PROSTATE CANCER

PROSTATE CANCER

 

Prostate Cancer Incidence, Diagnosis and Staging

 

            Cancer of the prostate gland is a common cause of death, accounting for about 2 to 3 percent of all male deaths (2000). Adenocarcinoma of the prostate accounts for the majority of malignancies in men over age 65. The etiology is unknown. Sarcoma of the prostate is rarely found in children. Undifferentiated prostatic carcinoma and squamous cell carcinoma of the prostate probably represent variants of adult adenocarcinoma and are less responsive to the usual measures of control.

            Prostate cancer is also the most common cancer among men in the United Kingdom and the second most common cause of cancer-related deaths. In 1999, 20,842 new cases of prostate cancer were registered in the UK, giving a crude incidence rate of 75 cases per 100,000 men. Overall, 1 in 6 new cases of male cancers were prostate cancer and 9,491 men died from the disease. Prostate cancer accounts for 1 in 8 of all male cancer deaths (2002).

            The usual prostatic malignancy is glandular, not unlike the histologic configuration of normal prostate. Frequent mitoses, stromal invasion, and involvement of perineural lymphatics constitute the principal histologic criteria of diagnosis.

            Prostatic carcinoma is generally slowly progressive and may cause no symptoms. Late in the course of the disease, symptoms of bladder outlet obstruction, hematuria, and pyuria may appear. Matastases to the pelvis and lumbar spine may cause bone pain.

            Stony hard induration of the prostate raises the suspicion of prostatic malignancy and must be distinguished from granulomatous prostatitis, prostatic tuberculosis, prostatic calculi, and other more unusual prostatic diseases. The firm and nodularly irregular prostate is pathognomonic of prostatic carcinoma, later exhibiting extension of induration and fixation of the gland to the rectum and the lateral pelvic walls.

            There is a blood test for a protein called PSA, which can help to detect prostate cancer - but it needs to be used along with other tests to make a definite diagnosis. Prostatic carcinoma must be suspected on the basis of rectal findings. A solitary firm prostatic nodule should be biopsied immediately, preferably by open surgery to permit radical prostatectomy if indicated.

            The more extensive processes may be defined by needle biopsy, either transrectally or transperineally. An elevated serum acid phosphatase indicates a large local tumor or metastases. Prostatic carcinoma produces osteoblastic bony metastases, and their radiographic demonstration in the presence of a stony hard prostate is diagnostic of cancer. Aspiration of bone marrow and demonstration of prostatic cellular configuration in metastatic cells confirm a diagnosis of incurable disease.

 

Risk Factors Associated with Prostate Cancer

 

Many men are unaware they even have prostate cancer, it develops from cells within the prostate gland but it is usually very slow growing. However, in some cases, it may grow more quickly and spread to other parts of the body. Age is a risk factor – as it is rare to find prostate cancer in men under 50 (2002). About 9 per cent of prostate cancer cases are diagnosed in men in their 50s, 30 per cent in men in their 60s and 40 per cent in men in their 70s. But having an elderly relative with prostate cancer is not uncommon and does not increase a person’s own risk.

            Three risk factors for prostate cancer are associated with an increased likelihood of developing aggressive prostate cancer or dying of the disease. People with high levels of the acid-labile subunit (ALS) glycoprotein that regulates the bioavailability of the hormone insulin-like growth factor 1 (IGF-1) may have an increased risk for prostate cancer and its aggressive forms. Low plasma levels of vitamin D appear to significantly increase the risk of aggressive prostate cancer, especially in patients with a particular polymorphism of the vitamin D receptor (2005).

The major risks are increasing age, especially past 50, a family history of the cancer, having a high-fat refined ‘Westernised’ diet and being of African or African-Caribbean origin (2006). Knowing more about the risks won’t stop a person from getting prostate cancer, but it will increase their chances of spotting it as early as possible and getting it successfully treated.

 

Treatment Options – with reference to available guidelines

 

            Once cancer of the prostate gland does occur, the cancerous cells are usually stimulated to more rapid growth by testosterone and are inhibited by removal of both testes so that testosterone cannot be formed ( 2000). Also, prostatic cancer can be usually can be inhibited by administration of estrogens.

            Early and localized prostatic carcinoma may be cured by radical perineal or retropubic prostatectomy. Extensive local disease or metastases may preclude surgical cure, in which case diagnostic confirmation should be followed by hormonal control, irradiation, or both. The treatment of choice is bilateral orchiectomy accompanied by estrogens.

            Failure to respond to the hormone, or reactivation of disease, may be controlled with bilateral surgical adrenalectomy or “medical adrenalectomy.” Irradiation may provide prompt relief of pain from bony metastases refractory to other treatment and may be efficacious in control of local disease as well; long-term regression and possible cure of prostatic carcinoma have been observed in some cases treated by radiotherapy.

            Even some patients who have prostatic cancer that has already metastasized to almost all bones of the body can be successfully treated for a few months to years bye removal of the testes, by estrogen therapy, or both; after this therapy the metastases usually diminish in size and the bones partially heal (2000). This treatment does not stop the cancer but does slow it and sometimes greatly diminishes the severe bone pain.

 

External Beam Radiotherapy Technique

 

            Radiotherapy is the treatment of disease with radiation, especially by selective irradiation with x-rays or other ionizing radiation and by ingestion of radioisotopes. It is also called as radiation therapy. Long-term control of prostate cancer can be achieved in a relatively high-risk patient population using interstitial brachytherapy in combination with external beam radiation therapy (2003).

External beam radiation has proven successful in the treatment of localized prostate cancer and is associated with a success rate comparable to surgery for patients with localized prostate cancer. The survival rate for patients with localized prostate cancer, stages A and B, treated with external beam radiation is similar to that for age-adjusted cohorts without prostate cancer (1996).

External radiation generally is delivered in a daily dose of 180 cGy to 200 cGy for a period of 6 to 7 weeks (total dose 6200 cGy to 7400 cGy). Potential complications include impotence, incontinence, cystitis, urethral strictures, prostatitis, diarrhea, edema of the lower extremities and bone marrow suppression. Patients also may become physically tired, and they should be instructed to get as much rest as possible during their course of treatment. It is not uncommon for erythema to develop and for the skin to become red or dry in the area of treatment. Affected skin should be exposed to the air as much as possible and patients should be instructed to avoid wearing tight clothing. Patients also must be instructed not to use creams or lotions on affected skin without their doctor’s approval (1996).

 

Support Mechanisms Available to these Patients within the Radiotherapy Department

 

            Acute radiation sickness usually follows therapeutic irradiation. It is characterized by nausea, vomiting, diarrhea, anorexia, headache, malaise, and tachycardia of varying severity. The discomfort subsides within a few hours or days. Nutrition management of the client with cancer focuses on maximizing intake of nutrients and fluids ( 2004).

            Psychological interventions are also available for prostate cancer patients who underwent radiotherapy. These are usually handled by nurses. Response to this intervention has been very positive from both nurses and patients, nurses feel that they are better equipped to help patients emotionally and patients feel better able to cope with what can be a very traumatic time ( 2005).

 

 

 

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