3. Cross section of prostate
• The prostate
gland sits
between a man's
bladder and
rectum at the
bottom of his
pelvis. It is
about the size
of a walnut.
4. Functions of the prostate
gland
• To create the seminal fluid which mixes
with and carries sperm out of the penis
upon ejaculation.
• To pump the semen and sperm with
sufficient power out of a man's body on
its way to fertilizing a woman's egg.
• The prostate functions as a gland and
contains muscle fibers which contract
and relax.
5. Prevalence
• Researchers estimate that 50% of
men over 50 years of age, and
• 70% of men over 70 years of age
have some form of prostate cancer.
6. Risk factors
• Family history
• Age
• Diet- high fat
• Vit. D deficency
• Occupation
• STD
• Viral infection
7. What can go wrong with
the prostate
• Three main types of problems
Infection,
Enlargement, and
Cancer
8. Infection
• Prostate infections can be brief or
long-lasting, mild or severe, easy or
difficult to treat. Symptoms of
prostatitis can include frequent and
painful urination, other urinary
difficulties, or pain during
ejaculation.
9. Enlarged prostate
• Prostate enlargement, called benign
prostatic hyperplasia (BPH),
• A part of the normal aging process of
the prostate.
• Men in their twenties can suffer
from BPH, by the age of 60, and
• 90% will suffer from it by age 85.
10. Prostate cancer
• Prostate cancer is the growth of
malignant cells in the prostate. The cells
reproduce and may spread beyond the
prostate gland.
• Prostate cancer ordinarily grows slowly
and does not, by itself, cause death –
if it stays in the prostate.
11. Prostate cancer symptoms
• A man with prostate cancer may or may
not have symptoms.
• A need to frequently urinate, especially
at night
• Difficulty starting urination or holding
back urine
• Inability to urinate
• Weak or interrupted urine flow
12. Prostate cancer symptoms
• Painful or burning urination
• Difficulty obtaining an erection
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower
back, hips or upper thighs
13. Progression of prostate
cancer
• Most prostate cancer will grow slowly
• In some cases can grow rapidly
• The treatment depends on several
factors - the disease stage,
- the man's age and life
expectancy,
- doctor's recommendations,
- own decisions.
14. Staging of prostate cancer
• The doctor will determine the extent
of the disease by using various
diagnostic tests, imaging, and other
tests to find out whether the cancer
has spread. This is called "staging."
• The stage of the disease will help
determine treatment options.
15. TNM system
• T stage
• N stage
• M stage.
• “Metastasis” refers to the spread of
cancer cells from the prostate gland
to another part of the body.
16. Staging
• Is confined to the prostate
• Has grown beyond the prostate
• Has spread, and if so, where it has
spread
• This is called “staging” the disease.
Determining the cancer stage is
crucial to deciding the best
• treatment.
17. Staging
• T1: The cancer is microscopic.
• T2: The doctor can feel the cancer with
a DRE.
• T3: The cancer has begun to spread
outside the prostate and may involve the
seminal vesicles.
• T4: The cancer has spread to lymph
nodes, bones, lungs or other organs.
18.
19. Detection
• Prostate-Specific Antigen(PSA)
is a substance the prostate
gland naturally produces to help liquefy
semen. A small amount of PSA naturally
enters the bloodstream. If higher-than-
normal levels of PSA occur (above a
level of 4 ng/ml), it may indicate
prostate infection, inflammation
(prostatitis), enlargement of the
prostate gland or cancer.
20. Detection
• DRE -- can tell the doctor if the
cancer is T1, T2, or beyond T2.Can
find any abnormalities in the texture,
shape or size of the gland.
• Biopsy -- when prostate cancer is
detected, a biopsy will take small
samples of tissue from the prostate.
21. Detection
• A Urine test. A urine test checks the
urine for abnormalities that may
indicate a problem. The test does not
detect prostate cancer, but it can help
detect or rule out other conditions with
similar symptoms.
• Transrectal ultrasound. This involves
inserting a small probe into the rectum.
The probe emits sound waves to produce
a picture of the prostate gland.
22. Magnetic resonance
imaging
• By producing a very clear picture of the
prostate, the MRI can show whether
the cancer has spread outside the gland
into the seminal vesicles or bladder.
23. Detection
• Radionuclide bone scan
• Computed tomography (CT)
• Endo- rectal MRI - Even more accurate
than the MRI to help determine if the
prostate cancer is confined to the
gland. The test can also help detect the
site of prostate
24. Detection
• Prostatic Acid Phosphatase (PAP)
• Lymph node biopsy -- Conducted to find
if cancer has spread from the prostate
to nearby lymph nodes.
