Introduction
The prostate is a
glandular organ present only in males.
It surrounds the neck of the bladder and the first part of the urethra
and contributes a secretion to the semen. The gland is conical in shape and
measures 3 cm in vertical diameter and 4 cm in transverse diameter. It has got
five lobes anterior, posterior, two lateral and a median lobe. Since the first
part of the urethra pass through it, any lesion in the prostate will produce
difficulty in passing urine.
Diseases of the prostate
gland:-
1) Prostatitis:-
This is the inflammation
of the prostate gland due to bacterial infection.
2) Benign enlargement of
the prostate:-
This is a non-cancerous
tumour of the prostate seen after the age of 50. 3) Cancer of the prostate:-
This is the 4th most
common cause of death from malignant diseases in males.
Cancer of the prostate.
Cancer of the prostate
is directly linked with the male sex hormones(androgens). If the levels of the sex
hormone increases the growth rate of cancer also increases. It is found that
after the removal of testes there is marked reduction in the size of a tumour.
Site of tumour:-
Prostate cancer is seen
mainly in the posterior lobe. Non-cancerous enlargement is seen in other lobes.
Changes in the gland in
cancer:-
The gland becomes hard
with irregular surface with loss of normal lobulation. Histologically prostate
cancer is an adenocarcinoma(cancer of the epithelial cells in the gland)
Growth:-
Growth rate is very fast
in prostate cancer. The tumour compresses the urethra and produces difficulty
in urination.
Spread of tumour:-
Metastasis in cancer of the
prostate is very early.
1) Local spread:-
From the posterior lobe,
the cancer cells go to the lateral lobes and seminal vesicles. Tumour cells
also move to the neck and base of the urinary bladder.
2) Lymphatic spread:-
Through the lymph
vessels, cancer cells reach the internal and external iliac group of lymph
nodes. From there cells move to retroperitoneal(Behind the peritoneum) and
mediastinal lymph nodes(in the chest)
3) Spread through the
blood:-
Spread of cancer cells
takes place through the periprostatic venous plexus and reaches the vertebral
veins while coughing and sneezing and finally enders the vertebral bodies of
the lumbar vertebrae.
Signs and symptoms of
prostate cancer:--
Signs and symptoms
depend upon the stage of the cancer. The following symptoms may be seen.
1) No symptoms:-
Tumour is small and only
in the posterior lobe. This is diagnosed
accidentally.
2) Slight difficulty in
urination:-
Here the tumour is
enlarged and urethra is slightly compressed. Shortly there will be frequent
urge for urination with difficult urination.
3) When the tumour
spread to all nearby areas including neck of bladder and urethra there will be
painful urination with bleeding. Urine comes drop by drop.
4) Retention of urine:-
When the urethra is
completely compressed there will be retention of urine. This can lead to
hydronephrosis, renal failure etc. In this condition, the patient may get
convulsions due to renal failure and finally coma.
5) Signs of metastasis:-
Some patients come with
the signs and symptoms of metastasis.
a) Lumbosacral pain due
to spread of cancer cells to lumbar and sacral vertebrae.
b) Fracture of the spine
due to cancerous growth in the spine.
c) Swelling, pain and
fluid collection in the abdomen due to lesion in the abdomen.
d) Respiratory
complaints due to cancer of mediastinal lymph nodes and lungs.
e) General weakness due
to spread of cancer to different parts of the body.
f) Anaemia due to involvement
of bone marrow and increased destruction of RBCs.
Clinical examination:-
Includes per rectal
examination to feel the prostate gland, palpation of the abdomen to feel the
swelling in kidneys and any tumours. Patient is examined from head to foot to
find out any lesions.
Investigations:-
1) Complete blood
investigations;-
RBC,WBC,Platlets,ESR,bleeding
time ,clotting time etc.
2) Urine analysis:-
Microscopic examination
to detect pus cells, occult blood, casts, Crystals etc.
3) Renal function
tests:-
Blood urea level, serum
creatinine level, electrolyte level etc.
4) Serum acid
phosphatase:-
Increased in cancer of
prostate.
5) x-ray of the spine:-
To detect any tumour or
fracture.
6) Ultrasonography;-
Gives an idea about prostate,
bladder, kidney etc.
7) C T scan:-
More detailed
information about organs and tumour.
8) MRI of the spine:-
Gives detailed
information about spine, disc and nearby soft tissues.
9) Lymphangiography:-
Gives an idea about the lymphatic
spread of cancer.
10) Biopsy to confirm
cancer:-
The biopsy is taken from
the tumour and is send for histopathological examination under the microscope. This
will detect the presence of cancer cells.
Treatment:-
1) If there is retention
of urine catheterisation is needed.
2) Dialysis if kidney
failure.
3) If there is coma
monitoring of all vital functions along with parenteral nutrition and electrolyte
supply.
4) Specific treatment is
prostatectomy(removal of the prostate)
Partial prostatectomy:-
Here only the affected
lobe is removed.
Radical prostatectomy:-
Total removal of the prostate
along with nearby lymph nodes.
5, Hormone therapy:-
Stilbestrol is given to
reduce tumour growth. Since this treatment increases the chance for
cardiovascular disease phosphorylated diethylene stilbesterol is used nowadays.
6) Chemotherapy:-Drugs
like cyclophosphamide, cisplatin etc are given.
7) Radiotherapy is also
done for some cases.
8) Homoeopathy:-
Homoeopathic drugs like
carcinogen, conium, sabal, Crotalus, thuja, iodum, selenium, staphysagria,
sulphur etc can be given according to symptoms. Constitutional homoeopathic
medicine will give great relief and can increase the life span.
9) Yoga and meditation are
also helpful.
