Health Information

Prostate is a glandular organ present only in males. It surrounds the neck of bladder & the first part of urethra and condributes 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

a)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 sex hormone increases the growth rate of cancer also increases.It is found that after the removel of testes there is marked reduction in the size of tumour.
b) Benign enlargement of the prostate
This is a non cancerous tumour of the prostate seen after the age of 50.
c) Prostatitis
This is the inflamation of the prostate gland due to bacterial infection.

Spread of tumou
Metastasis in cancer of prostate is very early.

a) Spread through the blood
Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae.
b) 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.
c) Lymphatic spread
Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes.From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest)

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 cance
The gland becomes hard with irregular surface with loss of normal lobulation .Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland)

Growth
Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.

Clinical examination
Includes per rectal examination to feel the prostate gland,palpation of abdomen to feel the swelling in kidneys and any tumours.Patient is examined from head to foot to find out any lesions.

Signs and symptoms of prostate cancer
Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.

a) No symptoms
Tumour is small and only in the posterior lobe. This is diagnosed accidentely.
b) 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.
c) 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.
d) Retention of urine
When the urethra is completely compressed there will be retention of urine.This can lead to hydronephrosis, renal failure ect.In this condition patient may get convulsions due to renal failure and finally coma.
e) Signs of metastasis
Some patients come with the signs and symptoms of metastasis.
1) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.
2) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.
3) Anaemia due to involment of bone marrow and increased destruction of RBCs.
4) Fracture of spine due to cancerous growth in the spine.
5) General weakness due to spread of cancer to different parts of the body.
6) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.

Investigations

1) Biopsy to confirm cancer
Biopsy is taken from the tumour and is send for histopathological examination under the microscope.This will detect the presence of cancer cells.
2) Urine analysis
Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.
3) Ultra sonography
Gives idea about prostate,bladder,kidney ect.
4) Renal function tests
Blood urea level,serum creatinine level,electrolyte level ect.
5) MRI of the spine
Gives detailed information about spine ,disc and nearby soft tissues.
6) Complete blood investigations
RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.
7) x-ray of the spine
To detect any tumour or fracture.
8) C T scan
More detailed information about organs and tumour.
9) Lymphangiography
Gives idea about lymphatic spread of cancer.
10) Serum acid phosphatase
Increased in cancer of prostate.

Treatment

1) Specific treatment is prostatectomy(removal of prostate)
Partial prostatectomy
Here only the affected lobe is removed.
Radical prostatectomy
Total removal of prostate along with nearby lymphnodes.
2) If there is retention of urine catheterisation is needed.
3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.
4)Hormone therapy
Stilbestrol is given to reduce tumour growth.Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.
5) Homoeopathy
Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms.Constitutional homoeopathic medicine will give great relief and can increase the life span.
6) Yoga and meditation is also healpful.
7) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given.
8) Dialysis if kidney failure.
9) Radiotherapy is also done for some cases.

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