Introduction: Prostate is a glandular organ present only in males. It surrounds the neck of bladder & the first part of 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 laterals and a median lobe. Since the first part of the urethra pass by it any lesion in the prostate will produce difficulty in passing urine.
Diseases of the prostate gland:
This is the inflammation of the prostate gland due to bacterial contagion.
2) Benign enlargement of the prostate:
This is a non malignant 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 sex hormone increase the growth rate of cancer also increases. It is found that after the removal of testes there is marked reduction in the size of 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 severe with irregular surface with loss of normal lobulation. Histological prostate cancer is an adeno carcinoma (cancer of the epithelial cells in the gland)
Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.
Spread of tumour:
Metastasis in cancer of 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 meditational lymph nodes (in the chest).
3) Spread through the blood:
Spread of cancer cells take place by the per-prostatic venous plexus and reaches the vertebral veins whilst coughing and sneezing and finally ends the vertebral bodies of the lumbar vertebrae.
Signs and indications of prostate cancer:
Signs and evidences depend upon the point of the cancer. The following indications may be seen.
1) No symptoms:
Tumour is small and only in the posterior lobe. This is diagnosed accidently.
2) Slight difficulty in urination:-
Here the tumour is enlarged and urethra is slightly compressed. Shortly there will be frequent urge for urination with severe urination.
3) If 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 ect. In this condition patient may get convulsions due to renal failure and eventually coma.
5) Signs of metastasis:-
Some patients come with the signs and evidences of metastasis.
a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.
b) Fracture of spine due to malignant 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 lymphnodes 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.
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 notice out any lesions.
1) Complete blood investigations:
RBC, WBC, Platlets, ESR, bleeding time ,clotting time ect.
2) Urine analysis:
Microscopic examination to find pus cells, occult blood, casts, Crystals ect.
3) Renal aim tests:
Blood urea level, serum creatinine level, electrolyte stage ect.
4) Serum acid phosphatase:
Increased in cancer of prostate
5) X-ray of the spine:
To find any tumour or fracture
6) Ultra sonography:
Gives idea about prostate, bladder, kidney ect.
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
Gives idea about lymphatic spread of cancer
10) Biopsy to confirm cancer:-
Biopsy is taken from the tumour and is sending for histopathological examination under the microscope. This will detect the presence of cancer cells.
1) When there is retention of urine catheterisation is needed.
2) Dialysis when kidney failure.
3) When there is coma monitoring of all vital functions along with parentral nutriment and electolyte supply.
4) Specific treatment is prostatectomy (removal of prostate)
Here only the touched lobe is removed.
Total removal of prostate along with nearby lymphnodes
5, Hormone therapy:
Stilbestrol is given to reduce tumour growth. Since this treatment increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.
Drugs like cyclophosphamide, cisoplatim ect are given.
7) Radiotherapy is also done for some cases.
Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, and sulphur ect can be given according to symptoms. Constitutional homoeopathic medicine will give great assuagement and can increase the life span.
9) Yoga and meditation is also helpful.