In men, the prostate is a tiny organ with a walnut-like form. It is situated halfway between the aperture of the bladder and the base of the penis. The prostate performs two jobs. Helping with urinary control is its primary purpose. The prostate also creates a fluid that feeds and carries sperm.
A protein called PSA aids in the maintenance of the liquid form of semen. To achieve fertilization, the sperm must remain in this liquid form. The prostate gland changes in numerous ways as men age. These modifications include prostate hypertrophy without cancer and the development of malignancy.
Vaginal difficulties may result from prostate enlargement. The proportion of males with subclinical prostate cancer rises with age. Men aged 70 and older will have some prostate cancer in 70% of cases. However, few will require treatment. Around 15% of men with subclinical prostate cancer may eventually acquire a cancer diagnosis, although only 2-3% of those will pass away.
The PSA test has offered males a higher chance at early detection despite the unavailability of blood diagnostics for breast cancer. Although PSA is a hormone that all men generate, it should only be seen in semen, not blood. Although an increased PSA doesn't always indicate cancer, it indicates a problem with the prostate gland, necessitating a urologic assessment and workup. Prostate cancer is more likely to exist if the PSA level keeps increasing.
PSA testing has undergone additional lab testing over the past few years. This study developed a Percent Free Ratio, Prostate Health Index, and urine testing to decrease unnecessary prostate biopsies. A biopsy can find small tumors that X-rays and rectal examinations cannot see. It can result in a falsely negative biopsy.
CAUSES
What precisely causes prostate cancer is unknown. If a direct family member develops prostate cancer, especially if discovered before age 60, there is a six-fold increased chance. It is four times more likely to occur if a direct family member is diagnosed at age 80 or later than it would be otherwise.
PREVENTION
There is no reliable prostate cancer prevention strategy. According to statistics, being obese, eating improper foods, and consuming excessive animal fat increase risk. Free radicals are produced by animal fat and blood nitrates. Free radicals might hasten the development of cancer.
SCREENING
According to the American Cancer Association, males should start getting a PSA screening at age 50. Especially in black males with a family history of prostate cancer or voiding issues, many urologists begin PSA screening around age 40. A significant push was to screen all men 50 years ago. Data over time has demonstrated that this frequently resulted in unneeded therapy. As one reaches the age of 75, this unnecessary treatment is especially appropriate. We must screen males reasonably likely to live long as the mean age rises.
DETECTION
Annual PSA levels during testing may rise, as previously mentioned. A PSA growth of more than 0.5% per year is alarming. Urinary symptoms, microscopic hematuria (blood in the urine), or blood in the ejaculate can all occur in particular males. Men over 40 should undergo a digital rectal exam (DAE) every year. If cancer is suspected, your urologist might advise a prostate ultrasound, MAI, and biopsy. Because they develop in the prostate gland, most malignancies are adenocarcinomas. Occasionally, the urethra that passes through the prostate can develop transitional cell carcinoma.
DIAGNOSIS
Your urologist will advise a prostate biopsy if the results of the DRE and PSA indicate that cancer has to be ruled out. You'll need an ore-oo antibiotic and a Fleet enema to get ready for this surgery. During the transrectal probe insertion procedure, the patient is prone. A needle is inserted into the probe while it is in clear view. Specific equipment is used to drive or shoot the needle into the prostate tissue that has to be examined. 1 to 2 cm are put into the prostate. To evaluate every aspect, more samples are required for larger prostates. Biopsies typically have 12 to 16 cores. Infections and bleeding in the urethra and rectum are uncommon.
TREATMENT
Treatment is based on a patient's age, health, tumor grade, stage, and voiding symptoms. Six elderly Gleason people who have small-volume cancer are noted. Both radical robotic surgery and the implantation of brachy radiation seeds are candidates for definitive therapy in younger individuals with the disease that is thought to be organ-confined. External radiation and cryofreezing are used for older patients who have a higher risk of early metastases or cannot undergo surgery requiring general anesthesia.
Metastatic Treatment: Most patients will see some remission with the reduction of testosterone, regardless of whether they had progressed illness at the time of diagnosis or after treatment, showing a rising PSA. The testicles are either removed or leuprolide acetate, which will put the testicles to sleep, is injected. Remissions might range in length for many patients. Tumors with smaller volumes and lower grades have the best prognosis. Ideally, it won't be long before the PSA rises. Your doctor may suggest different anti-androgen treatments if your PSA level increases. Prednisone can cure pain and malaise symptoms when other treatments are ineffective, and bone radiation can treat metastatic pain. Andropause is brought on by testosterone deprivation ( male menopause.)
PROGNOSIS
Cancer stage and grade determine prognosis; cells are rated under a microscope. The specimen is assessed on a scale of 1 to 5, with 5 denoting the most aggressive cancer. 1 and 2 grades are uncommon (3 - 4.) Several body parts may be affected by prostate cancer at once, and each area's grading may differ. Because prostate cancer is multilocular, Gleason scores are used to describe it. The two primary cancer grades together. A biopsy grade increases the number by one. The Gleason scale goes from 2 to 10. Very few scores are rated between two and five (6 - 8.) Around 10% of scores are categorized as (9 - 10.) Staging is determined by the prostate's volume and CT, MRI, bone, and ultrasound studies.
If your doctor advises stopping PSA screening due to age, you must firmly insist on continuing the test if you disagree. Patients should continue surveillance only if the Gleason score is below eight and the cancer volume is modest. Larger cancer volumes and high-grade tumors do not react well to any treatments. The patient must understand the risks and alternatives and consult with their urologist.
