What is the symptom of prostate cancer? How serious is prostate cancer?

Prostatic Problems

The prostate exists only in the male. Women are spared this dilemma of the ardent cavalier and of the aging male. The prostate is an accessory sex organ that provides part of the fluid in the ejaculate. There is no physical awareness of the normal prostate, but the diseased prostate is a source of great discomfort. It produces symptoms when it becomes enlarged, infected or contains a tumor.

This organ is composed of many glands which produce prostatic secretion. The prostate is very much under the influence of hormones but itself produces no hormones. It is a heart shaped structure that surrounds the outlet of the urinary bladder.
The import nee of the prostate as a provocator of symptoms is accounted for by its strategic position. By its overgrowth, congestion or enlargement it can distort the width, angularity or position of the bladder out'et channel. The consequence of this is obstruction, irritation or inflammation of the bladder, with its attendant symptoms of pain, urinary frequency, blood in the urine, painful urination and alterations in the force, as well as impairment of kidney function.

What is prostate cancer? 

Can I see my prostate gland? Where is it? 

The gland lies in front of the rectum and behind the bladder, high up in the area between the thighs and behind the scrotum. You cannot see it. However, a doctor can examine it digitally by palpation within the rectum.

What junction has it served all these years? Should I have been aware of its existence? 

The prostatic fluid provides part of the sugars, nutrients, acid proteins and enzymes which make your sperm viable and allows for its motility and survival once ejaculated. A part of the male sexual excitement is related to transitory congestion of the prostate.

I have to get up at night to urinate. I am also voiding more frequently during the daytime, and my urinary stream is less forceful than formerly. These are the early signs of prostate trouble. That is, these are indications of partial obstruction to the outflow of urine.

What can happen now? 

It is possible that part of the obstruction is due to swelling caused by an associated prostatic infection. If the infection can be eliminated, these symptoms can often be considerably attenuated. The infectious component is evaluated by examining the urine and prostatic fluid for pus, bacteria and debris.

In some individuals these obstructive symptoms remain relatively unchanged for many years, and many can get along with only minor inconveniences. In others they may become so progressively aggravated that relief can be accomplished only by surgery.

What causes the prostate to become enlarged? 

Prostatic enlargement is usually encountered in association with congestion, infection, glandular overgrowth (sometimes called benign prostatic hypertrophy often abbreviated as BPH), benign tumors, or cancer. It is for the physician to determine which of these is the case for any particular patient. Infection and congestion are most frequent in early manhood; in the middle years prostatic overgrowth is more common, either with or without infection. In the aged a tumor of the prostate becomes an important cause of urinary problems.

What causes prostatic congestion and injection? 

Prostatic congestion is often initiated by sexual irregularities and aggravated by alcohol, condiments, or prolonged sitting. Infection means that there are active microorganisms infecting the gland and causing it to swell and become painful.

What is the nonsurgical treatment for acute prostatic enlargement? 

An effort is made to reduce the swelling and its side effects by giving antibiotics for the associated infection. The specific infecting bacteria are identified in the urinary or prostatic fluid, and the most effective antibiotic is utilized. Periodic sitz baths provide a source of heat to the infection; these often have a general soothing effect. The diet is regulated to reduce irritant stimulus to prostatic activity. Sexual restraint is advised during the acute process. Chronic prostatic infection and congestion may be avoided by elimination of the inciting cause.

How can I evaluate my own symptoms; that is how can I tell under treatment whether I am getting better or worse? 

Your symptoms are becoming worse if you have to void every two hours, night and day, develop dribbing of urine, have a long hesitation in starting the stream, and get an infection in the bladder or kidney with chills, fever or pain. If the urine shows continued infectious material in its contents and if the bladder doesn't empty completely even if you are voiding, then the obstruction is unrelieved.

What happens if I just can't urinate, try as I may? 

This is called acute, retention of urine. It means that the urine already present in the bladder cannot be expelled. Sometimes a hot bath and a sedative will allow for voiding. It is otherwise necessary to empty the bladder by drawing the urine out by means of a catheter.

What is catheterization? Is it painful? 

