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Prostate Cancer

    For a gland that looms so large in the male psyche, the prostate is surprisingly unimposing, tipping the scales at a mere half an ounce. The prostate, located under the bladder and in front of the rectum, is actually a composite of 30 to 50 smaller glands. These subglands, which produce the fluid that contributes to semen, are organized into five lobes, all held together and in place by a more or less tough covering.
    Two factors give this male sex gland such a disproportionate influence in a man's life. One, it occupies a strategic position, wrapped around the neck of the bladder, where urine is stored, and the urethra, the tube though which the urine is discharged. What's more, in the sixth decade of life, the gland usually begins to enlarge. So pervasive is the process, that about a quarter of men in their early fifties, half the men in their sixties, and three quarters of those 70 and older have enlarged prostates.
    Many experts attribute this growth spurt to a change in hormonal balance, in particular the male sex hormone testosterone. When a boy reaches puberty, a rising tide of testosterone prompts the tiny prostate to grow to its walnutlike size. The gland remains stable until the early fifties, when hormones once again stimulate-growth, by as much as 45% every 10 years. Given the prostate's position around the bladder and urethra, severe enlargement can trigger urinary problems.

Signs and symptoms of prostate cancer

- frequent urination, particularly at night
- difficult holding back urine or starting urination
- weak or interrupted urine flow
- pain or burning upon urinating
- inability to urinate at all
- painful ejaculation
- bloody urine or semen
- chronic pain or stiffness in the lower back

Treatment

    Prostate cancer is typically treated through surgery, radiation therapy, hormone therapy or a combination of these methods. A radical prostatectomy entails the surgical removal of the entire prostate as well as bordering tissues. Until recently, many men found this option abhorrent, perhaps understandably. In order to reach the gland, surgeons generally made an incision through the area hosting the nerves that control erections and the opening of the bladder.
    As a result, the operation left many men impotent and unable to control urination. But the technique has since been refined so that the crucial nerves may be bypassed, thus reducing the chances of incontinence and sexual dysfunction. Patients with stage 3 tumours usually receive external or interval radiation, while the primary form of treatment for stage 5 cases is hormonal therapy. This may be carried out in one of several ways:

1) Patients are administered the female sex hormone estrogen to stop the testicles from producing testosterone.

2) Daily or monthly injections of luteinising hormone-releasing hormone (LHRH) agonist, a synthetic substance that also prevents testosterone production.

3) Orchiectomy, the surgical removal of the testicles, the main source of male hormone production.

    Oddly enough, sometimes the most sensible medical response to prostate
cancer is to do nothing at all. By and large, the malignancy is
extraordinarily indolent or slow growing. Whereas breast cancer may double
in size every three months, some prostate tumours can take two to four years
to achieve such growth. As a result, there are instances when prostate
cancer is, relatively speaking, a minor threat.