Prostate Cancer

Prostate Cancer

Prostate Overview

The prostate, an exclusively male glandular organ, envelops the bladder neck and the initial section of the urethra, contributing secretions to semen. Conical in shape, it measures 3 cm vertically and 4 cm horizontally, featuring five lobes: anterior, posterior, two lateral, and a median lobe. Lesions in the prostate can lead to urinary difficulties due to its role in urethral passage.

Prostate Gland Disorders

1. Prostatitis: Inflammation resulting from bacterial infection.
2. Benign Prostatic Hyperplasia (BPH): Non-cancerous growth, typically after age 50.
3. Prostate Cancer: The fourth leading cause of male cancer-related deaths.

Prostate Cancer

Androgens, male sex hormones, directly influence prostate cancer growth. Elevated hormone levels correlate with increased tumor growth. Testes removal significantly reduces tumor size, indicating hormonal influence.

Tumor Location

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

Cancerous Gland Changes

The gland hardens, featuring an irregular surface and loss of normal lobular structure. Histologically, prostate cancer presents as adenocarcinoma.

Tumor Growth

Prostate cancer progresses rapidly, compressing the urethra and causing urinary difficulties.

Tumor Spread

Metastasis occurs early

1. Local spread: Cancer cells extend to lateral lobes, seminal vesicles, and the bladder neck and base.
2. Lymphatic spread: Cells migrate to internal and external iliac lymph nodes, progressing to retroperitoneal and mediastinal nodes.
3. Hematogenous spread: Via the periprostatic venous plexus to vertebral veins, potentially leading to spinal vertebral involvement.

Prostate Cancer Signs and Symptoms

Symptoms vary with cancer stage

1. Asymptomatic: Small, posterior lobe tumors often discovered incidentally.
2. Mild Urinary Issues: Enlarged tumor slightly compresses urethra, leading to frequent urges and mild difficulty urinating.
3. Painful Urination and Bleeding: Tumor spread to nearby areas results in painful, bloody urination, often with urine dribbling.
4. Urinary Retention: Complete urethral compression causes urine retention, possibly leading to hydronephrosis, renal failure, and complications such as convulsions and coma.
5. Metastatic Signs: Lumbo-sacral pain, spine fractures, abdominal swelling and pain, respiratory symptoms, weakness, and anemia may indicate metastatic spread.

Clinical Examination

Includes rectal examination to assess the prostate, abdominal palpation for kidney swelling, and systemic evaluation for other lesions.

Investigations

1. Blood Tests: Complete blood count, renal function tests, and serum acid phosphatase levels.
2. Urinalysis: Examination for abnormalities.
3. Imaging: X-rays, ultrasound, CT scans, and MRI to assess tumor extent.
4. Lymphangiography: For lymphatic spread assessment.
5. Biopsy: Histopathological confirmation of cancer cells.

Treatment

• Urinary catheterization for retention, dialysis for kidney failure, and supportive care for coma.
• Prostatectomy: Partial or radical removal of the prostate.
• Hormone Therapy: Stilbestrol or phosphorylated diethylstilbestrol to inhibit tumor growth.
• Chemotherapy: Cyclophosphamide, cisplatin, etc.
• Radiotherapy.
• Homeopathy: Constitutional remedies like carcinocin, conium, sabal, etc.
• Yoga and meditation for supportive care