What is Adenocarcinoma of the Prostate - Prostate Cancer
Written by Gary Presant, MD
Sunday, 04 October 2009
Prostate cancer is a tumor that grows in the prostate gland in men. The prostate gland is part of the reproductive system. It stores seminal fluid, the substance that mixes with sperm to form semen.
What is going on in the body?
Normally, the prostate is a firm, walnut-shaped gland at the base of a man's bladder.
It surrounds the urethra, the tube that carries urine from the bladder to the outside of the body. A man with prostate cancer has a tumor in the prostate gland. In some cases, prostate cancer can grow slowly for many years. Other times, it may grow rapidly and spread swiftly to other parts of the body. It may also spread its cells throughout the lymph system or bloodstream and along nerve pathways.
What are the causes and risks of the disease?
No one knows what causes prostate cancer. Hormones, such as testosterone, control the growth of the prostate gland. They may contribute to prostate cancer. Viruses or chronic infections may contribute to prostate cancer. Researchers have recently identified a gene that is linked to some cases of prostate cancer. So far, prostate cancer has not been linked to common cancer-causing substances in the environment.
Following are some of the risk factors.
- Advanced age. Prostate cancer is seen mostly in men over the age of 55.
- Diet. Fruits, vegetables, and fatty fish may lower a man's risk for prostate cancer. A high fat diet may increase the risk.
- Ethnic background. Prostate cancer occurs most often in African and northern European ethnic groups. It is less common in American Indian and Asian men.
- Family history of cancer. A man's risk is higher if his father or brother had prostate cancer.
Men who have had a vasectomy, who smoke, or who have been exposed to a metal called cadmium may also be at an increased risk.
What are the treatments for the disease?
The proper management of the many stages of prostate cancer is controversial. Depending on the grade and stage of the cancer, some options are as follows:
- cryosurgery to freeze cancer cells
- external radiation to the prostate and pelvis
- hormone therapy
- radioactive implants put directly into the prostate, which slowly kill cancer cells
- surgery to remove part or all of the prostate and surrounding tissue
- surgical removal of the testicles to block testosterone production
- watchful waiting and monitoring only
Hormone therapy or chemotherapy is used mostly for men with advanced stage D disease. Hormone therapy includes use of the following:
- antiandrogens, such as flutamide and bicalutamide, that block the action of testosterone
- corticosteroids, such as prednisone
- GnRH agonists, also known as LHRH analogues, such as goserelin and leuprolide, which reduce the body's production of testosterone
- medicines that stop the production of testosterone, such as ketoconazole and aminoglutethimide
Treatment for men with prostate cancer that has spread through the body is usually confined to making them as comfortable as possible. Often the prostate is not removed. A cure for prostate cancer is not available. Researchers continue to search for a cure.
What are the side effects of the treatments?
Following are some common side effects of radiation or surgery for prostate cancer:
- erectile dysfunction
- swelling of the extremities
- urinary incontinence
Occasionally, radiation or surgery may cause the following:
- bladder inflammation
- bone marrow suppression
- inflammation of the lining of the small intestine
- lowered blood counts
- severe swelling in the legs and feet
Depending on exact treatment, hormone therapy may cause the following conditions:
- erectile dysfunction
- a higher risk of blood clots in the leg
- osteoporosis, or bone thinning
- swelling in the breasts
Often given intravenously, chemotherapy has certain common side effects, such as:
- bleeding disorders
- higher risk of infections
- lowered blood counts
Cryosurgery or radiation implants can be painful and expensive. However, these treatments may preserve sexual function.
What happens after treatment for the disease?
After treatment, men are regularly monitored for side effects and a recurrence of the cancer.
How is the disease monitored?
The following are used to monitor the disease:
- bone scans
- chest X-rays
- CT scans of the pelvis
- digital rectal exams
- PSA tests, which are sensitive and specific for recurrence of cancer
- ultrasound of the prostate