By Sola Ogundipe
Prostate cancer is the most common malignancy diagnosed in men. On an annual basis globally, approximately 1.1 million men are diagnosed with prostate cancer and more than 300,000 will die of prostate cancer each year.
The prostate is a walnut sized gland that is part of the male reproductive system. It is located beneath the urinary bladder and in front of the rectum. The prostate makes some of the fluid that nourishes and protects sperm cells in the semen. Just behind the prostate are the seminal vesicles, which make most of the fluid for the semen.
The urethra is a tube that carries urine and semen out of the body through the penis, running through the prostate. The activity and growth of the prostate is stimulated by male hormone Testosterone.
Prostate cancer is to men what breast cancer or cervical cancer is to women. Prostate cancer has the potential to grow and spread quickly, but for most men, it is a relatively slow growing disease. It is important for patients to discuss with their doctors the various aspects of their particular type of prostate cancer to understand how aggressive it is and how best to treat it.
Many men with prostate cancer have no symptoms related to their cancer. For those that do have symptoms, they could include any of the following:
Urinary problems – weak urine stream, difficulty initiating urination, stopping and starting during urination; urinating frequently, especially at night, pain or burning with urination. These symptoms are also often associated with noncancerous enlargement of the prostate, called benign prostatic hypertrophy (BPH).
Blood – in the urine and semen.
Pain – in the hips, pelvis, spine or upper legs. Also pain or discomfort during ejaculation.
Men with certain risk factors are more likely to develop prostate cancer. Perhaps the most significant of these risk factors is age.
Old age particularly 65 and over is the main risk factor for prostate cancer. The older a man gets, the more likely he will develop prostate cancer. The disease is rare in men under 45 years of age.
Family History – one’s risk of prostate cancer is higher if you have a father, brother or son with prostate cancer.
Race – prostate cancer is more common among black men and less common among Asians and Caucasians.
Certain Prostate Changes – men with cells called high grade prostatic intraepithelial neoplasia (PIN) may be at increased risk for prostate cancer.
Certain Genome Changes – research suggests that the risk for prostate cancer many be linked to specific changes on particular chromosomes. Having a risk factor does not mean that one will develop prostate cancer. Most men with any of the above risk factors will still never develop the disease.
Screening and diagnosis
Diagnosis of prostate cancer should be part of a routine annual examination by a primary care doctor. The prostate cancer tests for early detection and screening are the Digital Rectal Exam, DRE, combined with a blood test to measure the Prostate Specific Antigen, PSA level, in the bloodstream. Abnormal DRE, elevated PSA or confirmation of more advanced Prostate Cancer will require additional testing.
A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. Needle biopsies of the prostate are usually done under TRUS guidance.
Prostate Specific Antigen – PSA
This is an enzyme found in the blood produced exclusively by prostate cells. Normal levels of PSA in the blood are small amounts between 0-2.5 ng/ml. Higher than normal levels, greater than 2.5 ng/ml, can be caused by cancer or benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma. All elevated readings of PSA should be checked.
Occasionally, a Digital Rectal Exam, DRE, does not reveal any abnormalities, but the PSA is elevated. Sometimes the opposite is true, and PSA is normal, but the DRE is abnormal. For this reason, the Prostate Specific Antigen PSA blood test together with the DRE is best for early detection.
Normal prostate cells and prostate cancer cells make PSA even if they are outside the prostate. That is why PSA monitoring after treatment is so important. Returning prostate cancer cells, confined to the prostate or that have spread to the bone or lymph nodes, will cause the PSA to rise. Prostate Specific Antigen PSA is important for diagnosis, treatment and follow-up as well as useful for comparing treatment results.
How age affects PSA
Research has investigated what PSA levels within age ranges should raise concern about the likelihood of significant prostate cancer. Based on age, what PSA level might trigger a referral to a urologist? Using these PSA trigger levels they “detected all relevant PCa with a significant reduction of biopsies.” If you are less than 49 the trigger level is 1.75ng/ml; 60-69 (2.25) and above 70 (3.25).
PSA is measured by a simple blood test. The typical test for diagnosis and risk group determination is the “total PSA” which is simply a measure of all the PSA. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive technology (monoclonal antibody technique).
Prostate Cancer Gleason Score
Diagnosis is confirmed with a biopsy. The biopsy can give important indications as to how extensive the cancer is within the prostate by the number of cores that are positive for cancer. The pathologist will also look for perineural invasion, (cancer invading small nerves within the prostate), which can be an indication of how likely the cancer is to spread outside of the gland. Prostate Cancer Gleason Score is Set by Inspection of Prostate Cancer Cells how quickly it grows and how likely it is to spread outside of the gland.
The Prostate Cancer Gleason Score score ranges from 2 to 10. To determine the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue.
The most common cell pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common cell pattern, the pathologist gives it a grade of 1 to 5. The pathologist adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice, e.g. 5 + 5 = 10.
A high Gleason score (such as 10) means a high-grade prostate tumour. High-grade tumours are more likely than low-grade tumours to grow quickly and spread.
When diagnosed with prostate cancer
When facing a diagnosis, there are a lot of things for you to consider. Is prostate cancer or a benign condition? How bad is this prostate cancer ? Which treatment is right for you ? What are the side-effects of treatment? How long is the recovery time and which doctor is best ?
The good news is that the probability of survival for most prostate cancer patients is very good. However, you need to complete treatment. Some treatments increase the likelihood that your prostate cancer will not return.
What to do next
It is extremely unusual that there is any need for you to rush to a decision. Most cancers have been quietly sitting in the prostate, slowly growing for 10-15 years. You haven’t just gotten cancer, you have just been diagnosed with cancer, that you have been living with for a long time. No need to become an instant expert. Take your time, become informed. Learn about available treatment options. Select several specialists who can describe the different treatments. Arrange consultations and discuss the options.
World Cancer Day: Lifetouch Africa tasks Nigerians
President/Executive Director, Lifetouch Africa, an African women health initiative, Mrs Awele Chukwuedo Ossai, has called for a collective effort to check the rise of breast and cervical cancers scourge in Nigeria.
She made this known during a one-week programme held in Ibadan to mark the World Cancer Day,which was set apart by the World Health Organisation to create awareness on the need to rise against cancers .
In a bid to ensure a cancer-free society, Lifetouch Africa engaged in a multi-dimensional intervention to commemorate the world cancer day with activities such as a football match/awareness campaign, followed by an awareness session with the disabled, a radio awareness session reaching over 250,000 workers in Lagos State, and a flag off of the nation-wide capacity building project for nurses in selected local government areas in Oyo State, in collaboration with the Oyo State Ministry of Health (Non Communicable Disease Unit. Through this programme the NGO trained nurses from selected local governments in the state on cervical screening (Visual inspection with acetic acid and Papsmear ).
The aim is to ensure adequate trained hands in cancer preventive services towards a free breast and cervical cancers Nigeria.