Cancer of the Prostate

The prostate gland is located at the base of the penis, just below the bladder and in front of the rectum.

Symptoms

Prostatic symptoms are usually caused by enlargement of the prostate and are very common in men over 40. Such enlargement can either be benign or malignant and the symptoms they cause vary from difficulty in urinating, to dribbling, or difficulty in holding back urine. Enlargement which blocks the free-flow of urine is usually benign ((non cancerous) and the condition is relieved by surgical removal of part or of all the prostate.

Prostatic cancer, which can be treated either by surgery, radiotherapy or hormonal therapy, spreads readily outside the prostatic gland to the skeleton, in particular the pelvis and lower spine. It is only very rarely that cancer of the prostate develops without giving urinary difficulties, in which case the first sign of trouble may be low backache due to metastatic spread to the bone.

Diagnosis

Cancer of the prostate is revealed on internal examination as a rather irregular and unusually firm area in the otherwise smooth, soft prostatic gland. Only a biopsy will clinch the diagnosis and establish whether or not the growth is malignant.

Treatment

It is not unusual for elderly patients to have cancerous cells present in the prostate. In most of these patients the disease is harmless and therefore no aggressive treatment may be necessary because the cancer is growing so slowly that it is unlikely to cause any complications or spread outside the gland.

In cases where the tumour has not spread but is actively growing, removal of the prostate is necessary. An alternative treatment is radiotherapy which attempts to destroy the growth by means of radiation.

The prognosis, as well as the patient’s comfort and general condition, is determined by the eventual spread of cancer outside the prostatic gland. Very rarely this spread may occur at a time when rectal examination does not reveal any abnormality in the prostate.

Since the prostate is under hormonal control of testosterone produced in the testes, removal of the testes (castratiom or orchidectomy) sometimes influences the spread of the disease and may temporarily relieve the discomfort due to bone pain.

Cancer affecting other genital organs of the male, mainly the scrotum and penis is fortunately uncommon and usually treated by surgery or radiotherapy. More frequent is cancer of the testis, which will be described elsewhere.