Introduction
Prostate cancer is a tumor that grows in the prostate gland. Prostate cancer is very common. Microscopic examination of prostate tissue after surgery or at autopsy showed the presence of cancer in 50% of men aged over 70 years and in all men aged over 90 years. Most cancers do not cause symptoms because of its spread is very slow.
Cause
The cause is unknown, although several studies have shown an association between diets high in fat and elevated levels of testosterone. Prostate cancer is the leading cause of cancer deaths in men and No. 3 is the leading cause of cancer kematin in men over 74 years. Prostate cancer is rarely found in men aged less than 40 years. Men who have a higher risk for prostate cancer is a black man aged over 60 years, farmer, painter and cadmium exposure. The lowest incidence was found in Japanese men and vegetarians.
Prostate cancers are grouped into:
- Stage A: lump / tumor can not be palpated on physical examination, usually discovered by accident after prostate surgery because of other diseases.
- Stage B: tumor confined to the prostate and usually found on physical examination or PSA test.
- Stage C: tumor has spread beyond the prostate capsule, but not yet spread to the lymph nodes.
- Stage D: Cancer has spread (metastases) to the regional lymph nodes or other body parts (eg bones and lungs).
Symptom
Prostate cancer usually develops slowly and causes no symptoms until the cancer has reached an advanced stage. Sometimes the symptoms resemble BPH, which include difficulty in urination and frequent urination.
The symptoms are caused by cancer causing partial blockage in the flow of urine through the urethra.
In some cases, prostate cancer can only be diagnosed after spreading to the bones (especially the pelvic bones, ribs and spine) or to the kidneys (causing kidney failure). Bone cancer causes pain and will cause bones to become brittle so prone to fracture (broken bone). Once the cancer spreads, usually the patient will have anemia. Prostate cancer can also spread to the brain and cause seizures and other neurological or mental symptoms.
Other symptoms are:
- Immediately after urination, usually urine still dripping
- Pain when urinating
- Pain when ejaculating
- Lower back pain
- Pain when defecating
- Nocturia (urination at night)
- urinary incontinence
- Bone pain or bone pain when pressed
- Hematuria (blood in urine)
- abdominal pain
- Weight loss
Diagnosis
The best way to screen prostate cancer is to do rectal examinations and blood tests.Rectal examination in patients with prostate cancer would indicate the presence of hard lumps of irregular shape. On examination the blood was measured levels of prostate specific antigen (PSA), which is usually elevated in patients with prostate cancer, but also can increase (not too high) in patients with BPH.
If a lump is found on rectal examination, ultrasound examination should be conducted. By doing a screening x-rays or bone, can be known of the spread of cancer to bone.
Other tests that can be done are:
- Analysis of the urine
- Cytology of urine or prostatic fluid
- Prostate biopsy
Treatment
Appropriate treatment for prostate cancer is still debated. Treatment options vary, depending on the stage:
In the early stages can be used prostatectomy (removal of prostate) and radiation therapy. If the cancer has spread, it could be hormonal manipulation (reducing testosterone levels through medication or removal of the testes) or chemotherapy.
Pembedahan
Radical prostatectomy (removal of the prostate gland)
Often performed on stage cancer A and B. The procedure is long and is usually performed under general anesthesia or spinal. An incision is made in the abdomen or perineal area and the patient should undergo hospital treatment for 5-7 days. Complications that may occur is impotensia and incontinence uri.In patients who are still active sexual life, can be done Potency-sparing radical prostatectomy.
Orkiektomi (removal of the testes, castration)
Removal of both testicles cause a reduction in testosterone levels, but these procedures cause physical and psychological effects that can not be tolerated by the patient. Orkiektomi is an effective treatment, not requiring re-treatment, is cheaper than the drugs and after undergoing orkiektomi the patient does not need to undergo hospital treatment. Orkiektomi usually done on the cancer that has spread.
Radiation Therapy
Radiation therapy is primarily used to treat cancer of A, B and C. Usually if the risk of surgery is too high, then do radiation therapy. Radiation therapy to the prostate gland can be done in several ways:
External radiation therapy
performed in a hospital without the need to undergo hospitalization. Side effects such as decreased appetite, fatigue, skin reactions (such as redness and irritation), injury or burns to the rectum, diarrhea, cystitis (bladder infection) and hematuria. External radiation therapy is usually performed 5 times / week for 6-8 weeks.
Transplant iodine beads
gold or iridium radioactive directly on prostate tissue through small incisions. The advantage of this form of radiation therapy is that radiation is directed directly to the prostate with less tissue damage in the surrounding.
Medication
Hormonal manipulation
The goal is to reduce testosterone levels. Decrease in testosterone levels are often very effective in preventing the growth and spread of cancer. Hormonal manipulation is mainly used to alleviate symptoms without curing the cancer, ie for example in patients whose cancer has spread.
Synthetic drug whose function resembles LHRH (luteinizing hormone releasing hormone), is increasingly being used to treat advanced prostate cancer. An example is Lupron or zoladeks. These drugs suppress the formation of stimulating the testes to testosterone (this is called chemical castration because it has the same result with the removal of the testes). Drugs administered in the form of injections, usually every 3 months. The side effects are nausea and vomiting, facial flushing, anemia, osteoporosis and impotence.
Other drugs used for hormonal therapy is androgen inhibitor (eg flutamid), which prevents the attachment of testosterone on prostate cells. Side effects include impotence, liver disorders, diarrhea, and gynecomastia (enlarged breasts).
Chemotherapy
Chemotherapy is often used to treat symptoms of prostate cancer resistant to hormonal treatment.
Usually given a single drug or combination of drugs to destroy cancer cells.
Drugs that can be used to treat prostate cancer are:
- Mitoxantronx
- Prednisone
- Paclitaxel
- Dosetaxel
- Estramustin
- Adriamycin.
The side effects vary and depend on the drugs given.
Observation
Whatever type of treatment is undertaken, the patient will be monitored closely on the development of disease. Monitoring include:
- Blood tests to determine levels of PSA (usually every 3 months - 1 year).
- Skening and / or CT scan to determine the spread of bone cancer.
- Complete blood count to monitor signs and symptoms of anemia.
- Monitoring signs and other symptoms indicating disease progression (eg fatigue, weight loss, more severe pain, decreased bowel and bladder function, and weakness).
