The cancer growth
The symptoms
- hesitancy in urinating, urgency, especially during night, incomplete voiding, stream weakness; sometimes blood in urine or sperm.
- bone pains; signalling extension to skeleton; pains in legs, hips, backbone.
The diagnosis
- clinical examination: digital palpation of rectum by trained professional;
- the tumor markers: the PSA assay: the cut-off is 4.0 ng/ml. When level is between 4 and 10 ng/ml, there is doubt: there can be a benign prostatic hyperplasia (adenoma). The difference between cancer or benign condition can be greatly helped by measuring the FPSA (free PSA ) and ratio FPSA/ PSA : normally, it is higher than 0,25: the lower the ratio, the higher the risk for cancer.]
- transrectal ultrasound.
- instrument biopsies, for evaluation of the location and size of the tumor. Since they are not without risk, these biopsies often can be avoided with the FPSA assay.
The treatment
it depends on the tumor stage when discovered: whether localised (limited to capsular invasion), or enlarged. Some medical teams advise just a simple surveillance for limited forms; this does not mean exemption from treatment, and in particular, hormone therapy.
- surgery: radical prostatectomy, or partial prostatectomy;
- radiation: huge advances in machines and protocols;
- hormone therapy: aimed at lowering the testosterone level: this is hormonal ablation. Meaning impotence and hot flashes;
- chemotherapy: rarely used.
The post-treatment follow-up
- clinical exams;
- ultrasound;
- PSA and FPSA assays. After prostatectomy, the PSA level comes to 0. Any PSA increase signals recurrence.
Prevention
much controversial, this is a choice for each individual and his Doctor: this is your concern.
It means regular rectal exams, and PSA /FPSA dosages.