. Internal radio therapy can not be used because in this type of cancer, the cancerous cells may have already spread to other areas away from the prostate gland, and the therapy may not reach all the cells. Active monitoring is an option for the men who are not so fit to undergo radiotherapy or surgery.  If the cancer has spread outside the prostate gland, surgery and external radio therapy are combined with hormone therapy to treat the cancer.

b) Treatment for prostate cancer that comes back

After undergoing treatment, prostate cancer may come back. Doctors respond to such cases with a hormone therapy, if the patient shows the symptoms. If the patient underwent surgery during the first treatment, the doctors will recommend external radio therapy to the prostate. High frequency ultra sound therapy and cryotherapy are not so effective at this stage but they can also be used.

c) Treating the prostate cancer that has spread

Such a cancer has no cure. However, lowering the level of the testosterone in the body may control the cancer. This can be done through the hormone therapy. The hormones can be administered in form of tablets, or monthly injections. The testosterone levels can also be reduced by the removal of the testicles, (castration or orchidectomy). This is effective in that it has been known to control the cancer in many men for a few years. If the first treatment was a success, the doctors can treat the patient with chemotherapy or steroids, to control the cancer for some time. If the prostate cancer has spread to the bones and causes pain, the doctor may perform radio therapy to reduce the pain in the bones. (Wilkes L

2004, pgs143 to 151)

Implications of the cancer

Many men that have been diagnosed with the cancer say that they prefer to under go the treatment with their wives. Te professionals in the treatment of the cancer need to discuss effective methods of treating the cancer, because it affects the sex life of the couples. There should also be the screening the patients for depression, because it has been known to cause depression in to the couples.

Summary

Prostate cancer is common among many men. Should be the responsibility of the men to ensure that they are checked against prostate cancer. Furthermore, they should ensure that they avoid eating the kinds of foods that may cause them to have the cancer. Those who have been diagnosed should take the doctor’s prescription. The medication given should be followed strictly; otherwise serious causes like death may follow.