Understanding the prostate
The prostate is a gland and is part of the human reproductive system. It is below the bladder and above the rectum, encompassing the entire back of the first portion of the urethra. The prostate contributes to the production of seminal fluid that helps to load sperm during ejaculation. One of the most common prostate problems is its benign growth, which, over time, can compress the urethra and cause difficulty urinating, explains the best urologist in Delhi.
No one knows exactly what causes prostate cancer. However, it is known that it is not a contagious disease and that some risk factors make certain men more likely than others to develop it.
Prostate cancer is the most common malignant tumor in men and it is estimated that on average one in six men will develop the disease, says the urologist in Delhi.
Age – Age is the most important factor, being uncommon before age 45 and most common after age 60.
Family history – If a first-degree relative (father or brother) has already developed the disease, the risk is greater.
Race – It is believed that the racial issue may be important in the development of prostate cancer. In the United States, the disease is more common among blacks. But this is not necessarily repeated in other countries, in which there are groups descended from African tribes of different ethnicities. In the East, in general, it is less frequent. However, this low incidence may not have exclusively the racial factor as a justification, since Orientals who migrate to the West and acquire local habits, present a progressively higher risk of prostate cancer in subsequent generations.
Diet – Some studies suggest that prostate cancer is related to a diet rich in meat and animal fat, while a diet rich in fruits and vegetables could be a protective factor. Conditions such as benign prostate growth, obesity, smoking, having undergone a vasectomy, a viral infection of the prostate and a lack of physical exercise are not considered risk factors, explains the urologist in Rohini.
Early detection– Since localized or early stage prostate cancer usually does not cause symptoms, you should try to discover the disease before the symptoms appear. For that, it is recommended to perform the examination of the prostate by digital rectal examination. The collection of a blood test, PSA (acronym in English for prostate specific antigen) is a controversial topic in the medical field, although the dosage of this substance is an important marker for prostate cancer. On the one hand, the risk of false positives may be associated with invasive and unnecessary interventions. But, on the other hand, early detection is linked to a better prospect of total tumor elimination. American guidelines suggest that men as young as 50 years of age go to the urologist in Pitampura to investigate the health of the gland.
- Touch examination – Also known as digital examination of the prostate by the rectum, it is performed by the doctor to identify hardened areas in the prostate and other changes that may lead you to suspect cancer. It lasts a few seconds and is painless.
- PSA – It is measured in the blood and used as a marker of prostate cancer, suggesting the presence of the disease mainly when the total value is greater than 2.5 ng/ml. However, it can increase in other prostate diseases, such as benign growth and prostatitis (infection and inflammation of the prostate). There are other fractions of the PSA (free and linked to other molecules) and other parameters that can help the doctor to suspect an eventual prostate cancer, such as the speed of growth of the PSA (how much it increases from year to year), the density of the PSA (ratio of the test result to the size of the prostate) and the expected PSA for age.
Symptoms – Mostly prostate cancer have no symptoms. The discomfort to urinate or the presence of blood in the urine or sperm are more related to the benign growth of the prostate or prostatitis. A urological evaluation is often necessary to clarify the real source of these symptoms, says the best urologist in Pitampura.
Diagnosis – Localized prostate cancer does not appear in most imaging tests such as ultrasound, tomography, MRI and PET-SCAN. Therefore, the diagnosis is made through biopsy (removal of small fragments by a fine needle inserted through the rectum) guided by ultrasound and made with sedation. The removed fragments are analyzed by a pathologist who evidences the existence or not of the problem.
This exam has become standardized and routinely performed in the best institutions, with a low risk of serious complications and with a quick return of the individual to his normal activities. A biopsy exam performed does not completely exclude the presence of the disease and other biopsies may be necessary depending on the analysis of several risk factors.
Disease stages – When the diagnosis is confirmed by biopsy, it is necessary to perform a series of tests that will determine whether the disease is located in the prostate, whether it is just beyond the limits of the prostate, or whether malignant cells have already spread to other organs. .
- Localized disease – It is the stage that can offer the greatest chances of cure. There are some options for Prostate Cancer Treatment for managing the disease to be discussed:
- Surgery – It is called radical prostatectomy. It consists of the complete removal of the prostate, seminal vesicles and eventually lymph nodes that may be compromised. After removal of the gland, the bladder is connected to the urethra using stitches and a probe is left that goes out through the hole in the penis. This probe drains the urine, protects the stitches and remains after surgery for a time ranging from five to 14 days. In surgery, it is possible or not to preserve the nerves responsible for the erection that pass very close to the prostate and this depends mainly on the local conditions, mainly on the suspicion of invasion of the nerves by the tumor. Surgery can be done through three different routes: the conventional open route, the laparoscopic route or the perineal route.
- The open route consists of an abdominal incision made below the umbilical scar until close to the bone above the base of the penis.
- The laparoscopic approach consists of an abdominal access through four or five incisions from 5 mm to 10 mm, with gas insufflation and a view of the surgical field through a monitor connected to a microcamera inserted in the abdomen through one of these holes. This technique can also be performed with the aid of a robot (called Da Vinci).
- The perineal route consists of an incision between the scrotum and anus with direct access to the prostate. This way, there is a limitation on the possibility of removing the nodes. There is no consensus on the best access route to perform radical prostatectomy and some surgeons have more experience and / or preference for one technique or another. The advantages and disadvantages of each should be discussed with the urologist in Delhi.
- Radiotherapy – It consists of the application of radiation directed to the prostate. It can be done by external radiation (3-D conformational and with modulated intensity – IMRT Intensity Modulated Radiation Therapy) or by implanting radioactive seeds (brachytherapy) in the prostate, which is done under anesthesia.
- Locally advanced disease – When the tumor exceeds the limits of the gland, there are some possibilities for prostate cancer treatment to be considered and discussed, such as blocking the male hormone for a period prior to, concomitant with or after surgery or radiotherapy.
- Metastatic disease – When identifying sites for the spread of the tumor to other organs, such as bones, for example, the prostate cancer treatment may be blocking the male hormone (testosterone). Malignant cells in the prostate grow stimulated by testosterone and blocking this hormone can cause the tumor anywhere in the body to regress and become latent. There are several ways to block the hormone and the procedure to be adopted, as well as its possible side effects, should be discussed with the urologist in Delhi. When the disease no longer responds to hormone therapy, current chemotherapy is effective in treating symptoms and increasing the life expectancy of patients with prostate cancer.