Understanding Prostate Cancer: Insights from Melchiore Buscemi MD


The men's prostates are small organs shaped like walnuts. It is situated between the base of the penis and the bladder opening. The prostate serves dual purposes. The primary purpose is to aid in urinary control. The prostate also produces fluid that transports and nourishes sperm.

Prostate Specific Antigen (PSA) is a protein that aids in the preservation of the liquid state of sperm. This liquid state is required for continued sperm motility and fertilization to occur. The prostate gland undergoes several changes as men age. These changes range from the development of cancer to benign prostate enlargement.

Prostate enlargement can cause voiding difficulty. The proportion of men with subclinical prostate cancer increases with age. 70% of men aged 70 and older will have prostate cancer, but only a small percentage will require treatment. As subclinical prostate cancer advances, approximately 15% will receive a cancer diagnosis, but only 2% to 3% will perish.

Despite the absence of blood tests for early breast cancer detection, the PSA test has improved men's chances of early detection. All men produce PSA, but it should only be detected in the sperm, not the blood. An increasing PSA does not necessarily indicate cancer, but it does indicate something is wrong with the prostate gland, necessitating a Urologic evaluation and workup. If the PSA level continues to rise, the likelihood of prostate cancer also increases.

In recent years, PSA testing has undergone additional laboratory evaluation. This study established a Percent Free Ratio, a Prostate Health Index, and urine testing to reduce the number of unnecessary prostate biopsies. X-rays or rectal exams cannot detect small tumors, but a biopsy can. This may result in a false-negative biopsy.

CAUSES

Unknown is the exact cause of prostate cancer. There is a sixfold increased risk if a direct family member has been diagnosed with prostate cancer before age 60. If a close relative is diagnosed at age 80 or later, the risk is four times higher than in the absence of a family history.

PREVENTION

There is no accurate prostate cancer prevention plan. According to statistics, a person is at greater risk if they are obese and consume a diet affluent in animal fat. Animal fat and blood nitrates generate free radicals. Free radicals may accelerate the development of cancer.

SCREENING

The American Cancer Society recommends PSA screenings for men beginning at age 50. Numerous Urologists initiate PSA testing at age 40, especially in black men with a family history of prostate cancer or voiding difficulties. In the past, there was a solid push to screen all men over 50. Over time, data indicate that this frequently resulted in unnecessary treatment. This unnecessary treatment is especially appropriate for those over the age of 75. As the average age increases, we must identify men likely to live long life.

DETECTION

As previously stated, annual PSA testing levels could begin to rise. A PSA increase of more than 0.5% per year is alarming. Certain men may experience urinary symptoms, microscopic hematuria (blood in the urine), or blood in the ejaculate. All men over 40 should undergo a digital rectal exam annually (DAE). Your Urologist may recommend a prostate ultrasound, MAI, and biopsy if cancer is suspected. Because they originate in the prostate gland, most cancers are adenocarcinomas. Occasionally, transitional cell cancer can arise from the urethra that passes through the prostate.

DIAGNOSIS

If the DRE and PSA indicate that cancer must be ruled out, the Urologist will suggest a Prostate biopsy. For this procedure, you will need a Fleet enema and ore-oo antibiotics. The patient is prone during the insertion of a transrectal probe. Under direct observation, a needle is inserted into the probe. A specific device is used to shoot or propel the needle to the evaluation-required areas of the prostate. 1 to 2 cm is inserted into the prostate. The larger the prostate, the greater the number of samples required to evaluate all areas. Typically, biopsies consist of 12 to 16 cores. Bleeding and infections of the urethra and rectal area are uncommon.

TREATMENT

Age, health, tumor grade, stage, and voiding symptoms determine treatment. Several elderly Gleason and six individuals with low-volume cancer are observed. Younger patients with a presumed organ-confined disease are candidates for definitive treatment via radical robotic surgery or brachy radiation seed placement. External radiation and cryofreezing are reserved for older patients, those with a higher risk of early metastasis, and those who cannot undergo a procedure requiring general anesthesia.

Whether you have advanced disease at the time of diagnosis or a rising PSA after treatment, most patients will experience remission with the removal of testosterone. The testicles are surgically removed or injected with leuprolide acetate, which puts the testicles to sleep. Numerous patients will experience remissions of varying lengths. The prognosis is best for tumors with a smaller volume and a lower grade. Hopefully, there will be a long interval before the PSA begins to rise. If the PSA level rises, your doctor may recommend anti-androgen therapies. Radiation to the bone can treat metastatic pain, and prednisone can relieve pain and malaise symptoms when other treatments fail. Testosterone depletion will result in andropause ( male menopause.)

PROGNOSIS

Cancer grade and stage determine prognosis—microscopes grade cells. The specimen is graded from 1 to 5, with 5 representing the most aggressive form of cancer. Grades 1 and 2 are uncommon (3 - 4.) Prostate cancer can independently affect multiple areas, and grading can vary for each area. Gleason scores characterize multifocal prostate cancer. Add the two significant types of cancer. One grade from a biopsy doubles the number—the scores for Gleason range from 2 to 10. Few scores are rated between (2-5), and the majority are rated between (6-10) (6 - 8.) Approximately 10% of scores are categorized as "Fail" (9 - 10.) Staging is determined by the prostate's volume and ultrasound, MRI, bone, and CT scans.

If your doctor recommends discontinuing PSA screening due to age, you must insist on continued screening if you find the suggestion unacceptable. Patients should only continue surveillance if the Gleason score is less than eight and the cancer volume is small. High-grade tumors with larger cancer volumes do not respond favorably to any treatment. Patients must communicate with their Urologist and comprehend treatment options and potential risks.

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