Prostate Cancer
Prostate cancer is one of the most common types of cancer. Prostate cancer begins when cells in the prostate gland start to grow out of control. The prostate is a gland found only in males. It makes some of the fluid that is part of semen. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.
The prostate is below the bladder (the hollow organ where urine is stored) and in front of the rectum (the last part of the intestines). Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate.
The size of the prostate can change as a man ages. In younger men, it is about the size of a walnut, but it can be much larger in older men.
Stages –
Cancer staging is complex and accounts for many different factors. Usually, the lower the number, the less the cancer has spread. Stages may include:
• Stage I: Cancer is only present in the prostate gland.
• Stage II: Cancer has not yet spread from the prostate, but a person will have a higher PSA level.
• Stage III: The cancer may have spread to nearby tissues.
• Stage IV: Cancer may have spread to distant parts of the body.
Symptoms –
Prostate cancer may cause no signs or symptoms in its early stages.
Prostate cancer that’s more advanced may cause signs and symptoms such as:
• Trouble urinating
• Decreased force in the stream of urine
• Blood in the urine
• Blood in the semen
• Bone pain
• Losing weight without trying
• Erectile dysfunction
Causes –
Researchers are unsure of the exact cause of prostate cancer. It develops when specific changes occur, usually in glandular cells. When prostate gland cells appear abnormal, a doctor may refer to these changes as prostatic intraepithelial neoplasia (PIN). Nearly 50% of all males over the age of 50 years have PIN.
At first, the changes will be slow, and the cells will not be cancerous. However, they can become cancerous with time. Cancer cells can be high or low grade.
Risk Factors –
While doctors do not know exactly why prostate cancer occurs, the following risk factors may make it more likely:
• Age
The risk of prostate cancer increases after the age of 50, but it is rare before 45.
• Race or ethnicity
The condition is more common in Black people than white people. Asian and Hispanic people have a lower risk than Black or white people.
• Family history
A person with a close relative who has a history of prostate cancer has a higher chance of developing it themselves.
• Genetic factors
Inherited features, including changes to the BRCA1 and BRCA2 genes, may increase the risk.
• Diet
Some evidence suggests that high fat diets may increase the risk of prostate cancer.
Complications –
Complications of prostate cancer and its treatments include –
• Cancer that spreads (metastasizes).
Prostate cancer can spread to nearby organs, such as your bladder, or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it’s unlikely to be cured.
• Incontinence.
Both prostate cancer and its treatment can cause urinary incontinence.
Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery.
• Erectile dysfunction.
Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.
Diagnosis –
If a person has symptoms that may indicate prostate cancer, a doctor will likely –
• ask about symptoms
• ask about personal and medical history
• conduct a blood test to assess PSA levels
• carry out a urine test to look for other biomarkers
• carry out a physical examination, which may include a digital rectal exam (DRE)
If a doctor suspects cancer, they may recommend further test like –
• PCA3 test: This looks for the PCA3 gene in the urine.
• Transrectal ultrasound: This involves inserting a probe with a camera into the rectum.
• Biopsy: A doctor will take a tissue sample for examination under a microscope.
Only a biopsy can confirm the presence and type of cancer. A person who needs monitoring rather than treatment may need a routine MRI or CT scan.
Techniques used to determine the aggressiveness of the cancer include –
▪︎ Gleason score
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score.
• Gleason scores of 5 or lower are not used.
• The lowest Gleason score is 6, which is a low-grade cancer.
• A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer.
A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
▪︎Genomic testing
Genomic testing analyzes your prostate cancer cells to determine which gene mutations are present. This type of test can give you more information about your prognosis. But it’s not clear who might benefit most from this information, so the tests aren’t widely used.
Treatment –
Treatment will depend on the cancer stage, among other factors, such as the Gleason score and PSA levels. It is also worth noting that many treatment options may be applicable, regardless of the stage of cancer.
▪︎ Early stage prostate cancer
If the cancer is small and localized, a doctor may recommend:
• Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action. Prostate cancer grows slowly, and the risk of treatment side effects may outweigh the need for immediate treatment.
• Surgery
A surgeon may carry out a radical prostatectomy to remove the tumor. In addition to removing the prostate, the procedure may also involve the removal of the surrounding tissue, seminal vesicles, and nearby lymph nodes. A doctor can perform this procedure using either open, laparoscopic, or robot-assisted laparoscopic surgery.
• Radiation therapy
This uses radiation to kill cancer cells or prevent them from growing. Options for early stage prostate cancer may include –
~ External radiation therapy
This method uses a machine outside the body to send radiation toward the cancer cells. Conformal radiation therapy is a type of external radiation that uses a computer to help guide and target a specific area, minimizing the risk to healthy tissue and allowing a high dose of radiation to reach the prostate tumor.
~ Internal radiation therapy
Also known as brachytherapy, this method uses radioactive seeds that a doctor implants near the prostate. A surgeon uses imaging scans, such as ultrasound or computed tomography to help guide the placement of the radioactive substance.
▪︎ Advanced prostate cancer
As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, treatment options will change. Options can include:
• Chemotherapy
This option uses drugs to help stop the growth of cancer cells. While it can kill cancer cells around the body, it may cause adverse effects.
• Hormonal therapy
Androgens are male hormones. The main androgens are testosterone and dihydrotestosterone. Blocking or reducing these hormones appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most of the body’s hormones. Various drugs can also help.
• Immunotherapy
This method uses a person’s immune system to help fight cancer. Scientists can use substances the body produces, or create them in a lab, to help boost or restore the body’s natural defenses against cancer.
• Targeted therapy
This method uses drugs or other substances that identify and attack specific cancer cells.
Ayurvedic Perspective –
As per Ayurveda, if the factors, including lifestyle and diet, that cause the imbalances are not reversed, the situation may deteriorate further. The more toxic type of Ama called Amavisha can develop. When Amavisha affects the blood, fat tissues and Shleshaka Kapha in the prostate region, it can cause a breakdown in communication between prostate cells.
The natural intelligence in the prostate area gets disrupted. This means that the cells can forget their own nature and start to grow uncontrollably. This can lead to prostate cancer.
Beneficial Herbs –
One way to keep the prostate functioning well is to use certain spices while cooking. They help reduce ama (toxins) in the body and pacify the vata dosha, the aggravation of which is often responsible for prostate problems.
• Haldi (Turmeric)
Haldi is extremely beneficial for the prostate as it helps clear away amavisha (a more toxic form of ama) and balances Ranjaka pitta (a type of pitta most prevalent in the liver), thus purifying the blood and urine.
• Methi (Fenugreek)
Methi reduces enlargement in the prostate, which is the leading issue that occurs due to an unhealthy prostate. Incorporate methi seeds in your diet by adding them in dishes and paranthas.
• Jeera (cumin), Saunf (fennel), and Pudina (mint)
These spices help balance the vata and regulate bowel movements and urination through their anti-flatulent and diuretic properties. You can brew a herbal tea using these spices or add them to your dishes and salads.
Ayurvedic Formulations –
• Kanchnar Guggulu
• Varunadi Kashaya
• Vriddhivadhika Vati
• Gokshura Guggulu
• Shila Sindur
• Chandraprabha Vati
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