In the problem of acute retention the catheter is a relief affording friend. When this hollow rubber, silk or plastic tube is inserted into the bladder through the penile channel, it completely alleviates the pain due to the distention of the bladder by the retained urine. The urine is immediately released. The procedure is not painful if the catheter is well lubricated and the manipulation performed skillfully and in an unhurried fashion. There are many tricks of the trade in passing the catheter that are learned by experience and practice. Gentleness will avoid injury to the delicate lining membranes. It is especially important to observe sterile precautions to avoid introducing bacteria.

What is the significance of the fact that I had to have my urine taken from me by a catheter? 

In some individuals the catheter can be removed in a few days and they are able to void normally. In others the obstruction is so advanced that its removal only brings about a second episode of retention. These individuals require surgery. In an intermediate group it is evidence of progressive obstruction, which may require surgery in the future.

When is there no alternative to surgery? 

When there is uncontrolled infection, significant obstructive pressure on the other urinary organs, formation of bladder stones and or evidence of deteriorating kidney function (uremia). The congestion of the enlarged prostate may cause blood to appear in the urine. The veins in this area can become varicose and bleed easily.

What is cystoscopy? When is it necessary? 

This is a method of looking directly into the urinary bladder to evaluate the changes in its wall and in its contents. It is the only way to make a direct diagnosis of a bladder tumor, bladder infection or a bladder stone and to recognize the changes brought about by prostatic obstruction. The cystoscope is an instrument with a light, a lens and a water channel used for looking into the interior of the bladder. This is an operative procedure that must be done under sterile conditions. It can be carried out painlessly with any variety of anesthesia; local anesthesia is so effective that cystoscopy can be accomplished in a properly equipped office on an ambulatory basis. The information that it offers is the only way that allows for proper diagnosis and management of diseases in this area.

What makes the prostate become enlarged by glandular overgrowth? 

No one knows the precise answer to this except that it is related to hormonal changes. The older man in a sense becomes somewhat less masculine and more feminine  less facial hair and change in disposition of body fat are the most obvious external manifestations. Associated hormonal changes with possible decreased testicular function can bring about compensatory prostatic enlargement.

How frequent is this problem? The process is common. It affects about 50 percent of men in the sixty-five or older age group. What does enlargement mean? 
The organ increases in size (actually grows) within the confines of its original capsule and in so doing distorts its shape from a normally smooth regular surface to one that becomes nodular. It would be comparable to many bumps growing within and expanding and distorting the smooth surface of a plum. The actual weight of the organ may increase by ten to twenty times. The overgrowth of the gland is called prostatic hypertrophy. An infection in the gland is called prostatitis. An enlarged gland can also be infected.

The normal adult prostate is the size of a walnut and weighs about 15 grams. A moderately enlarged prostate (called +2) is the size of a lemon and weighs 15-50 grams. A greatly enlarged prostate (+3 or +4) can achieve the size of an orange or grapefruit and weigh 50-125 grams or even more.

How does the enlargement cause difficulty? 

The channel for the voiding of urine passes through the prostate. Prostatic enlargement may affect this flow by altering the shape, length, course, diameter or lining of this pathway. Any of these changes may result in impaired outflow of urine with increased backup pressure. This back pressure affects the bladder and then the kidneys. It is basically a mechanical block to urinary flow, which can then become secondarily complicated by congestion and infection.

Does everyone with an enlarged prostate have problems? 

Not necessarily. It depends on how the enlargement affects the urinary channel. It this is not changed appreciably, there will be no symptoms.

Thus there is no absolute correlation between the size of the gland and the symptoms. A small area of overgrowth strategically situated and altering the bladder outflow is more significant than a large overgrowth which doesn't affect the urinary channel.

What is the purpose of an operation for an enlarged prostate? 

The purpose of the surgical procedure is to eliminate the obstruction to urinary flow and to restore the patient to a normal frequency and force of urination with freedom from pain, infection and impaired kidney function.

How is the operation performed? 