• ProstaScint™ scan -- Detects the
spread of prostate cancer to lymph
nodes and other soft (non-bone) organs.
25. Treatment
• Hormonal therapy
Prostate cancer cells are stimulated by
the male hormone called testosterone.
By eliminating testosterone, hormonal
therapy can slow down the growth of
the cancer cells. The testicles produce
95% of a man's testosterone. There are
three basic methods of hormonal
therapy.
26. HT selection criteria
• Ht is suggested when prostate cancer
has spread beyond the prostate gland to
other parts of the body.
• Men whose cancer has returned after
radical prostatectomy or radiation
therapy also are candidates for
hormonal therapy.
27. Effectiveness of HT
• A drop in hormone level can affect all
prostate cancer cells. The treatment
can control prostate cancer for up to
several years.
• Some prostate cancers can grow with
little or no male hormone, then the
doctor may suggest other forms of
treatment.
28. CAB
• Combined androgen blockage orally
administers the female hormone
estrogen (or other substance) to
stop the testicles from producing the
male hormone.
29. HT
• LHRH therapy administers "luteinizing
hormone-releasing hormone," or LHRH
analogs. Usually taken orally by the
patient, LHRH prevents the testicles
from producing male hormone. The
therapy saves the testicles and works
as well as surgical castration.
30. Orchiectomy
• If surgical castration is performed, the
adrenal glands compensate for the
removal of the testicles by producing
more male hormone.
• Even after having his testicles removed,
a man will have to take drugs to block
the flow of male hormone.
Risk of Orchiectomy
• Surgical castration is not reversible.
It may require hospitalization.
32. Side effects of HT
• Impotence
• Loss of sexual desire
• Hot flashes
• Weight gain
• Fatigue
• Reduced brain function
• Loss of muscle mass
33. Side effects of HT
• At first, LHRH may tend to increase
tumor growth and make the patient's
symptoms worse. This problem is
called "tumor flare."
• Patients who receive androgen
blockage treatment may have nausea,
vomiting or tenderness and swelling
of the breasts.
34. Radical prostatectomy
• Radical prostatectomy is major
surgery that removes the entire
prostate gland plus some surrounding
tissue.
• pelvic lymph nodes may also be
sampled for a biopsy.
• The goal is to remove the cancer
entirely and prevent its spread to
• other parts of the body.
36. Radical prostatectomy
selection criteria
• A radical prostatectomy is generally
recommended only for men in good
health who have a life expectancy of
ten years or more.
• Success rates for a radical
prostatectomy range from 70-85%.
39. Risks of radical
prostatectomy
• Heart attack
• Stroke
• Blood clots in the legs
• Infection at the incision site
• Post-operative bleeding
• Death (rare)
• Recovery
40. Side effects of radical
prostatectomy
• Incontinence (in about 10% of cases.)
• Impotence
• A study in the Oct. 3, 2000, issue of
the Journal of the National Cancer
Institute revealed that two years
after the radical prostatectomy,
79.6% of men reported that they
were impotent.)
41. Laparoscopic
prostatectomy
• A less invasive procedure, called a
laparoscopic prostatectomy, eliminates the
need for a large surgical incision to remove
the prostate. As a result, the patient may
experience less pain and scarring, faster
recovery and less risk of infection.
42. Cryotherapy
• It is minimally invasive and has fewer
complications than surgery.
• The goal is to eradicate prostate cancer by
freezing the prostate cells.
• Freezing destroys the entire prostate,
including cancerous tissue.
• The latest generation of cryotherapy uses
ultra-thin needles to produce iceballs of
extreme sub-zero temperatures.
44. Cryotherapy selection
Criteria
• Cryotherapy is an option for prostate
cancer patients who want to avoid major
surgery or the risks of "watchful
waiting.” Cryotherapy can treat
prostate cancer in high risk patients as
well as radiation treatment failures.
45. Effectiveness of
cryotherapy
• A recent study showed that 97.6% of
patients treated with new-generation
minimally invasive cryotherapy were still
cancer-free after twelve months.
Cryotherapy for prostate cancer can be
repeated, and it can also be used as a
secondary treatment when other
primary treatments fail.
46. Side effects of
cryotherapy
• Incontinence or urethral scarring
• Moderate pelvic pain
• Blood in the urine
• Mild urinary urgency
• Scrotal swelling
• These side-effects usually go away
within a few weeks.
50. Prostate cancer treatment
can cause
• Physical,
• Psychological and
• Emotional challenges
• Break in relationships
• Sexual, and other issues
during the course of treatment and
recovery.
51. Depression
• A diagnosis of
prostate cancer
triggers many
emotions. There is
fear, uncertainty,
anger, anxiety,
depression.
