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Prostate Cancer

There are unexplained differences in the incidence of cancer of the prostate in different parts of the world: it is relatively uncommon in men of Japanese and Indian ancestry, and more common in those of African ancestry. It is twice as common in men of African-American descent and is more likely to present at an advanced stage. The number of reported cases seems to be increasing, but this may be due to an increased awareness, the growing number of elderly men who are surviving, and better ways of making the diagnosis.

Introduction of the PSA blood test in the late 1980's enhanced prostate cancer detection. A dramatic increase in the detection rate in the early 1990's was followed by a subsequent decline and was thought to be due to detection of early small tumours. Cancer which is found by an elevated PSA or a prostate nodule on digital rectal examination is referred to as a clinical cancer. Cancer found only at autopsy is called a latent tumour. However the total annual number of new cases shows an increase and this is frequently interpreted in an alarmist way to justify screening programs.

What is Prostate Cancer?

The risk of prostate cancer rises with age or in men with a family history of the disease. It's rare in men under 50 but gets progressively more common later in life, Prostate cancer is the most common non-skin cancer in men. At the age of 50 about 15% of prostates contain islands of cancer: by 80 the figure is nearly 100%. Cancer of the prostate accounts for less than 0.5% deaths in each age group over the age of 60. Prostate cancer is also diet related - a high fat diet may increase your risk - and becoming more common with rising levels of obesity and diabetes in Western countries.

All prostate problems present similar symptoms, particularly difficulty in passing urine, which might mean frequent nightly toilet breaks, poor urine flow and strain or pain when urinating or ejaculating. Other symptoms including lower back pain, pain in the hips or pelvis and erection problems can also be caused by other problems. A less common symptom is blood in the urine but this is unusual
Prostate cancers develop differently in different men, some growing slowly or staying dormant for many years and causing no problems and some growing quickly and needing early detection and treatment. Prostate cancer develops when a single cell in the prostate begins to multiply out of control and forms a tumour. Some cells may break away and travel to other parts of the body, starting new tumours. Prostate cancer is treatable and can be cured in many cases.

Read more about treatment for Prostate Cancer

Anatomy

The prostate gland is found only in the male reproductive system, being located below the bladder and surrounding the tube (urethra) that carries urine from the bladder to the penis. Any enlargement of the gland therefore tends to constrict urine flow through the tube, giving early indications of possible problems. The prostate is normally about the size of a walnut and is very important for a man's sex life, producing some of the fluid in semen, which mixes with the sperm produced by the testes. It also produces a protein called prostate-specific antigen (PSA) that turns the semen into liquid. When something goes wrong with the prostate, it can affect a man's sex life, his long-term health and with prostate cancer can lead to death. There is a consistent rise in the aging male in the size of the prostate and therefore the level of PSA which although normally secreted into semen or lost in urine, also spills over into the bloodstream where it can be measured.

The gland is surrounded by a sheet of muscle and a fibrous capsule. The growth of prostate cells and the way the prostate gland works is dependent on the male sex hormone, testosterone, which is produced in the testicles.
The rectum (back passage) is close to the rear part of the prostate gland. Near to the prostate are collections of lymph nodes. These are small glands, about the size of a bean.

Assessment

Following consultation with your doctor, he or she may do some of the following tests or refer you to a hospital specialist (urologist).

  • A digital rectal examination (DRE) enables your doctor to feel your prostate through the wall of your rectum. By inserting a lubricated, gloved finger into your rectum your doctor will detect hardening or irregularity of your prostate, indicating cancer.
  • A PSA blood test will test the amount of prostate-specific antigen (PSA) in a sample of your blood. PSA is produced both by normal and cancerous prostate cells and high levels of PSA may indicate cancer but could be caused by other prostate diseases.
  • Next, your doctor may recommend prostate biopsy, a surgical procedure to take a small piece of tissue using a needle. This will be examined in a laboratory to confirm if it is a tumour and how fast it is growing.
  • A PCA3PlusTM test is a urine-based molecular test for patients who have elevated serum PSA and a negative biopsy result. Used to determine which men should have a follow-up biopsy, it is an extremely accurate predictor for prostate cancer.

