1 in 6 Men are Diagnosed with Prostrate Cancer: What Every Man Should Know

What is prostate gland? SIU School of Medicine – www.siumed.edu      Irish Cancer Society – www.cancer.ie –        It is walnut shaped gland. –        Directly below the bladder (stores urine). –        In front of the rectum (buttocks). –        Can be felt from the rectum. –        1^st 3cm of urethra (tube that passes out urine) is in the gland. –        Has a capsule covering the gland and 3 zones

• Cancer usually starts from the peripheral zone.
• Cancer happens within the capsule.
• Slowly intrudes to urethra and blocks it.

What are the Screening tests available? –        There are 2 commonly done screening tests.

1. Per Rectal Examination (PRE)

• You will be lying down on your side with your buttocks at the edge of the bed and knees bent to your chest.
• A doctor will insert a finger into your rectum.
• The doctor will make a clock-like motion to feel for the size of the prostate.2.

        2. Prostate Serum Antigen (www.cancer.gov )

• Protein produced by prostate gland.
• Widely used to screen for prostate cancer and also to monitor the progress after treatment.
• Normal result is 4.0ng/mL
• If it is raised, there is higher chance of prostate cancer.

PSA screening encouraged yearly if, – Men over 50 years; – Concerned of prostate cancer; – Family history of prostate cancer. PSA is not specific. – Anxiety can cause increased PSA. – Some men with raised PSA might not have prostate cancer. – Does not tell how fast the cancer is growing. What are the risk factors for prostate cancer? –        Factors that increases the chances of getting prostate cancer. (American Cancer Society)

• Age more than 65 years old;
• More common in African-American or Caribbean men;
• Family history of prostate cancer;
• High intake of red meat or fat dairy products;
• Obesity;
• Smoking;
• Previous infection of prostate;
• Genetics.

What are the symptoms?

Early Symptoms of Prostate Cancer – http://www.songamstud.co.kr/

Other Early Symptoms –  Blood in urine –  Pain when urinating –  Unable to get an erection Late Symptoms –          Back pain or bone pain –          Reduced appetite –          Loss of weight How is the diagnosis made? Based on the “ American Cancer Society” –        Medical history and physical examination; –        Transrectal ultrasound (TRUS)

• Uses sound waves to create an image of the prostate on the screen.
• A small probe will be inserted into the rectum.
• Sound waves will enter the prostate and echoes are captured by probe.
• Procedure takes less than 10 minutes.

–        Prostate Biopsy

• A procedure where a sample of prostate tissue is removed and looked under a microscope.
• Can be done when doing a TRUS.
• A small, hollow needle will be inserted through wall of rectum.
• This is repeated 8 to 18 times, 12 samples are usually taken.
• Procedure may be painful.
• Results usually takes 1 to 3 days, but may be longer.
• The sample will be graded.

–        If there is a spread, the following will be done.

• Bone scan – to see if cancer has reached the bone;
• CT scan – to see if cancer has reached the lymph nodes;
• MRI;
• Lymph node biopsy – lymph nodes will be removed and looked under microscope.

What are the current treatment Options? According to the National Cancer Institute –        Watchful Waiting or Active Surveillance

• For older men with no signs and symptoms.
• For men with other medical conditions and cancer found during screening.
• Watchful Waiting

ü  Patient’s condition will be closely monitored with no treatment. ü  Treatment given when signs or symptom appear or change. ü  Treatment is to relief symptoms or improve quality of life.

• Active Surveillance

ü  Patient’s condition closely followed with no treatment. ü  Treatment given when there are changes in test results. ü  Certain investigations will be done – PRE, PSA test, TRUS, to see if cancer is growing. ü  Treatment is to cure the cancer. –        Surgery

• Patient in good health and tumour is in the prostate gland only.
• Can cause problem getting an erection, leaking of urine or stools and hernia which is a bulge of fat or small intestine.
• Radical prostatectomy

ü  Surgery to remove prostate, tissue around it and the ducts that release semen. ü  Can be done from abdomen, rectum or urethra (used to pass urine). –        Radiation Therapy

• Cancer treatment using high-energy X-rays to kill cancer cells and stop them from growing.
• Depends on type and stage of cancer.
• May increased risk of bladder or gastrointestinal cancer.

–        Hormone Therapy

• Removes hormones or blocks the actions of hormones.
• Stops cancer cells from growing.

–        Chemotherapy

• Cancer treatment uses drugs to stop growth of cancer cells.
• Can be taken by mouth or injected into blood stream.

What is the prognosis? –        If treated early, most patients live more than 5 years  Any newer treatments available? –        Still being tested.

• Cryosurgery
• High-intensity Focused Ultrasound
• Proton Beam Radiation Therapy

 Prepared by: –        Ng Shien Yee, Semester 9 Student, International Medical University –        A/Prof Rumi Khajotia, Department of Internal Medicine, International Medical University –        Sharmini Gangadaran, Academic Services, Clinical School, International Medical University