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Enlarged Prostate

An Overview of Enlarged Prostate and Common Causes!  

Prostatic Carcinoma


Prostate cancer is the most common malignancy in men and is also one of the most curable form of cancers. It is commoner in African Americans than their Caucasian counterparts and the reasons for this are yet unknown.   The disease ranks as the second leading cause of cancer related deaths ( after lung cancer) for males in the U.S. It is estimated that blacks have twice as many deaths from the disease than Caucasians.

It is estimated  that about two-third of cases discovered at autopsy were completely asymptomatic ( the affected individuals did not show symptoms of the disease). Even though the disease is rare before the age of 50, the incidence increases with age, thereafter. There are notable differences in the incidence among different populations across the world, but this differences have also been attributed to environmental factors.

Causes Of Enlarged Prostate

Causes Of Enlarged Prostate

Symptoms Of Enlarged Prostate
Benign Prostatic Hyperplasia
Prostatic Carcinoma

Prostatitis
  Prostate Cancer


Some prostate carcinomas may grow slowly and therefore show minimal symptoms, while others are quite aggressive and manifest very quickly with varied symptoms. the most common form of prostate carcinomas are Adenocarcinomas ( accounts for 95%). The remaining are squamous cell and transitional cell carcinomas. Prostate carcinomas arise mostly from the peripheral zones of the prostate gland unlike benign prostatic hyperplasia which occurs in the transitional (periurethral) zones. 

The cause of the disease is unknown but there are several risk factors that have been implicated and the most important of them is age. The prevalence increases geometrically after the age of 50 and this approaches 100 percent at age 90. The effect of environmental, cultural and dietary differences have also been suggested.  The prevalence is suspiciously higher in men who consumer diets that are high in fat. It is also suggested that the disease may be inhibited by diets rich in antioxidants. Other risk factors include race (commoner in blacks), positive family history, hormonal influence ( elevated androgen levels have been detected in some cases) and exposure to certain chemicals such as pesticide and herbicides. The bone is the most common site of metastasis from the disease. There is no sufficient evidence to support the efficacy of routine digital rectal exam as a screening method in individuals that do not have symptoms, but annual rectal examination is recommended anyway, as part of the overall health checkup.

Symptoms Of Prostate Carcinoma

Individuals with prostate cancer ( whether early or advanced stages) may not show any symptoms at all. In fact, in many cases, it is only detected on routine rectal examinations. Sings and symptoms of the disease are usually encountered when the disease is advanced in stage ( with or without metastasis). Affected individuals may present with the following symptoms: Pain while urinating, difficulty in urinating, increased frequency of urinating, blood in urine, urine retention, weight loss, lack of appetite, bone pain, back or hip pain and other complications. The complications may include spinal cord compression, pulmonary embolism and deep vein thrombosis.

Management Of Prostatic Carcinoma

Diagnosis Of Prostatic Carcinoma

The diagnosis of prostate cancer is often an incidental finding on digital rectal examination. Rectal examination is used both for detection and  estimation of degree of local spread of the disease. Palpation of the prostate reveals a characteristically hard, irregular and nodular consistency. Palpation of the seminal vesicles may also reveal local extensions of the tumor. Measurement of the serum level of prostate specific antigen (PSA) is the most sensitive test for early detection of cancer of the prostate ( particularly when combined with digital rectal exanimation) . PSA is also used to follow patient's response to treatment. But the value of routine screening of the PSA has not been fully established ( mainly because false positive results may occur in other conditions such as benign prostatic hyperplasia). Other investigative procedures that the doctors carry out include ultrasound-guided biopsy (which is the primary method of diagnosis), chest radiograph  and radionuclide bone scanning ( to evaluate and detect metastasis of the disease). Pelvic lymph node dissections are often carried out to grade the disease. The tumor is graded from 2-10 based on Gleason grading system.

Treatment Of Prostatic Carcinoma

The treatment modality depends on several factors: i) presence or absence of distant metastasis ii) patients choice iii) patients age and performance status.  Total or radical prostatectomy is often used for a cancer that is localized to the prostate and in patients with a 10 year minimum life expectancy. Total prostatectomy may be complicated by impotence and incontinence, but the incidence is minimal in experienced hands. Radiation therapy may be delivered in the form of external beam radiation or implantation of radioactive seed, but this form of treatment may be complicated by frequency of urination, bloody urine, strictures, impotence, incontinence or rectal complaints. External beam radiation may be administered in conjunction with androgen deprivation therapy. Patients with low stage cancer may be treated with interstitial brachytherapy with or without external beam radiation boost. Palliation treatment is often employed in cases where there is diffuse metastasis to the bone. Watchful waiting may play a role in patients with advanced disease or those with low stage cancers. Serial PSA and digital rectal examination monitoring in conjunction with androgen ablation therapy is often the method of approach for patients with lower than 7-10 year projected survival. Your doctor will discuss the treatment modalities with you. Please consult a licensed medical practitioner.

References

Chuang AY, Demarzo AM, Veltri RW, Sharma RB, Bieberich CJ, Epstein JI (2007). "Immunohistochemical Differentiation of High-grade Prostate Carcinoma From Urothelial Carcinoma". The American Journal of Surgical Pathology 31 (8): 1246–1255.

Andriole, GL; Roehrborn C, Schulman C, Slawin KM, Somerville M, Rittmaster RS (September 2004). "Effect of dutasteride on the detection of prostate cancer in men with benign prostatic hyperplasia". Urology 64 (3): 537–41; discussion 542–3.

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