27 Feb

Men have an organ called the prostate, roughly the size of a walnut. It stretches from the penile base to the bladder orifice. The prostate performs two main jobs. The primary benefit is improved bladder control. As a second point, the prostate creates a fluid that feeds and transports sperm.

A protein called prostate-specific antigen (PSA) keeps sperm fluid. For fertilization, sperm must remain mobile, which can only happen in a liquid environment. A man's prostate gland goes through several shifts as he ages. Among these alterations is the development of cancer and the enlargement of the prostate that does not involve cancer.

The symptoms of a swollen prostate include the inability to urinate easily. Subclinical prostate cancer is more common in older men. As many as 70% of men aged 70 and up will be diagnosed with prostate cancer, but only a fraction of those will require treatment. Subclinical prostate cancer has a diagnosis rate of about 15% and a mortality rate of 2% to 3%.

Even though there are no blood tests for detecting breast cancer in its early stages, the PSA test has improved the likelihood of early detection in men. PSA is a protein found in men but only detectable in men's sperm, not their blood. A rising PSA level warrants a Urologic evaluation and workup without other symptoms because something is wrong with the prostate gland. The likelihood of prostate cancer increases in tandem with an increasing PSA level.

More in-depth laboratory evaluation of PSA testing has occurred over the past few years. Several urine analyses and a Percent Free Ratio were calculated as part of this assessment to help rule out the need for unnecessary prostate biopsies. Although a rectal exam and X-ray imaging can help detect cancer, a biopsy is still required to confirm the diagnosis. A negative biopsy result might be misinterpreted as a result of this.


The precise causes of prostate cancer are still unknown. For example, if a close relative was diagnosed with prostate cancer before age 60, your risk increases sixfold. This risk is multiplied by four if a close relative is diagnosed at age 80 or older compared to those without a family history.


Prostate cancer prevention strategies are insufficient. Obesity and the wrong diet, exceptionally high in animal fat, increase the risk, according to the statistics. Animal fat and nitrates are both sources of free radicals in the body. The growth of any existing cancer is also thought to be accelerated by these free radicals.


The American Cancer Society recommends that men get PSA tests at age 50. In black men with a family history of prostate cancer or voiding difficulties, many Urologists begin PSA screening at age 40. Many years ago, there was a significant push to test all men over 50. Statistics have shown that this frequently resulted in unnecessary medical care. At 75, it's appropriate to subject oneself to this kind of unnecessary treatment. Because of the rising average age, we need to identify men with a high probability of living long lives.

DETECTIONIt has been previously stated that annual PSA testing levels may begin to rise. An alarming rate of PSA growth is more significant than 0.5% per year. Minor hematuria (blood in the urine) or ejaculatory hematuria (blood in the sperm) can cause urinary symptoms in some men. Every year, every man over 40 should get a digital rectal exam (DAE). If your urologist suspects cancer, they may suggest a prostate ultrasound, magnetic resonance imaging (MRI), and biopsy. Prostate cancers, which account for most cases, are almost always adenocarcinomas. Occasionally, the prostate can develop transitional cell cancer because of the urethra.


Your urologist may advise a Prostate biopsy if your DRE and PSA results indicate the need to rule out cancer. You'll need ore-oo antibiotics and a Fleet enema to prepare for this. The patient will be lying on their side during the procedure. There is a transrectal probe insertion. While watching the screen, a needle is inserted through the probe. A specialized tool is used to "shoot" or "propulse" the needle to the desired location within the prostate for testing. It is inserted into the prostate between 1 and 2 cm. More and more samples will be required to evaluate all aspects of a prostate of any size properly. The standard range for the number of cores taken in a biopsy is between 12 and 16. It is unusual to experience a rectal or urethral bleed or infection.

TREATMENTAge, health status, tumour grade, tumour stage, and voiding symptoms all play a role in deciding on a course of treatment. Many older patients can observe when their Gleason score is six, and their tumour volume is low. Patients who are younger and have a disease that is thought to be limited to one organ may be candidates for radical robotic surgery or brachy radiation seed placement as a definitive treatment. Cryopreservation and external radiation therapy are reserved for elderly patients, those at high risk of early metastasis, and those who cannot tolerate a general anaesthetic.

Cancer with Metastases: Whether a patient has advanced disease at diagnosis or a rising PSA after treatment, most will experience remission after discontinuing testosterone replacement therapy. The testicles can be surgically removed or sedated with an injection of leuprolide acetate. The duration of remission for many patients will be variable. A better prognosis is seen with smaller volume and lower-grade tumours. The longer time elapsing before the PSA starts to rise is always welcome. If your PSA level increases, your doctor may suggest taking anti-androgen medication. Treating metastatic pain with bone radiation is possible, and prednisone can help with pain and malaise when other treatments haven't worked. Andropause results from testosterone depletion ( male menopause.)


In cancer, comparing a patient's grade and stage to other patients provides insight into the patient's outlook. Microscopical examination of cells is used to assign grades. We will grade the specimen from 1 to 5, with 5 representing the most severe case of cancer. In most schools, students don't start in grades 1 and 2, which is why those levels are rare (3 - 4.) Prostate cancer may affect multiple sites, and the disease's severity will vary depending on where it has spread. Gleason staging was developed to categorize cancers like prostate cancer, which has multiple causes. The sum of the two most common cancer stages gives us this information. If only one grade is detected during the biopsy, there are twice as many cases. The Gleason scale has a total possible range from 2 to 10. Only a few scores are out of a possible (6 - 8.) A rough estimate suggests that 10% of total scores fall into the (9 - 10.) Cancer can affect one or both lobes of the prostate, and imaging techniques such as CT, MRI, and ultrasound can reveal cancer's spread beyond the gland, all contributing to the staging process.

If your doctor suggests stopping PSA screening due to age, you can disagree and request that screening be continued. After confirming that the Gleason score is less than eight and that there is only a small volume of cancer, I think it is acceptable for patients to continue observation. High-grade tumours, particularly those with larger cancer volumes, are notoriously unresponsive to treatment. The patient must actively converse with the urologist and demand that all treatment possibilities and associated risks be thoroughly discussed and comprehended.

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