CARCINOMA OF PROSTATE

CARCINOMA OF PROSTATE

Definition

• Carcinoma of prostate is a type of cancer that originates in the prostate gland.

Pathology

• Most prostatic cancers are adenocarcinomas.
• The cancer cells may be well-differentiated, moderately differentiated, or poorly differentiated.
• The cancer cells may have a glandular, cribriform, or solid pattern.
• The tumor may invade the surrounding tissues and may metastasize to lymph nodes, bones, or lungs.

Types

• Adenocarcinoma (most common type)
• Squamous cell carcinoma
• Transitional cell carcinoma
• Small cell carcinoma
• Neuroendocrine tumors

Causes

• The exact cause of prostatic cancer is not known, but several factors are associated with an increased risk:
  • Age: Risk increases with age.
  • Family history: Men with a family history of prostatic cancer are at increased risk.
  • Ethnicity: Men of African descent are at increased risk.
  • Diet: A diet high in animal fat and low in fiber may increase the risk.
  • Genetics: Mutations in the BRCA2 gene may increase the risk.

Clinical Features

• Most men with prostatic cancer are asymptomatic in the early stages.
• As the tumor grows, it may cause:
  • Urinary problems: Difficulty starting or stopping the flow of urine, weak urine flow, or frequent urination.
  • Blood in the urine or semen.
  • Pain in the back, hips, or pelvis.
  • Weight loss.
  • Fatigue.
  • Weakness.

Investigations

• Digital rectal examination (DRE): To feel the prostate gland.
• Prostate-specific antigen (PSA) test: To measure the level of PSA in the blood.
• Ultrasound: To visualize the prostate gland and surrounding tissues.
• Biopsy: To collect a sample of tissue from the prostate gland for examination under a microscope.
• Imaging studies: To detect metastases to lymph nodes, bones, or lungs.

Complications

• Urinary tract problems: Urinary retention, incontinence, or frequency.
• Bone pain or fractures.
• Neurological problems: Weakness, numbness, or paralysis.
• Metastases to lymph nodes, bones, or lungs.

Management

• Active surveillance: Monitoring the cancer with regular check-ups and biopsies.
• Watchful waiting: Delaying treatment until symptoms appear.
• Surgery: Removing the prostate gland, surrounding tissues, or lymph nodes.
• Radiation therapy: Using high-energy rays to kill cancer cells.
• Hormone therapy: To reduce the production of male hormones, which can fuel the growth of cancer cells.

Treatment

• Radical prostatectomy: Removing the prostate gland. Step 1 → Step 2 → Step 3 Step 1: Make an incision in the abdomen to access the prostate gland. Step 2: Identify and isolate the urethra and seminal vesicles. Step 3: Remove the prostate gland, surrounding tissues, and lymph nodes.
• Radiation therapy: Step 1 → Step 2 → Step 3 Step 1: Position the patient for radiation therapy. Step 2: Deliver high-energy rays to the prostate gland and surrounding tissues. Step 3: Monitor the patient for side effects.

Homeopathic Therapeutic Medicines

• Lycopodium: Indicated for urinary problems, such as difficulty starting or stopping the flow of urine.
• Calcarea carbonica: Indicated for weakness, fatigue, or weight loss.
• Phosphorus: Indicated for urinary problems, such as frequent urination or blood in the urine.
• Conium: Indicated for neurological problems, such as weakness, numbness, or paralysis.

Blood Supply

• The prostate gland receives its blood supply from the following arteries:
  • Prostatic arteries
  • Vesical arteries
  • Urethral arteries

Nerve Supply

• The prostate gland is innervated by the following nerves:
  • Autonomic nerves (sympathetic and parasympathetic)
  • Somatic nerves (pudendal nerve)

Clinical Anatomy

• The prostate gland is a small, walnut-sized gland located in the pelvis.
• It surrounds the urethra and is adjacent to the seminal vesicles.
• The prostate gland is divided into three lobes: anterior, posterior, and median.

