PROSTATE GLAND AND ITS COMPLICATIONS

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Health Lecture on Prostate Gland and its Complications delivered by Dr. Saliu AbdulWaid Niran – Senior Urological Surgeon, Lagos General Hospital.

OUTLINE

  • ANATOMY OF THE PROSTATE GLAND
  • FUNCTION OF THE PROSTATE GLAND
  • ETIOLOGY
  • EPIDEMIOLOGY
  • PREVENTION
  • CLINICAL PRESENTATION
  • OTHER DISEASES OF THE PROSTATE GLAND
  • MANAGEMENT

CLINICAL PRESENTATION

Asymptomatic: Elevated PSA or incidental DRE.

 LUTS
 Haematospermia
 Perineal or voiding discomfort
 Symptoms of renal failure/anuria
 Malignant Priapism
 Rectal obstruction
 Lower limb swelling
 Anorexia
 Weight loss
 Bone pain
 Pathological fractures
 Neurological Symptoms/Signs in lower limbs
 Anaemia

DIAGNOSIS
 History
 Physical findings
 DRE
 Prostate Biopsy
 MRI

MANAGEMENT
 Watchful Waiting
 Active surveillance
 Radical prostatectomy
 Radical external beam radiotherapy.
 Brachytherapy
 Cryotherapy
 High-intensity focus ultrasound
 Surgical castration
 Medical castration
 Anti- Androgen

OTHER DISEASES OF THE PROSTATE
 BENIGN PROSTATIC HYPERPLASIA (BPH)
 PROSTATITIS

CONCLUSION
 A stitch in time saves nine
 Early diagnosis affords cure
 Men above the age of 40 years should ensure regular evaluation

INTRODUCTION

Prostate cancer is the most common cancer in  African men and the sixth leading cause of cancer-related death globally. It is found among 300 in 100,000 men prevalence rate of  3 to 4%. Cancer of the prostate is seen in younger age groups in African by a decade than in western nations.

ANATOMY

The prostate is exclusively a male body part.

Prostrate is an inverted cone-shaped organ that lie below the bladder /urine reservoir. The prostate encloses the tube (urethra) through which urine passes from the bladder and penis to the exterior.

The prostate produces fluid that nourishes the sperm cells.

CAUSES OF PROSTRATE CAREER

The specific cause of cancer of the prostate is not known, however, there are risk factors which include :

Old age – prostate cancer is rarely seen in men less than 40yrs of age,  the chance of having prostate cancer increases as one gets older especially after 50yrs.80%of cancer of the prostate is found in men who are 65years and above.

Race –  Prostate cancer is most common among the black but rare in Asia.

Family history of prostate cancer – the risk is higher if there are close relatives prostate cancer 5% of the prostate are inherited. Men with close relatives with breast or ovarian cancer.

Eating habits/Obesity: The role of diets is not clear. However, there is a higher chance of having prostate cancer in men that consume a significant quantity of red meat and fats. These individuals will consume less of vegetables and fruits and subsequently have a high tendency to be obese.

Sexual activity: Higher incidence of prostate cancer is found in men who had a vasectomy. There are several studies that revealed that frequent sexual intercourse protects men from having prostate cancer, though there are conflicting data.

SYMPTOMS OF PROSTATE CANCER

The majority of men with prostate cancer don’t have any complaints.  A complaint is usually seen when prostate cancer has grown rapidly and bigger to compress the tube that carries urine or when cancer spreads to other parts of the body.

Complaints are usually

  • Trouble peeing (urinating) – Difficulty to pass urine, in spite of a pressing urge to pee.
  • Frequent urination
  • Nocturia – walking up to urinate at night while sleeping more 3times per night.
  • Passage of bloody urine.
  • Erectile dysfunction
  • Retrograde ejaculation – the presence of sperm  in urine while peeing
  •  If cancer has spread to bones/ back – pain in the bone & back
  • Chest –difficulty  to  breathe,  or coughing  out blood
  • Weight loss
  • Kidney failure

INVESTIGATIONS

Screening tests for prostate cancer are required for men that are 50yrs  of age and above and for those men less than 40   with risk factors.

Blood test for Prostate-specific antigen (PSA )– PSA is produced by the prostate and the level of PSA increases when there is prostate cancer, although there are other diseases/conditions that can increase the level of PSA.

Digital rectal examination – this involves a doctor putting his finger into the butt and feel for prostate if enlarged.

Ultrasound scan  – This is used to estimate the size of the prostate and status of other organs such as kidney, unit, bladder.

Prostate biopsy – This involves the collection of a sample from the prostate and sent for microscopic examination. This is done when there is a suspicion of a prostate from elevated PSA  level or an abnormal finding on rectal examination. The prostate will the scored ( Gleason score)

Other tests such as bone scan, Magnetic resonance imaging are requested when there is presence/evidence of the spread of cancer to other parts of the body (brain, spinal cord, chest, bones). 

PREVENTION

  • Consumption of fruits and vegetables
  • Regular exercises
  • Avoidance of smoking
  • Prompt treatment of sexually transmitted infections

TREATMENT

The treatment depends on the

  • Age & overall health
  • Presence or absence of spread of prostate cancer
  • Gleason score

Options of treatment include:

Watchful waiting –i.e just watching cancer. This is applied in men with low Gleason scores and in older or frail patients.

  • Surgery – this is done to remove the prostate and usually done when the disease is very early or diagnosed incidentally when investigating for some different from prostate cancer
  • Radiation – Radiation can be used to kill or destroy cancer cells when picked before it is well established or spread outside the prostate. There are several methods of radiation treatment for prostate cancer. However, radiotherapy is not readily available in our clime.
  • Hormonal therapy – involves the use of drugs to deprive the cancer cells hormone that makes the cancer cells to grow. This can be by  removal of both testes/balls that produce the hormone.
  • Palliative care – It is done when a career has spread outside the prostate at this stage surgery or radiation  is done to not to care the disease but to retrieve symptoms & slow cancer down

Other diseases of the prostate

  • benign prostate hyperplasia

CONCLUSION

Prostate cancer is a serious and disabling disease that is seen in men especially above 65 yrs. Regular screening and prompt presentation in hospital in men are required for prompt diagnosis and treatment.

May Allah free us from all form illness amin