PROSTATE CANCER

Introduction:-

The prostate is a male-specific glandular organ that encircles the bladder neck and the initial segment of the urethra, playing a role in the production of seminal fluid. This gland has a conical structure, with a vertical diameter of approximately 3 cm and a transverse diameter of about 4 cm. It consists of five lobes: one anterior, one posterior, two lateral, and a median lobe. Given that the first segment of the urethra traverses the prostate, any abnormalities in this gland can lead to challenges in urination.

 

Diseases of the prostate gland:-

1) Prostatitis:-

The condition involves inflammation of the prostate gland caused by a bacterial infection.

Cancer of the prostate

Prostate cancer is closely associated with male sex hormones, known as androgens. An increase in the levels of these hormones correlates with a heightened growth rate of the cancer. Research indicates that following the surgical removal of the testes, there is a significant decrease in tumor size.

Site of tumour:-

Prostate cancer primarily occurs in the posterior lobe, while benign enlargement is observed in the other lobes.

Changes in the gland in cancer:-

The gland exhibits a hardened texture with an uneven surface and a disruption of its typical lobular structure. Histologically, prostate cancer is classified as an adenocarcinoma, which originates from the epithelial cells within the gland.

Growth :-

Prostate cancer exhibits a rapid growth rate. The tumor exerts pressure on the urethra, leading to challenges in urination.

Spread of tumour:-

Metastasis in prostate cancer occurs at an early stage.

1) Local spread:-

Cancer cells from the posterior lobe spread to the lateral lobes and seminal vesicles. Additionally, tumor cells can migrate to the neck and base of the urinary bladder.

2) Lymphatic spread:-

Cancer cells travel through the lymphatic vessels to the internal and external iliac lymph nodes. Subsequently, these cells can spread to the retroperitoneal lymph nodes, located behind the peritoneum, as well as to the mediastinal lymph nodes found in the chest.

3) Spread through the blood:-

The dissemination of cancer cells occurs via the periprostatic venous plexus, extending to the vertebral veins during actions such as coughing and sneezing, ultimately infiltrating the vertebral bodies of the lumbar vertebrae.

Signs and symptoms of prostate cancer:--

The manifestations and indicators of cancer vary according to its stage. The subsequent symptoms may be observed.

1) No symptoms:-

The tumor is minor and located solely in the posterior lobe. Its diagnosis was made incidentally.

2) Slight difficulty in urination:-

The tumor has increased in size, resulting in slight compression of the urethra. This will soon lead to frequent urges to urinate, accompanied by difficulty in urination.

3) When the tumor extends to adjacent regions, including the neck, bladder, and urethra, individuals may experience painful urination accompanied by bleeding, with urine passing in a slow, drop-by-drop manner.

4) Retention of urine:-

When the urethra is fully obstructed, urine retention occurs. This can result in hydronephrosis and renal failure, among other complications. In such cases, the patient may experience convulsions as a consequence of renal failure, potentially leading to coma.

5) Signs of metastasis:-

Certain patients present with indications and manifestations of metastasis.

a) Lumbar and sacral pain resulting from the metastasis of cancer cells to the lumbar and sacral vertebrae.

 

b) Spinal fracture caused by the presence of malignant growths within the spine.

 

c) Abdominal swelling, pain, and fluid accumulation attributed to lesions in the abdominal region.

 

d) Respiratory issues arising from cancer affecting the mediastinal lymph nodes and lungs.

 

e) Overall fatigue due to the dissemination of cancer to various regions of the body.

 

f) Anemia resulting from bone marrow involvement and heightened destruction of red blood cells.

Clinical examination :-

The examination encompasses a rectal assessment to evaluate the prostate gland, abdominal palpation to detect any kidney swelling or tumors, and a comprehensive head-to-toe evaluation to identify any lesions.

Investigations:-

1) Complete blood investigations;-

RBC, WBC, Platelets, ESR, bleeding time, clotting time, etc

2) Urine analysis:-

Microscopic analysis to identify the presence of pus cells, hidden blood, casts, crystals, and other elements.

3) Renal function tests:-

Blood urea nitrogen level, serum creatinine concentration, electrolyte concentrations, and similar parameters

4) Serum acid phosphatase:-

Increased in cancer of prostate

5) x-ray of the spine:-

To detect any tumour or fracture.

6) Ultra sonography;-

Gives idea about prostate,bladder,kidney ect.

7) C T scan:-

More detailed information about organs and tumour.

8) MRI of the spine:-

Gives detailed information about spine ,disc and nearby soft tissues.

9) Lymphangiography:-

Gives idea about lymphatic spread of cancer.

10) Biopsy to confirm cancer:-

A sample is extracted from the tumor and forwarded for histopathological analysis using a microscope. This process will identify the presence of cancerous cells.

 

 

Treatment:

1) Catheterization is required in cases of urinary retention.

2) Dialysis is indicated for kidney failure.

3) In the event of a coma, it is essential to monitor all vital signs while providing parenteral nutrition and electrolyte replenishment.

4) The specific intervention for prostate issues is prostatectomy (surgical removal of the prostate).

Partial Prostatectomy:

This procedure involves the removal of only the affected lobe of the prostate.

Radical Prostatectomy:

This entails the complete removal of the prostate along with adjacent lymph nodes.

5) Hormone Therapy:

Stilbestrol is administered to inhibit tumor growth. Due to the increased risk of cardiovascular disease associated with this treatment, phosphorylated diethylstilbestrol is now preferred.

6) Chemotherapy:

Medications such as cyclophosphamide and cisplatin are utilized.

7) Radiotherapy may also be employed in certain situations.

8) Homeopathy:

Homeopathic remedies like carcinogens, conium, sabal, Crotalus, thuja, sodium, selenium, and staphysagria can be prescribed based on symptoms. Constitutional homeopathic treatment can provide significant relief and potentially extend life expectancy.

9) Practices such as yoga and meditation can also be beneficial.

FAQs

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