Understanding Prostate Cancer: Melchiore Buscemi MD's Perspectives and Information

In men, the prostate is a tiny organ with a walnut-like form. It is situated halfway between the aperture of the bladder and the base of the penis. The prostate performs two jobs. Helping with urinary control is its primary purpose. The prostate also creates a fluid that feeds and carries sperm. A protein called PSA aids in the maintenance of the liquid form of semen. To accomplish fertilization, the sperm must remain in this liquid form. The prostate gland changes in numerous ways as men age. These modifications include prostate hypertrophy without cancer and the development of malignancy.

Vaginal difficulties may result from prostate enlargement. The proportion of males with subclinical prostate cancer rises with age. Men aged 70 and older will have some prostate cancer in 70% of cases; however, few will require treatment. About 15% of men with subclinical prostate cancer may eventually acquire a cancer diagnosis, although only 2-3% of those will pass away.

The PSA test has offered males a higher chance at early diagnosis despite the unavailability of blood diagnostics for breast cancer. Although PSA is a hormone that all men generate, it should only be seen in semen, not blood. Although an increased PSA doesn't always indicate cancer, it indicates a problem with the prostate gland, necessitating a urologic assessment and workup. Prostate cancer is more likely to exist if the PSA level keeps increasing.

PSA testing has undergone further lab testing over the past few years. To reduce the need for unneeded prostate biopsies, this examination led to the determination of a Percent Free Ratio, Prostate Health Index, and numerous urine investigations. It is conceivable to have a tiny tumour that is not palpable on a rectal exam or visible on X-ray imaging, even if a sample is required to prove malignancy. It can result in a falsely negative biopsy.


What precisely causes prostate cancer is uncertain. If a direct family member develops prostate cancer, especially if discovered before age 60, there is a six-fold increased chance. It is four times more likely to occur if a direct family member is diagnosed at age 80 or later than it would be otherwise.


There is no reliable prostate cancer preventive strategy. According to statistics, being obese, eating improper foods, and consuming excessive animal fat increase risk. Free radicals are created in the blood by nitrates and animal fat. Also, it is thought that if cancer is already present, these free radicals will accelerate its development.


According to the American Cancer Association, males should start getting a PSA screening at age 50. Especially among black males with a family history of prostate cancer or voiding issues, many urologists begin PSA screening around age 40. A significant push was to test all males beyond 50 years ago. Data over time has demonstrated that this frequently resulted in unneeded therapy. Once one approaches 75, this unneeded therapy is especially appropriate. We must select males reasonably likely to live longer as the mean age rises.

Annual PSA levels during testing may rise, as previously mentioned. A PSA growth of more than 0.5% per year is alarming. Urinary symptoms, microscopic hematuria (blood in the urine), or blood in the ejaculate can all occur in particular males. Men over 40 should get a digital rectal exam (DAE) every year. If cancer is suspected, your urologist could advise a prostate ultrasound, MAI, and biopsy. Since they develop in the prostate gland, most malignancies are adenocarcinomas. Sometimes, the urethra that passes through the prostate might develop transitional cell carcinoma.


Your urologist will advise a prostate biopsy if the results of the DRE and PSA indicate that cancer has to be ruled out. You'll need an ore-oo antibiotic and a Fleet enema to get ready for this surgery. The patient is turned onto their side for the treatment. A transrectal probe is implanted. In full view, a needle is inserted via the probe. Specific equipment is used to drive or shoot the needle into the prostate tissue that has to be examined. 1 to 2 cm are put into the prostate. To evaluate every aspect, more samples are required for bigger prostates. Biopsies typically have 12 to 16 cores. Infections and bleeding in the urethra and rectum are uncommon.

Age, health status, tumour grade, stage, and voiding symptoms all factor into treatment options. Many elderly individuals with small-volume cancer and a Gleason score of six are given the option of an observation. Both radical robotic surgery and the implantation of brachy radiation seeds are options for definitive therapy in younger individuals with an illness that is thought to be organ-confined. External radiation and cryofreezing are used for older patients with a higher risk of early metastases or who cannot undergo surgery requiring general anaesthesia.

Therapy for Metastasis:

Most patients will see some remission with the reduction of testosterone, regardless of whether they had an advanced illness at the time of diagnosis or after therapy, showing a rising PSA. The testicles are either removed or leuprolide acetate, which will put the testicles to sleep, is injected. Remissions might range in length for many people. Tumours with smaller volumes and lower grades have the best prognosis. Ideally, it won't take too long until the PSA starts to climb. Your doctor may suggest other anti-androgen treatments if your PSA level increases. Prednisone can cure pain and malaise symptoms when other treatments are ineffective, and bone radiation can treat metastatic discomfort. Andropause is brought on by testosterone deprivation ( male menopause.)


The grade and stage of one's cancer are compared to establish one's prognosis. Cells are examined under a microscope to provide grades. The sample will be graded between 1 and 5, with 5 denoting the most aggressive cancer. Grades 1 and 2 are uncommon; most students are given grades (3 - 4.) Several body parts may be affected by prostate cancer at once, and each area's grade may differ. A Gleason score was developed to categorize cancer due to the multifocal nature of prostate cancer. The two well-known cancer grades are added to arrive at this conclusion. The number increases by two if a biopsy only reveals one grade. The Gleason scale goes from 2 to 10. Very few scores are rated between two and five (6 - 8.) Around 10% of scores are categorized as (9 - 10.) To assess the extent of cancer beyond the gland, ultrasonography, MRI, bone, and CT scans are used to evaluate the amount of cancer in one or both prostate lobes.

If your doctor advises stopping PSA screening due to age, you must firmly insist on continuing the test if you disagree. If the Gleason score is below eight and there is only a tiny amount of cancer, I think it is fair for people to continue being observed. Larger cancer volumes and high-grade tumours do not react well to any treatments. The patient must communicate openly with their urologist and insist on thorough explanations of all alternatives and hazards.

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