Benign Enlargement of Prostate and Prostate Cancer

What is the prostate?

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BPHanimation

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. It is approximately the size of a walnut.

The urethra – a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body – goes through the prostate.

There are thousands of tiny glands in the prostate – they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.

Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. More than 2 million men in the US count themselves as prostate cancer survivors.

Signs and symptoms of prostate cancer

During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:
Both BEP and Cap appear with same symptoms, So every patients with LUTS should consult a urologist and Urologist should do digital rectal examination and Serum PSA and if required Transrectal Ultrasonography and Transrectal Prostate Biopsy to exclude Prostate Cancer.

Lower Urinary Tract Symptoms (LUTS):

  • The patient urinates more often
  • The patient gets up at night more often to urinate
  • He may find it hard to start urinating
  • He may find it hard to keep urinating once he has started
  • There may be blood in the urine
  • Urination might be painful
  • Ejaculation may be painful (less common)
  • Achieving or maintaining an erection may be difficult (less common).

If the prostate cancer is advanced the following symptoms are also possible:

  • Bone pain, often in the spine (vertebrae), pelvis, or ribs
  • The proximal part of the femur can be painful
  • Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
  • Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
  • Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord).

Diagnosis:

  • Serum PSA (Prostate Specific Antigen) – the only screening test you can do yearly to detect Prostate Cancer
  • TRUS (Trans-rectal Ultrasonography) and biopsy can detect Prostate Cancer

ACKU Treatment Options for BEP

  • Transurethral Resection of Prostate (TURP)
  • Transurethral Enucleation of Prostate by Laser

In Bangladesh only ACKU provides Thulium Laser 120 Watt and we are doing TURP (Thulep) successfully.

Advantages :

  • Minimum Bleeding,
  • No side effects on sex.
  • Minimum hospital stay.

Treatments for prostate cancer

The following treatments are separated into early stage and advanced stage prostate cancers.

Early stage prostate cancer

If the cancer is small and contained – localized – it is usually managed by one of the following treatments:

  • Watchful waiting – not immediate treatment is carried out. PSA blood levels are regularly monitored.
  • Radical prostatectomy – the prostate is surgically removed by Laparoscopic approach or open.
  • Brachytherapy – radioactive seeds are implanted into the prostate.
  • Conformal radiotherapy – the radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment, thus minimizing healthy tissue exposure to radiation.
  • Intensity modulated radiotherapy – beams with variable intensity are used. An advanced form of conformal radiotherapy usually delivered by a computer-controlled linear accelerator.
    Treatment recommendations really depend on individual cases. In general, if there is a good prognosis and the cancer is in its early stages, all options can be considered. However, they all have their advantages and disadvantages. The patient should discuss available options thoroughly with his doctor.

More advanced prostate cancer

If the cancer is more aggressive, or advanced, the patient may require a combination of radiotherapy and hormone therapy. Radiotherapy requires treatment on an everyday basis for up to about eight weeks. Radical surgery is also an option – the prostate is removed. Traditional surgery requires a hospital stay of up to ten days, with a recovery time that can last up to three months. Robotic keyhole surgery has the advantage just a couple of days in hospital, followed by a much shorter recover period. However, even robotic keyhole surgery may not be ideal for very elderly patients.

In advanced prostate cancer hormone therapy is very effective in slowing down, and even stopping the growth of cancer cells. Even if the hormone therapy stops working after a while, there are still other options the patient will be able to discuss with his doctor, such as participating in clinical trials.

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