Prostate Cancer: Symptoms and Treatments

Prostate Cancer: Symptoms and Treatments

What is Prostate cancer

The prostate is a gland of the male reproductive system. It is located just below the bladder and, like a ring, it surrounds the urethra, the channel through which urine and sperm emerge outside the body. The role of the prostate is to produce prostatic fluid, one of the components of sperm with seminal fluid and spermatozoa, to temporarily store sperm before ejaculation, then to contract at the time of ejaculation, thus participating in the expulsion of sperm.

Prostate cancer is the most common type of cancer in men: it is estimated that 1 in 7 men will be diagnosed, most often in their 60s. Although no particular cause has been discovered, there is a genetic predisposition.

Most prostate cancers evolve very slowly. In fact, the vast majority of men diagnosed with this cancer will die of another cause. In many cases, the tumor remains localized in the prostate and has limited health effects, sometimes causing urinary or erectile dysfunction. However, some cancers may evolve and spread more rapidly.

Prostate cancer is the second leading cause of male cancer deaths in North America after lung cancer.

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Types of Prostate cancer

Adenocarcinoma is the most common form of prostate cancer. It represents about 95% of cases.

The severity of the cancer depends on the extent of the tumor (local, with nearby or distant metastases) and the type of cancer cells. There is a score to measure the prognosis of prostate cancer, that is, to say the risks it presents for the person affected. This is the Gleason score.

This score assigns two figures of 3 to 5 during the microscope examination of the prostate tissue, corresponding to grades 3, 4 or 5. The number 3 corresponding to benign prostatic tissue and the number 5 to the most aggressive.

With these numbers, to obtain a score that can range from 2 to 10, the sum of 2 grades, that of the most frequent cell populations in the prostate and the highest score observed. Thus, a score of 6 (1-1) corresponds to a slightly aggressive cancer, 7 a little more, and the higher the number, the more the aggressiveness of the tumor increases.

Prostate cancer

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Symptoms of Prostate cancer

At first, prostate cancer causes no symptoms. Note that those listed below may be related to another prostate disease, such as benign prostatic hypertrophy.

Difficulty urinating: difficulty starting to urinate or retaining urine, inability to urinate, need to urinate frequently (especially at night), low urine output, burning or pain at the time of urination 'urinate.

Blood in the urine or sperm.

Frequent pain or stiffness in the lower back, hips or upper thighs.

Urinary function changes: frequent urge, urinary urgency, need to push, retention of urine, burns while urinating.

Changes in the genital area: painful ejaculations, or difficulty getting an erection. Predisposed people

Note that some men "at risk" will never have prostate cancer. Several risk factors are under study.

Age

 In North America, prostate cancer affects mostly men over 60 years of age. The average age at the time of diagnosis is 70 years, and 80 years at the time of death. Younger, only 0.5% of prostate cancers appear before age 50, and 22% between 55 and 64 years ...

Family history. The risks are higher when the father or brother has already suffered from this disease, suggesting a genetic predisposition. This hypothesis is reinforced by the discovery that carriers of the BRCA1 and BRCA2 genes have an increased risk of prostate cancer.

Ethnicity

Men of African descent are at greater risk than Caucasians, who are more at risk than Asians. It is estimated that Indians and Chinese are about 50 times less affected by prostate cancer than Westerners. However, when they migrate to countries where this disease is more common, their risk also increases. This suggests that factors not only related to genes, but also to food exert an influence.

Obesity

An overweight, high-risk male is at a higher risk of having advanced prostate cancer.

Inflammation or prostate infection increases the risk of prostate cancer when it lasts a long time.

Tall men have a higher risk of prostate cancer.

Men who have been exposed to pesticides pose a slightly higher risk of prostate cancer, especially if they have a history of prostate cancer in their family.

Exposure to cadmium or rubber derivatives in the workplace also increases the risk of prostate cancer.

Treatments for prostate cancer

Several treatment options are available depending on the stage and speed of progression of prostate cancer. They should be discussed with the attending physician who will inform the patient of the risks and benefits of each treatment.

Waiting under surveillance

Supervised waiting (more or less active, as the case may be) may be chosen as a therapeutic option when the tumor is well circumscribed (the cancer cells are confined to the prostate). We do not give drugs and we do not perform surgery, but we closely monitor the evolution of the tumor.

Moreover, if the tumor grows very slowly, and the person is old, the tumor will not have time to grow before other health problems occur. Indeed, as more invasive treatments often cause complications (pain, inability to have an erection, urinary incontinence, infection), it is sometimes better to observe without intervention.

Surgery

It involves removing all the cancer cells by operating the prostate (total prostatectomy or radical prostatectomy) and some adjacent tissues (seminal vesicles). This surgical procedure causes fewer and fewer problems, such as urinary incontinence and erectile dysfunction, as surgical techniques have progressed. Erectile dysfunction occurs in about 1 in 5 men in their 50s who undergo prostatectomy. The erectile and urinary functions usually return to normal during the 2 or 3 years following the operation.

Radiotherapy

It consists of destroying cancer cells:

For radiotherapy: using external electromagnetic radiation (emitted by a radiotherapy device), trying to spare peripheral healthy tissue. Radiation therapy is an alternative to surgery. - For brachytherapy: using rays emitted by radioactive seeds inserted and left in place in the prostate. It allows the rays to have a very localized and targeted action zone.

Hormonal treatment

This approach, in the long term, aims to administer drugs that will act to deprive cancer cells of the male hormones they need to grow. It makes it possible to reduce the size of the tumor and to envisage a radiotherapy treatment. It is also indicated to slow the progression of prostate cancer.

Chemotherapy

Chemotherapy is reserved for cancers no longer respond to hormonal treatment. It consists in administering, by injection or in the form of tablets, toxic chemical agents in order to eliminate the cancerous cells. There are several, which have different mechanisms of action and different adverse effects.

Prostate cancer

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