Prostate Cancer
1/7 men will get prostate cancer in their lifetime
14-16%, 1/36 men will die
Seminal Vesicle
Accessory gland that produces a nutrient rich solution which is a major component of semen. The nutrients they contribute are used by the sperm cells to fuel their movement through the female reproductive tract.
Prostate Gland
Accessory gland that produces a thin milky white fluid that contains nutrients for sperm. This gland is doughnut shaped and is wrapped around the prostatic urethra. It is roughly the size of a chestnut, but enlarges naturally as a man ages
PSA stands for Prostate Specific Antigen
An antigen is a type of protein. This test has been used since the 1980's. Until recently, many doctors encouraged yearly PSA screening for men beginning at age 50.
Vas Deferens
During sexual activity, sperm cells travel from the epididymis up the right and left vas deferens into the body cavity. The vas deferens loop over the ureters of the urinary system and arrive at the prostate gland. The sperm then travel into a "tunnel" through the prostate gland called the ejaculatory duct
needle biopsy
If prostate cancer is suspected (for example due to high PSA numbers) A biopsy is the removal of some tissue for analysis. To remove the tissue a biopsy gun is inserted into the rectum and 6-18 needle samples are removed from the prostate tissue. During a biopsy analysis, the cells are identified as cancerous or non-cancerous and genetic analysis may be performed to identify what type of cancer cells are present
This image shows changes in estrogen in women and testosterone in men with age.
In men, testosterone declines with age but not abruptly. This decline in testosterone leads to physiological changes.
common treatment for an enlarged prostate includes a transurethral resection of the prostate
In this process, a resectoscope is inserted into the penile urethra up to the enlarged prostate. At the prostatatic urethra, an electrical loop is extended which removes excessive tissue and thus opening up the urethral orifice
second most common form of cancer in men after skin second most common cause of death after lung cancer
Prostate cancer is a very common form of cancer in men, and it is common cause of cancer death
side effects of radiation
Radiation treatments can impair sexual functioning (although risk is much less than with prostatectomies) and the radiation may not kill all the tumor cells allowing for the tumor to grow back again
Epididymis
Site of sperm cell maturation. The epididymis is a chamber sitting on top of each testis. Sperm are stored and mature inside the epididymis.
PSA is produced by healthy prostate cells
Some PSA regularly "leaks" into the bloodstream and it is here that it can be tested for. When a prostate enlarges (especially with cancer), PSA levels increase. If extremely high levels of PSA are detected in the blood, then cancer is suspected. This graph shows the normal increase in PSA found in men as they age. While men in their 40's typically have a PSA level of around 2.5, PSA can naturally increase to 6.5 or higher in men in their 70's. In the case of prostate cancer, these numbers can reach double their normal range or even higher
This slide shows the progression of prostate cancer from a very early stage to metastasizing. In most men, it takes many years to go from stage A to D.
The earlier that prostate tumors can be found, the more successful surgery will be and the better the chances of survival.
Gleason score
The potential for prostate cancer to spread can be expressed as a . . . It is the spread of cancer cells that results in death from cancer a system of grading prostate cancer tissue based on how it looks under a microscope, ranges from 2 to 10 and indicate how likely it is that a tumor will spread-low score is similar to prostate tissue and tumor less likely to spread, high-cancer tissue is diff from normal
healthy prostate
The prostate gland is located below the urinary bladder and the urethra passes through the prostate gland It is about the size of a walnut until around age 50. After 50, the prostate gland will naturally begin to enlarge in many men
prostate cancer risk factors
The risk of having prostate cancer increases with a age Men 60 - 79 yrs old have a risk of 1 in 7 of being diagnosed with prostate cancer. Family history, ancestral background and occupation (farmers) can have effects on each individuals risk factors
Erectile Tissue
These three columns of tissue are permeated by blood sinuses. Upon arousal, the arteries of the penis dilate and blood enters the sinuses producing an erection.
Inside the testes within the scrotal sac are many coiled tubules called seminiferous tubules
These tubules are the site of sperm production. Millions of sperm cells are created daily
Penile Urethra
Tube that transports both urine and semen from the male body by way of the penis.
Prostate cancer is a relatively slow growing cancer
When localized in the prostate, it is usually not fatal, but does cause discomfort. It is after prostate cancer metastasizes (breaks up and spreads) to other locations of the body that it becomes life-threatening
prostate cancer increases dramatically as a man ages
While only an estimated 100 men under the age of 50 died due to prostate cancer in 1999, 10,000 men over 85 succumbed to the disease African Americans have the highest incidence and mortality from prostate cancer
side effects of hormonal therapy
although relatively affective, can impair sexual functioning and does not eliminate the tumor cells. Instead of killing the tumor cells, it only halts (or slows) their growth
Hormone therapy
an alternative approach for those who do not want to undergo surgery or radiation. Drugs are administered that block the production of testosterone from the cells of the testes (chemical castration). Because testosterone is responsible for accelerating cell growth in the body, eliminating it's production can slow or stop tumor growth in the prostate. Side effects include feminization of the body (because testosterone will no longer be present). Furthermore, the cancer cells are not removed or even killed
Radioactive Seed Implants -
are small pellets of radioactive material (the size of rice grains) that are inserted into the prostate gland where they deliver their radiation treatment from inside the body. These pellets deliver twice the dose of radiation as external beam radiation and are left in place when they are done delivering the radiation.
