Prostate cancer

Dr Tatenda Simango

I hope I find you well and in good health. There is an alarming increase in Covid-19 cases internationally. There has also been an upward trend in the number of cases being detected in Matabeleland. We should remain vigilant and keep maintaining the preventative measures for Covid-19 so that we curb its spread.

This week we continue with our awareness of November month of men’s health, with a closer look at prostate cancer.

Prostate cancer is cancer that occurs in the prostate. The prostate is a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm. The prostate is located in the pelvis and is surrounded by the rectum, the bladder, it has a blood network around it that are responsible for erectile function, and the urinary sphincter that is responsible for passive urinary control.

Doctors know that prostate cancer begins when cells in the prostate develop changes in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The changes tell the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. In time, some abnormal cells can break away and spread (metastasize) to other parts of the body.

The frequency of both non-cancer and malignant (cancerous) changes in the prostate increase with age. Autopsies of men in the eighth decade of life show hyperplastic changes in 90% and malignant changes in 70% of individuals.
Risk factors

· Older – Age It’s most common after age 50.

· Race – Black people have a greater risk of prostate cancer than do people of other races. possibly related to the higher levels of testosterone seen in Africans

· High consumption of dietary fats and red meats are cooked is believed to increase risk.

· Family history – first-degree relative who had prostate cancer increase ones risk of developing the cancer. Also, if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer, your risk of prostate cancer may be higher.

· Obesity – People who are obese may have a higher risk of prostate cancer

Protective factors include exercise, weight control, healthy diet rich in fruits and vegetables and limit the intake of red meat and have more white meat. An interesting study showed that regular sexual intercourse, of at least 3 times a week will reduce the risk of developing prostate cancer.

The need to pursue a diagnosis of prostate cancer is based on symptoms, an abnormal digital rectal examination (DRE), or an elevated serum Prostate Specific Antigen (PSA).

The urologic history should focus on symptoms of

· outlet obstruction,

· continence,

· potency, or a change in ejaculatory pattern.

· hesitancy,

· Intermittent voiding, a diminished stream,

· incomplete emptying,

· Blood in the semen

· Bone pain

· Losing weight without trying

· and post-void leakage.

Symptoms
· Sensation of not emptying your bladder completely after you finished urinating.

· Sensation to urinate again less than 2 h after you finished urinating?

· Have you found you stopped and started again several times when you urinated?

· Difficult to postpone urination?

· Have you had a weak urinary stream?

· Having to push or strain to begin urination?

· How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

Degree of symptoms does not always relate to gland size. Resistance to urine flow reduces bladder compliance, leading to nocturia (urinating frequently at night), urgency, and, ultimately, to retention (blockage of urine causing extreme pain).

Infection, tranquilizing drugs, antihistamines, or alcohol can precipitate urinary retention. Symptoms of metastatic (spread) disease include pain secondary to bone metastases, although many are asymptomatic despite extensive spread. Less common are symptoms related to spinal cord compression.

A blood test called a Prostate Specific Antigen (PSA) is done to help rule give direction to the possibility of prostate cancer. PSA are produced in the cells of the prostate. PSA is prostate specific, not prostate cancer specific, and increases may occur from prostatitis, non-malignant enlargement of the gland (BPH), prostate cancer, and prostate biopsies. Levels should be undetectable if the prostate has been removed. The normal range of PSA is 0 to 4 ng/mL.

Testing is advised to begin at age 40. It is particularly useful for men with values that are rising in the seemingly “normal” range. Rates of rise _0.75 ng/mL per year suggest cancer.

Asymptomatic patients do not require treatment regardless of the size of the gland, while those with an inability to urinate, gross haematuria (blood when urinating), recurrent infection, or bladder stones may require surgery Metastases to the prostate may occur to the bladder or colon cancers invade the gland by direct extension. The side effects of treatment, including impotence, incontinence, and bowel dysfunction, are unacceptable for these cases.

Treatment options include removal of the prostate. Therapies such as finasteride (drug), which blocks the conversion of testosterone to dihydrotestosterone, have been shown to decrease prostate size, increase urine flow rates, and improve symptoms. Surgical orchiectomy (removal of the testicles) is the “gold standard” approach but is least acceptable by patients.

Factors associated with recovery of erectile function include younger age, quality erections before surgery, and the absence of damage to the neurovascular bundles (nerves and blood vessels). Erectile function returns in a median of 4 to 6 months if both bundles are preserved.

Till next week.