 

Bladder Cancer

There are more than 3000 deaths from bladder cancer each year in the UK, mainly in people aged over 55. It's rare in people under 40 and Caucasian (white) people are significantly more at risk than those of African or Asian origin. Although the death rate amongst women has remained the same for a long time, the death rate amongst men is slowly dropping. Research has identified some possible causes but the major risk factor in the UK is cigarette smoking, causing 50% of cases in men and 30% in women. Cigarette smoke contains chemicals known to be carcinogenic with increasing risk the more cigarettes are smoked. Workplace chemicals and prolonged exposure to them are the other main cause of bladder cancer, for example, those used in dye factories, rubber, gasworks, plastics and other chemical industries. These chemicals were banned in the UK in 1967. However, it can take about 25 years after exposure to the chemicals for bladder cancers to develop. If you think that you were exposed to certain chemicals through your work, let your cancer doctor know. You may be able to claim Industrial Disease Benefit from the Department of Social Security.

In parts of the world where bilharzia (a chronic parasitic infection of the bladder) is common, there are many cases of cancer of the bladder. This infection does not occur in the UK, but can affect people who have lived in Africa, and such countries as Iraq or Egypt where it is associated with an infection of the bladder called schistomiasis, which is endemic in those countries.

What is Bladder Cancer?

Bladder cancer is more common than people realise. Over 10,000 cases are diagnosed each year in the UK. The majority of these (about 7,500) are diagnosed in men, meaning that, on average, one man in thirty will get bladder cancer at some time in his life. Bladder cancer occurs most commonly in people between 50 and 70 years of age. It is twice as common in men as in women. Bladder cancer is very rare in men and women younger than 40 years of age.

The most common symptom is blood in the urine, although there are many other conditions (such as bladder infections) which can cause this. The other less common symptoms (frequency of urination and pain when urinating) can also have other causes.

Read more about treatment for Bladder Cancer

Anatomy

The bladder is a hollow, muscular, balloon-like organ that collects and stores urine. It is in the lower part of the abdomen (the pelvis). Urine consists of water and waste products not needed by the body. The bladder is lined with a urine-proof membrane which stops the urine being absorbed back into the body. The cells of this membrane are called transitional cells or urothelial cells, and the lining membrane is called the urothelium.

The two kidneys produce urine, which is carried to the bladder by two tubes called ureters. The bladder stores the urine, and when it is full enough, nerve signals are sent to the brain. To get rid of the urine, the muscle of the bladder contracts, forcing the urine out of the body through a tube called the urethra.

  • In women, the urethra is a very short tube in front of the vagina.
  • In men the tube is longer and passes through the prostate gland and the penis. 

Bladder cancer spreads by extending into the nearby organs, including the prostate, uterus, vagina, ureters, and rectum. It can also spread to the pelvic lymph nodes or to other parts of the body, such as the liver, lungs and bones.

Diagnosis

If a patient shows symptoms that suggest bladder cancer, the doctor may check general signs of health and may then order lab tests and one or more of the following procedures:

  • Physical exam: The doctor feels the abdomen and pelvis for tumours. The physical exam may include a rectal or vaginal exam.
  • Urine tests: The laboratory checks the urine for blood, cancer cells and other signs of disease.
  • Cytoscopy: The doctor inserts a thin, lighted tube, called a cystoscope (a tube with a small camera on the end), through the urethra and into the bladder to examine the lining. The patient usually does not need anaesthesia for this procedure.
  • Intravenous pyelogram (IVP): An iodine-based contrast dye is injected into a vein and then a series of x-ray type images are taken at timed intervals. As the kidneys are responsible for removing contrast dye from the blood, it then collects in the urine in the bladder and shows up on the x-ray. This test is designed to study the kidneys, bladder, and ureters (the tubes which carry urine from the kidneys to the bladder). Abnormalities in the appearance of the kidneys or ureters, abnormalities in the distribution of contrast within a kidney, unequal amounts of dye in each kidney, or abnormalities in the collecting systems can be identified. These all suggest particular diseases and conditions.

Doctors

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