DEFINITIONS
Prostate cancer is a malignant tumor that grows in the prostate gland.
Prostate cancer is very common. Microscopic examination of prostate tissue after surgery and at autopsy showed the cancer in 50% of men aged over 70 years and in all men aged over 90 years.
Most of these cancers do not cause symptoms because of its spread is very slow.
CAUSE
The cause is unknown, although several studies have shown an association between high fat diets and increased levels of the hormone testosterone.
Prostate cancer is the leading cause of cancer deaths in men No. 3 and is the leading cause of cancer deaths in men over 74 years.
Prostate cancer is rare in men aged less than 40 years.
Men who have a higher risk for prostate cancer is a black man aged over 60 years, farmers, painters and cadmium exposure.
The lowest incidence was found in Japanese men and vegetarians.
- Prostate cancer grouped into: Stage A: lump / tumor not palpable on physical examination, usually discovered by accident after prostate surgery for other diseases.
- Stage B: tumor confined to the prostate and usually found on physical examination or PSA test.
- Stage C: tumor has spread outside the prostate capsule, but not to spread to the lymph nodes.
- Stage D: Cancer has spread to regional lymph nodes or other body parts (eg. bones and lungs).
SYMPTOMS
Prostate cancer usually develops slowly and does not cause symptoms until the cancer has reached an advanced stage.
Sometimes the symptoms resemble BPH, which is a difficulty in urination and frequent urination.
Symptoms are caused by cancer causing partial blockage of urine flow through the urethra.
Prostate cancer can cause red urine (because it contains blood) or cause the occurrence of sudden urine detention.
In some cases, newly diagnosed after prostate cancer spread to the bone (especially the pelvic bones, ribs and spine) or to the kidneys (causing kidney failure).
Painful bone cancer and brittle bones that easily fracture (broken bone).
When cancer spreads, the patient will usually anemic.
Prostate cancer can also spread to the brain and cause seizures and neurological symptoms of mental or other.
Other symptoms are:
- Immediately after urination, the urine is usually still dripping
- Pain when voiding
- Pain when ejaculating
- Lower back pain
- Pain when defecating
- Nocturia (urination at night)
- Incontinence uri (beser)
- Bone pain or bone pain when pressed
- Haematuria (blood in urine)
- Abdominal pain
- Losing weight.
DIAGNOSIS
The best way to prostate cancer screening is to plug rectal examination and blood tests.
Anal plug in prostate cancer patients would indicate a hard lump that does not irregular shape.
Blood tests performed on the measurement of levels of prostate specific antigen (PSA), which usually increases in prostate cancer patients, but also can increase (not too high) in BPH patients.
If the plug rectal examination found a lump, then performed an ultrasound examination.
With X-rays or bone scanning, can be known of the spread of cancer to the bone.
Check the usual options:
- urine analysis
- Cytology urine or prostatic fluid
- Prostate biopsy.
TREATMENT
Appropriate treatment for prostate cancer is still debated.
- Options treatments vary, depending on the stage: In the early stages can be used prostatectomy (removal of prostate) and radiation therapy
- If the cancer has spread, hormonal manipulation can be done (to reduce testosterone levels through medication or removal of the testes) or chemotherapy.
surgery
1. Radical prostatectomy (removal of prostate gland).
Often performed on stage cancer A and B.
Long procedure and is usually performed under general anesthesia or spinal.
An incision is made in the abdomen or perineal area and the patient should receive hospital treatment for 5-7 days.
Complications that may occur is uri impotensia and incontinence.
In patients who are still active sexual life, can be Potency-sparing radical Prostatectomy.
2. Orkiektomi (removal of the testes, castration).
Appointment of two testes causes decreased levels of testosterone, but this procedure led to physical and psychological effects that can not be tolerated by the patient.
Orkiektomi is an effective treatment, does not require repeated treatment, is cheaper than drugs and patients after undergoing orkiektomi not have to undergo hospital treatment.
Orkiektomi usually done on cancer has spread.
Radiation therapy
Radiation therapy used primarily to treat cancer A, B and C.
Usually if the risk of surgery is too high, then do radiation therapy.
Radiation therapy to the prostate gland can be done through several ways:
1. External radiation therapy, performed in a hospital without having to undergo hospitalization.
The side effects of decreased appetite, fatigue, skin reactions (such as redness and irritation), injury or burns to the rectum, diarrhea, cystitis (bladder infection) and haematuria.
External radiation therapy is usually performed 5 times / week for 6-8 weeks.
2. Transplant grain iodine, or iridium radioactive gold directly on the prostate tissue through small incisions.
The advantage of this form of radiation therapy is that radiation is directed directly to the prostate with the surrounding tissue damage less.
Drugs
1. Hormonal manipulation.
The aim is to reduce testosterone levels.
Decrease in testosterone levels are often very effective in preventing the growth and spread of cancer.
Hormonal manipulation is mainly used to relieve symptoms without a cure the cancer, ie for example in cancer patients has spread.
Synthetic drug whose function resembles LHRH (luteinizing hormone releasing hormone), the more widely used to treat advanced stage prostate cancer. Examples are lupron or zoladeks.
These drugs suppress the formation of stimulating the testes to testosterone (this is called chemical castration because it has the same result with the appointment of the testes).
Drugs given in the form of injections, usually every 3 months.
The side effects are nausea and vomiting, flushed face, anemia, osteoporosis and impotence.
Other drugs used for hormonal therapy is androgen inhibitor (eg flutamid), which works to prevent testosterone stuck in prostate cells.
Side effects are impotence, liver problems, diarrhea, and gynecomastia (breast enlargement).
2. Chemotherapy
Chemotherapy is often used to treat the symptoms of prostate cancer resistant to hormonal treatment.
Usually given a single drug or a combination of several drugs to destroy cancer cells.
Drugs that can be used to treat prostate cancer are:
- Mitoxantronx
- Prednisone
- Paclitaxel
- Dosetaxel
- Estramustin
- Adriamycin.
The side effects vary and depend on the drugs given.
Monitoring
Whatever type of treatment she lived, the patient will be monitored closely on the development of the disease.
Monitoring include:
- Blood tests to determine levels of PSA (usually every 3 months – 1 year).
- Scaning and / or CT scan to determine the spread of bone cancer.
- Complete blood examination to monitor the signs and symptoms of anemia.
- Monitoring other signs and symptoms that indicate progression of the disease (such as fatigue, weight loss, the more intense pain, decreased bowel function and bladder and weaknesses).