Semen
composed of millions of sperm cells from the testicles along with the fluids produced by the seminal vesicles, the prostate gland, and the bulbourethral glands. on average 280 mil sperm per ejaculate and twin into fallopian tube within about 12 hours and live for 4 days
prostate cancer is much more prevalent than lung cancer, it's death rate is much lower
f 200,000 cases of prostate cancer diagnosed, only about 40,000 resulted in death. Lung cancer on the other hand is much more deadly with almost all of the approximately 100,000 cases diagnosed resulting in death. This is due in part to better treatment of prostate cancer
Beam radiation treatments -
high doses of radiation are aimed at the prostate cancer in order to kill the cancerous tissue. This approach is good for those who cannot withstand the physical demands of a surgery or those who want to reduce the risk of side effects such as incontinence and impotence.
Benefits to PSA test
include that men are more likely to subject themselves to a simple blood draw than to a digital rectal exam. Most importantly, however, a PSA test can detect cancers much earlier than a digital rectal exam which gives doctors an earlier diagnosis and more time to treat appropriately
Because of the nerve damage, most men who have prostatectomies suffer from
incontinence (difficulty controlling urination) and impotence (difficulty in achieving an erection). The incontinence usually diminishes over time as some nerve damage heals, but impotence is often permanent
Radical Prostatectomy -
involves the complete removal of the prostate gland. Requires an incision from the naval to just above the penis. This fully removes any suspicious tissue and almost completely ensures no prostate cancer can remain in the body if the surgery is performed before the cancer leaves the prostate. However, the side effects to this treatment include the potential damage to nerves which control erection and urine flow from the bladder
Nerve-Sparing Prostatectomy -
involves the removal of a portion of the prostate gland that contains the suspicious tissue. This approach leaves more of the nerve tissue intact which greatly reduces the risk of impotence, but prostate tissue is left in place which may mean a return of prostate cancer.
Metastatic prostate cancer
often spreads to the lymph nodes around the colon and into the bones of the spine where it causes severe pain and possibly death.
Negative aspects of a PSA test
overly sensitive. Some elevated PSA levels can be due to recent sexual activity, use of certain medications, or just a naturally enlarged prostate and can, therefore producing false positives. Also, the PSA only detects approximately 80% of prostate cancers
Bulbourethral (Cowper's) Gland
pair of glands found at the base of the penis, underneath the prostate gland. These glands secrete an alkaline secretion during sexual activity which will protect the sperm cells from the acid environment of the penile urethra and the female reproductive tract. The fluid also serves as lubrication
enlarged prostate
restricting the urethra which can cause difficulty when urinating.
pathway of sperm
seminiferous tubules in testes stored in epididymis vas deferens urethra (accessory glands-seminal vesicles, prostate gland, bulbourethral glands/cowper's gland) exit body At the urethra, the sperm are accompanied by fluids that are produced by the accessory glands
Testis (testes)
site of gamete formation (sperm or spermatozoa) and testosterone production. The testis contains many coiled tubes called seminiferous tubules. The testes are located in the scrotum which suspends the testes outside of the body cavity where they are kept cooler than normal body temperature (essential for proper sperm cell development)
Prostatic Urethra
small portion of the urethra that passes through the center of the prostate gland and empties into the penile urethra. Note: the urethra is a common passageway for the urinary and reproductive system
urethra is restricted by an enlarged prostate
the bladder is unable to empty completely. This can cause distension of the bladder and dilation of the ureters as urine "backs up" towards the kidneys. This can cause extreme discomfort and potentially damage the tissue of the kidneys
When testosterone levels decline
the hypothalamus and pituitary respond by increasing their production of GnRH, FSH, and LH. This process keeps testosterone and sperm production under control and at a relatively constant level
"digital" rectal exam cannot identify the earliest stages of prostate cancer (stage A) but often find tumors at stage B before they have begun to swell out of the prostate tissue and before metastasis.
the physician inserts a gloved and lubricated finger into the rectum and feels the back of the prostate gland through the wall of the rectum. If there are growths on the back of the prostate gland, they can often be felt this way. Advantages to digital rectal exams include that they are inexpensive to perform and they are available to anyone as no special equipment is needed to conduct them. Digital rectal exams become common during physicals after age 40 for most men. Men with higher risk factors may start having digital rectal exams earlier
testosterone levels rise due to the action of FSH and LH
the testosterone has an inhibiting effect on the pituitary and hypothalamus which causes their hormone production to decline
Testosterone
then travels from the testes through the bloodstream where it targets many tissues throughout the body. Testosterone is responsible for male secondary sex characteristics. It stimulates growth of many body tissues including muscle, bone, and cartilage, as well as influencing male sex behavior and aggression
FSH (Follicle Stimulating Hormone) and LH (Lutenizing Hormone)
travel through the bloodstream to the testes where it causes the cells of the seminiferous tubules to begin producing the male gametes (sperm cells, spermatozoa). These hormones also stimulates the testes to begin production of testosterone
factors not causing prostate cancer
vasectomies, bicycling, sexual frequency
pituitary gland
where it causes the pituitary to begin it's production of FSH (Follicle Stimulating Hormone) and LH (Lutenizing Hormone)
Watchful Waiting
where the doctor monitors the prostate tumor, but waits to treat it aggressively In older men, prostate cancer may spread so slowly that they will probably die of other diseases