PROSTATE CANCER 

Anatomy

The prostate is a small, walnut sized gland, found in males in the lower pelvis, just below the bladder, surrounding a portion of the urethra (as it leaves the bladder). The prostate gland can be described as a collection of glands encased by a thin capsule of fibrous tissue. Its primary function is to add nutrients to the fluid that becomes semen.  Below the prostate is the front wall of the rectum and on either side are nerves and blood vessels.  The vas deferens are tubes that lead sperm from the testicles through the prostate to the urethra.  Fluid from the seminal vesicles, a gland adjacent to the prostate, also empties into the prostate.  The testicles produce sperm and a male hormone, testosterone. The bladder, above the prostate, is the organ that collects and empties urine.  Urine is made in the kidneys and filters down to the bladder by way of the ureters.  The urethra is a canal that extends from the bladder through the prostate, past the urinary sphincter, to the penis, and out the meatus. This canal carries urine from the bladder and also semen.

Non-cancerous Prostate Enlargement

In the presence of normal male hormones, the prostate in most men may grow and slowly increase in size.  This condition is known as benign prostatic hyperplasia (BPH) and is not cancerous.  Due to the positioning of the prostate this growth can cause a number of quality of life issues.  The growth of the prostate interferes with the passage of urine and can result in symptoms such as frequent daytime and nighttime urination , dribbling, and difficulty starting and stopping urination. Some symptoms associated with BPH are similar to those experienced by patients with advanced prostate cancer.  Education about the distinction between these diseases is important and should be discussed with a physician, especially in the setting of early detection.  

Traditionally, patients with BPH were treated with surgery. Over the past ten years treatment options for BPH have broadened to include; doing nothing, taking medications such as Hytrin or Proscar, laser surgery, or transurethral removal of the prostate (TURP).

Prostate Cancer

Prostate cancer is a malignant growth of the glandular cells of the prostate. 

Some prostate tumors are hormone sensitive, meaning that the tumor’s growth is stimulated by hormones.  In the prostate, the hormone testosterone is converted into another hormone, DHT (dihydrotestosterone), which may feed hormone sensitive tumors.

As the tumor grows, usually it is confined to the prostate.  When it reaches the capsule or shell of the prostate gland, the tumor may grow through the capsule and into the fat surrounding the prostate, the bladder, and/or the seminal vesicles.

Prostate cancer may also spread to other areas of the body.  Common sites of metastasis include the lymph nodes surrounding the prostate, the bone (spine and ribs), brain and lungs.

Although men with prostate cancer may never succumb to their disease, prostate cancer is the second leading cause of death in men.  Accurate staging is critical because it plays an  important role determining the treatment plan.

Staging

Staging is a system to identify location and size of a tumor, lymph node involvement, invasion of adjacent tissue, or metastasis to a distant site.

• Stage II (B): The cancer can be detected by digital rectal examination or an elevated prostate-specific antigen (PSA) test but there is no evidence that the cancer has spread outside the prostate to other organs.
• Stage III (C): Cancer has spread outside the covering (capsule) that encloses the prostate gland to surrounding tissues. The glands that produce semen (the seminal vesicles) may have cancer in them.
• Stage IV (D): Cancer has spread (metastasized) to the lymph nodes or to other parts of the body such as the liver, bones or lungs.
• Recurrent/Relapsed: Cancer has been detected or returned following an initial treatment with surgery and radiation or hormonal therapy. It may come back in the prostate or in another part of the body.

Prostate staging can also be described by using T (tumor size), N (extent of spread to lymph nodes), and M (extent of spread to other parts of the body).