Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer. Prostate cancer can only be known only when an autopsy is done. According to the several researchers about 80% of all men in their eighties had prostate cancer.
Prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells. According to Medilexicon`s medical dictionary, Prostatic intraepithelial neoplasia means “dysplastic changes involving glands and ducts of the prostate that may be a precursor of adenocarcinoma; low grade (PIN 1), mild dysplasia with cell crowding, variation in nuclear size and shape, and irregular cell spacing; high grade (PIN 2 and 3), moderate to severe dysplasia with cell crowding, nucleomegaly and nucleolomegaly, and irregular cell spacing.”
Cancer specialists say that nearly 50% of all 50-year-old men have PIN. The cells are still in place – they do not seem to have moved elsewhere – but the changes can be seen under a microscope. Cancer cells would have moved into other parts of the prostate. Doctors describe these prostate gland cell changes as low-grade or high-grade; high grade is abnormal while low-grade is more-or-less normal.
It has been seen that if any patient who was found to have high-grade PIN after a prostate biopsy, has a greater risk of having cancer cells in his prostate. In this case, doctors will monitor this type of patients carefully and possibly carry out another biopsy later on.
Type of prostate cancer
Before taking any step for the prostate cancer treatment, it is important to know the stage of the cancer, or how far it has spread. Doctors will go for which therapies will be used for removing the tumor only after knowing the cancer stage. TNM (Tumor/Nodes/Metastases) is the most common system of determining the stage of the cancer. There are many factors involve with this TNM such as the size of the tumor, how many lymph nodes are involved, and whether there are any other metastases.
It is very difficult to distinguish with the TNM system that the cancers that are still restricted just to the prostate, and those that have spread elsewhere. Clinical T1 and T2 cancers are found only in the prostate, and nowhere else, while T3 and T4 have spread outside the prostate.
There are many ways to find out whether the cancer has spread. Computer tomography will check for spread inside the pelvis, bone scans will decide whether the cancer has spread to the bones, and endorectal coil magnetic resonance imaging will evaluate the prostatic capsule and the seminal vesicles.
The Gleason Score
A pathologist will look at the biopsy samples under a microscope. If cancer tissue is detected, the pathologist then grades the tumor. The Gleason System of grading goes from 2 to 10. The higher the number, the more abnormal the tissues are compared to normal prostate tissue.
Two numbers are added up to get a Gleason score:
1. A number from 1 to 5 for the most common pattern observed under the microscope. This is the predominant grade and must be more than 51% of the sample.
2. A number from 1 to 5 for the second most common pattern. This is the secondary grade and must make up more than 5% but less than 50% of the sample.
A Gleason score of 7 can have two meanings. Look at these two examples below:
1. If the predominant grade is 3 and the secondary grade is 4, the Gleason score is 7.
2. If the predominant grade is 4 and the secondary grade is 3, the Gleason score is also 7.
However, the first example, with a predominant score of 3, has a less aggressive cancer than the second example, with a predominant score of 4.
It is crucial that the tumor is graded properly, as this decides what treatments should be recommended.
What are the symptoms of prostate cancer?
In the beginning of the prostate cancer there are many ways to find out symptoms of prostate cancer. Most men at this stage find out they have prostate cancer after a routine check up or blood test. The most important symptoms of the prostate cancer are as follows:
• The patient urinates more often
• The patient gets up at night more often to urinate
• He may find it hard to start urinating
• He may find it hard to keep urinating once he has started
• There may be blood in the urine
• Urination might be painful
• Ejaculation may be painful (less common)
• Achieving or maintaining an erection may be difficult (less common)
If the cancer is advanced the following symptoms are also possible
• Bone pain, often in the spine (vertebrae), pelvis, or ribs
• The proximal part of the femur can be painful
• Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
• Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
• Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord)
What are the causes of prostate cancer?
The specific cause of prostate cancer is yet to find. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.
• Age
Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50.
• Genetics
Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups – in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men. Studies indicate that the two genes – BRCA 1 and BRCA 2 – which are important risk factors for breast cancer and ovarian cancer have also been implicated in prostate cancer.
In a study scientists found seven new sites in the human genome that are linked to men’s risk of developing prostate cancer.
• Diet
A review of diets indicated that the Mediterranean diet may reduce a person’s chances of developing prostate cancer. Another study indicates that soy, selenium and green tea, offer additional possibilities for disease prevention – however, a more recent study indicated that combination therapy of vitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.
A US pilot study on men with low risk prostate cancer found that following an intensive healthy diet and lifestyle regime focusing on low meat and high vegetable and fruit intake, regular exercise, yoga stretching, meditation and support group participation, can alter the way that genes behave and change the progress of cancer, for instance by switching on tumor killers and turning down tumor promoters.
Other studies have indicated that lack of vitamin D, a diet high in red meat may raise a person’s chances of developing prostate cancer.
• Medication
Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk. A study found that statins, which are used to lower cholesterol levels, may lower a person’s risk of developing prostate cancer.
• Obesity
A study found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer.
• Sexually transmitted diseases (STDs)
Men who have had gonorrhea have a higher chance of developing prostate cancer, according to research from the University of Michigan Health System.
• Agent Orange
Veterans exposed to Agent Orange have a 48% higher risk of prostate cancer recurrence following surgery than their unexposed peers, and when the disease comes back, it seems more aggressive, researchers say. Another study found that Vietnam War veterans who had been exposed to Agent Orange have significantly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.
What are the treatments for prostate cancer?
If the cancer is in the early stage that means the size of tumor is small then there are some treatment factors which we can follow:
• Watchful waiting – not immediate treatment is carried out. PSA blood levels are regularly monitored.
• Radical prostatectomy – the prostate is surgically removed.
• Brachytherapy – radioactive seeds are implanted into the prostate.
• Conformal radiotherapy – the radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment, thus minimizing healthy tissue exposure to radiation.
• Intensity modulated radiotherapy – beams with variable intensity are used. An advanced form of conformal radiotherapy usually delivered by a computer-controlled linear accelerator.
Treatments for prostate cancer are really recommended on individual cases. However, doctors are the best person who can give you the needful treatments. So before taking any step please consult with your doctor.
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