It can be performed through an abdominal incision from within the urinary bladder (suprapubic prostatectomy) or from in front of the bladder (retropubic prostatectomy). In either procedure the overgrown portion of the prostate is shelled out from the capsule of the gland in the way that one removes an orange from within its peel. The entire prostate is not removed for benign obstructing overgrowth; only the excessive distorted portion is excised.

The operation can also be carried out from between the thighs by an incision just in front of the rectum; this is termed a perineal prostatectomy. It is the best approach for the removal of the entire gland and its appendages. A fourth approach carries out the corrective procedure through the penile channel without making an incision. In this transurethral operation a core of obstructing prostatic tissue is removed to reconstitute a good urinary channel. Each of these methods has specific advantages and disadvantages in its application to the particular patient and his special problems.

Many surgeons perform a simultaneous vasectomy. This renders the patient sterile but not impotent. It eliminates the painful scrotum swelling that formerly lingered for many weeks.

Are there any specific dangers associated with prostatectomy? 

The principal problem is bleeding, which in this area can be difficult to control. However, the urologist is particularly careful about this and makes every effort to avoid it completely and to manage it successfully when it happens. This problem has become less frequent in recent times.

The major danger of this disease and its operation is that many of the men are elderly and frail and thus subject to the complications of old age: pneumonia, blood disease, strokes, heart attacks and kidney failure. The danger is not in the technical aspects of the surgical procedure but in the general condition and fortitude of the patient's cardiovascular system.

Will my urinary problem be cured if the operation goes well? 

The vast majority of patients are well satisfied and almost all are improved. Some have temporary urinary dribbling, a few have incomplete control, and others have a poor urinary stream. A few patients require periodic stretching of the urinary channel. This is painlessly done in the urologist's office on an ambulatory basis. The relatively minor urinary inconveniences usually improve with time.

How long will I be in the hospital and what is the convalescent period? 

If the operation is done through the urinary channel, the hospital stay is about a week and many patients get around well by the third postoperative week. The abdominal procedure requires a two week hospitalization and a four week convalescent period. These are average figures for the uncomplicated cases.

What effect does prostatectomy have on sexual activity? 

The usual operation for prostatic overgrowth has no effect on sexual desire, which remains what it was before surgery. Sexual performance is not adversely affected. Those who were potent before remain so; those who were impotent before are not improved. The individual whose sexual powers are waning at the time of surgery may go either way. The most important change is that there is no sperm in the ejaculate. However, the sexual feeling and excitement are not altered in the potent individual.

How is early cancer of the prostate recognized? 

The surgeon suspects that the prostate contains a cancer when he feels a particularly hard, firm nodule in the gland during a rectal examination. In other instances the diagnosis is made on cystoscopic examination. The presence of cancer is confirmed by removing a piece of tissue for biopsy and microscopic examination. In a certain number of men the cancer remains locally confined for a long time. Early cancer of the prostate can be completely removed by a total prostatectomy.

What are the Signs and Symptoms of Prostate Cancer?

How did this prostate cancer get to be so advanced? 

Cancer of the prostate is a very common disease in old age. If it arises in an area that doesn't affect the urinary channel, it can become very large locally and have spread to the bones and lungs before it produces symptoms.

Most prostatic cancer is first diagnosed in an advanced stage. A simple blood test for the level of an enzyme (acid phosphatase) accurately indicates whether the cancer has spread beyond the local area.
It's possible to have cancer of the prostate in one part of the gland and benign prostatic hypertrophy in another area.

What can be done for advanced cancer of the prostate? 

Advanced cancer of the prostate is not treated by a radical surgical procedure. Fortunately the disease can be stabilized and antagonized but not cured by the administration of hormones. The effect can be pain relieving and long lasting.

In other men removal of both testicles significantly improves the results of hormone administration because it eliminates the principal source of the male hormone. The testes can be replaced with a prosthetic device so that there need be no cosmetic defect.

What is the sexual effect of removal of the testicles for cancer of the prostate? 

Removal of the testicles is, of course, castration. Because the cancer is usually encountered in the elderly male who is at the end of his active sexual life, it has less significance than it would have for a younger man. There are, obviously, striking exceptions to this. Castration results in impotence and sterility.


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