Carcinoma of Prostate

Pathology and Histological Grading of Carcinoma of Prostate including Gleason Score

• The prostate gland is a gland in the male reproductive system that surrounds the urethra and is located below the bladder.
• The most common type of cancer in the prostate gland is adenocarcinoma.
• Histological grading of carcinoma of prostate is done using Gleason score, which is based on the pattern of tumor cell growth.
• The Gleason score ranges from 2 to 10 and is calculated by adding the scores of two different patterns of tumor cell growth.
• The Gleason score is used to determine the aggressiveness of the cancer and to plan treatment.

Clinical Features including Digital Rectal Examination Findings

• Carcinoma of the prostate can cause symptoms such as difficulty urinating, frequent urination, and painful urination.
• Digital rectal examination (DRE) is a common method used to detect prostate cancer.
• During a DRE, a doctor inserts a gloved finger into the rectum to feel the prostate gland for any abnormalities.
• A hard or irregularly shaped prostate gland may be a sign of cancer.

TNM Staging of Prostate Cancer

• The TNM staging system is used to classify the extent of the cancer in the prostate gland, lymph nodes, and other parts of the body.
• The stages of prostate cancer are:
  • Stage I: The cancer is confined to the prostate gland.
  • Stage II: The cancer has spread to the surrounding tissues but not to the lymph nodes or distant parts of the body.
  • Stage III: The cancer has spread to the seminal vesicles or lymph nodes.
  • Stage IV: The cancer has spread to distant parts of the body, such as the bones or liver.

Diagnostic Evaluation including PSA, MRI, CT, Biopsy, Bone Scan, and Lymph Node Assessment

• Diagnostic evaluation for prostate cancer includes prostate-specific antigen (PSA) test, magnetic resonance imaging (MRI), computed tomography (CT) scan, biopsy, bone scan, and lymph node assessment.
• PSA test is a blood test that measures the level of PSA in the blood, which can indicate the presence of prostate cancer.
• MRI is used to visualize the prostate gland and surrounding tissues.
• CT scan is used to visualize the prostate gland and surrounding tissues, as well as other parts of the body.
• Biopsy is a procedure in which a doctor removes a small sample of tissue from the prostate gland for examination.
• Bone scan is used to detect cancer that has spread to the bones.
• Lymph node assessment is used to detect cancer that has spread to the lymph nodes.

Management of Carcinoma of Prostate

• The management of carcinoma of prostate depends on the stage and aggressiveness of the cancer.
• Treatment options include:
  • Active surveillance: This involves regular monitoring of the cancer with PSA test, DRE, and biopsy.
  • Radiation therapy: This involves using high-energy rays to kill cancer cells.
  • Surgery: This involves removing the cancerous part of the prostate gland.
  • Hormone therapy: This involves using medications to reduce the levels of male hormones, such as testosterone, which can fuel the growth of prostate cancer cells.

Homoeopathic Therapeutics for Carcinoma of Prostate

• Homoeopathic therapeutics for carcinoma of prostate include:
  • Calcarea carbonica: This is a homeopathic remedy that is used to treat prostate cancer that is accompanied by symptoms such as fatigue, weakness, and a loss of appetite.
  • Lycopodium clavatum: This is a homeopathic remedy that is used to treat prostate cancer that is accompanied by symptoms such as difficulty urinating, painful urination, and a feeling of incomplete emptying of the bladder.
  • Silica: This is a homeopathic remedy that is used to treat prostate cancer that is accompanied by symptoms such as a hard or irregularly shaped prostate gland, difficulty urinating, and painful urination.
  • Thuja occidentalis: This is a homeopathic remedy that is used to treat prostate cancer that is accompanied by symptoms such as a hard or irregularly shaped prostate gland, difficulty urinating, and painful urination.

Complications of Prostate Cancer

• Complications of prostate cancer include:
  • Urinary incontinence
  • Urinary frequency
  • Painful urination
  • Difficulty urinating
  • Erectile dysfunction
  • Infertility
  • Bone metastases
  • Lymph node metastases