Prostate
Cancer As A Source Of Abdominal Pain Introduction This
cancer is the most common cancer of men men above 50 in the United States. It
is for men what breast cancer is for women and this is true even on a histological
level, as both cancers are mostly glandular cancers
(=adenocarcinomas) and both are responding to hormones, breast cancer to estrogen
and prostate cancer to testosterone. About 200,000 new cases of prostate
cancer are diagnosed in the U.S. every year. The cancer grows slowly for a long
period of time inside the very tough prostatic capsule. Often it switches to the
other prostatic lobe (there are two lobes of the prostate gland). Next it breaks
through the capsule and invades the adjacent structures such as the seminal vesicles,
the urethra, bladder, pelvic lymph glands, the pelvic bone and via the blood stream
enters bones such as vertebral bodies or ribs. Prostate
Cancer Symptoms In the beginning of prostate cancer there
are no symptoms. This is why an annual prostate examination and annual PSA blood
test should be done once a year on every man 50 years or older. In case
of early prostate cancer the physician would pick up a hard lump in the prostate
on rectal examination and often the PSA would be positive (greater than 5). A
late sign of prostate cancer is when there is a bladder outlet obstruction with
urgency, frequent urination or blood in the urine. At this point the prostate
capsule is likely ruptured with local invasion, which would be a stage C out of
4 stages (stage A to D). When the cancer invades into the pelvic bone there would
be pain in that area. With vertebral bone metastases spontaneous compression fractures
can develop, with other bone metastases pathological fractures can spontaneously
occur. Prostate Cancer Tests In the beginning there
might be no symptoms. This is where the question of PSA screening has been discussed
among physicians for a long period. Some consensus seems to be developing.
As the PSA test is very sensitive, but not specific (as mentioned before, BPH
also often shows a positive PSA test), efforts are made to make the test more
specific by measuring the proportion of free versus protein bound PSA. The physician
also will likely order a transrectal ultrasound (=TRUS), which would show hypoechoic
lesions where the examining finger feels hard lumps. Another blood test, the serum
acid phosphatase test, is useful as it correlates well with lymph gland invasion,
but it is not specific for prostate cancer alone. Other conditions such
as multiple myeloma or hemolytic anemia would, for instance, also give a positive
test. However, a negative serum acid phosphatase test is reassuring that the prostate
cancer has not yet metastasized. The definitive test for prostate cancer after
all the other tests is a TRUS (=transrectal ultrasound) guided transrectal needle
biopsy. This can be done in a clinic without an anesthetic and usually 6
separate locations throughout the prostate are sampled to increase the accuracy.
The pathologist will then analyze these biopsy samples. This method is very accurate
and very specific and must be done to confirm or rule out prostate cancer. As
in all cancers a tissue diagnosis is the only way how to diagnose cancer of the
prostate, this is a "must".
Prostate
Cancer Treatment In stage A or B cancer, where the prostate
cancer has not extended beyond the prostate capsule, a radical selective prostatectomy
can be performed, which will safe this man's life. Let me explain: In the
past many urologists were of the opinion that there would be a "clinically
irrelevant" prostate cancer entity, as it often takes very long for prostate
cancer to metastasize. This is quite contrary to breast cancer where the cancer
metastasizes early. The difference is that in breast cancer there is no capsule
that confines the cancer, but in prostate cancer there is a very tough prostate
capsule, which confines the cancer cells until late stage B prostate cancer. One
of the big reasons why a man may not want to go for surgery is the fear that he
may lose his ability to have sex. Similar to the TURP procedure, where loss of
impotence is an issue (see chapter on "enlarged prostate") this concern
is very much in the mind of the man who is advised to have a radical selective
prostatectomy. In the past with a radical prostatectomy the nerves supplying
impulses to the penis for erection were severed. However, now the urologist can
explain that with the help of new technology using an operating microscope, in
most cases the selective radical prostatectomy
can preserve the nerves to the penis and therefore preserve potency after the
surgical procedure is done. However, the urologist can only do what is technically
possible and unfortunately there will be some cases where cancer tissue that has
to be removed has encased the nerve supply. In such a case in the interest of
the survival of the man's life, the nerves might have to be severed as the cancer
is removed. Overall the statistics show that about 85% of stage A and B
prostate cancer patients can have a successful selective radical prostatectomy
and only 15% lose their potency. For stage C cancer local radiotherapy treatments
or radioactive seed implants will likely slow cancer growth for a period of time,
but survival rates are much worse than for patients after a selective radical
prostatectomy. Occasionally the urologist might combine the two. In late stage
C and D prostate cancer patients hormone therapy aimed at removing testosterone
from the system can often buy significant survival time. The most effective
method is a bilateral orchiectomy (=removal of both testicles). A medical castration
can also be achieved with luteinizing hormone-releasing hormone analogues. The
urologist will explain, which therapy would be the best fit for a particular patient.
In late stage D patients emphasis is placed on pain relief with local radiotherapy
to bone metastases and possibly some chemotherapy to slow down cancer growth. Click
at this link for a more detailed review of prostate
cancer. |
