WHAT IS PROSTATE




Prostate cancer

The function of the prostate is to store and secrete a slightly alkaline (pH 7.29) fluid, milky or white in appearance, that usually constitutes 25-30% of the volume of the semen along with spermatozoa and seminal vesicle fluid. The alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The alkalinization of semen is primarily accomplished through secretion from the seminal vesicles. The prostatic fluid is expelled in the first ejaculate fractions together with most of the spermatozoa. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid those expelled in prostatic fluid have better motility, longer survival and better protection of the genetic material (DNA). The prostate also contains some smooth muscles that help expel semen during ejaculation.

Prostate cancer is now the most commonly diagnosed cancer of UK men.The prostate gland is located below the bladder and in front of the rectum. It’s about the size of a walnut, producing the liquid that nourishes, protects and carries sperm on ejaculation. It tends to increase in size with age, called benign prostatic hypertrophy, causing symptoms in some men like urinary frequency. If prostate cancer is found early, while still confined to the gland itself, chances of survival are excellent.

Symptoms


Often prostate cancer doesn't have any symptoms, but when they do occur they may include:

Urinating frequently
• Difficult or painful urination or ejaculation
• Delay or hesitancy before urinating
• A feeling that the bladder has not completely emptied
• Blood in urine or semen
• Disturbed sleep because of the need to urinate
In advanced prostate cancer, the following symptoms may occur:
• Weight loss
• Bone pain
• Pain in the loins, pelvis or lower back
• Blood in the urine

It's important to be aware that there are a number of other, non-cancerous medical conditions that may also cause these symptoms, for example infection or benign prostate enlargement, but should always be investigated.  There are several methods to check for the presence of prostate cancer. The simplest is the digital rectal examination, in which a gloved finger is inserted into the rectum, through which an enlarged prostate can be felt. Blood tests are the next step - prostate cancers cause the levels of certain chemicals in the blood to rise. More sophisticated tests include the use of ultrasound scans, and x-rays.
Being overweight or obese.
• Having a father or brother with prostate cancer.
• Being of African-Caribbean or African-American descent and in western countries.

Causes and risk factors

The causes of prostate cancer aren’t yet understood. Cases are rare in men aged under 50, however, there are certain things which place some men at higher risk of developing the disease than others:
• Being overweight or obese
• Having a father or brother with prostate cancer
• Being of African-Caribbean or African-American descent and in western countries
• There is some suggestion that a fat-rich diet may contribute to prostate cancer, but this is not proven
• Studies linking the cancer to vasectomy, an operation to remove a man's fertility, are contradictory


Treatment and recovery

If diagnosed early, treatment can be quite successful. Therefore, it's important to be aware of the symptoms and to see a GP as early as possible. Currently in the UK there are no routine screening programmes for prostate cancer. The key decision in prostate cancer is whether or not to treat at all. In many older men, the cancer progresses so slowly that surgery and other treatments may cause more harm than good. However, for those whose cancer is more aggressive, either already spreading or liable to spread beyond the prostate, surgery is usually the first option. A specialist may then arrange a biopsy of the prostate. This should indicate whether or not prostate cancer is present and whether or not it's aggressive. Other tests, such as x-rays or scans may be necessary, assessing the extent of the cancer. These results will also influence the types of treatment available. A prostatectomy means that the prostate gland is removed, normally along with small parts of the lymphatic system near the gland. Unfortunately, the operation often causes nerve damage which can make it sometimes impossible for men to achieve an erection afterwards, or maintain complete control over urination. However, modern ‘nerve-sparing’ surgical techniques - combined with drugs such as Viagra - mean that the effects on both sexual function and quality of life can be minimised.

The main advances in prostate cancer treatment are being made in surgery and radiotherapy. Surgeons are learning how to remove the prostate without causing the problematic nerve damage which was inevitable in the past. And radiotherapy technology advances mean that far higher doses can be targeted more precisely on the prostate, killing more cancer cells with fewer treatments. Recent advances include the use of a technique called brachytherapy. There are two major methods of prostate brachytherapy, permanent seed implantation and high dose rate (HDR) temporary brachytherapy. Permanent seed implants involve injecting approximately 100 radioactive seeds into the prostate gland. They give off their cancer-killing radiation at a low dose rate over several weeks or months, and the seeds remain in the prostate gland permanently. HDR temporary brachytherapy instead involves placing very tiny plastic catheters into the prostate gland, and then giving a series of radiation treatments through these catheters. Another option is High Intensity Focussed Ultrasound, which uses sound waves to ‘melt’ away the cancer. Most men with early prostate cancer are diagnosed because they have problems with bladder habits. A GP will perform a digital rectal examination (DRE) and arrange for any blood tests (a prostate specific antigen or PSA test). If this is elevated there is a possibility it may have been caused by prostate cancer. Patients are then referred to a specialist (urologist) for further investigations. If hormone therapy is no longer effective, there are a number of treatments to control the cancer and improve quality of life, which you should discuss with your specialist. There are a number of clinical trials available for people with prostate cancer which you should discuss with your specialist for suitability.



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