What is the prostate and what does it do?
The prostate is a male gland located below the bladder and around the urethra. Its main function is to secrete part of the seminal fluid that helps keep sperm alive and active. Its size may vary over time and usually increases in size as we age, especially over 40 or 50 years.
The prostate gland has a complex structure. 30% is fibromuscular tissue (composed of muscle and fibrous tissue), and 70% glandular elements that produce prostate fluid. It is also wrapped in a thin layer called the prostate capsule which separates it from adjacent tissues.
The glandular structure of the prostate can be divided into different zones. The main areas are:
– Transitional zone: Where the prostate adenoma (benign tumor) usually develops.
– Central zone: Relatively resistant to the development of pathologies.
– Peripheral zone: This zone is where most of the cancerous processes are generated.
What is prostate cancer?
The human body is made up of cells that divide, periodically, to replace the old or dead to maintain the integrity of internal organs. This process requires a balance that is regulated by control mechanisms that tell the cell when it should divide. When these control mechanisms are altered, an uncontrolled division of cells can occur, the consequence of which is their abnormal proliferation, giving rise to a tumour.
If the cells that form the tumor can invade surrounding tissues and organs (infiltration) or move to other parts of the body (metastasis) it is called a cancer or malignant tumor. When this abnormal proliferation of malignant cells occurs in the prostate we are faced with prostate cancer.
EARLY prostate cancer tends to have no or minimal symptoms.
The main symptoms of ADVANCED prostate cancer are:
– Difficulty to start urination and decrease the strength and flow of urine.
– Feeling of not having completely emptied the bladder.
– Having to urinate frequently (every two hours) and having to get up several times at night to urinate.
– Postmictional drip or incontinence.
– Urinary urgency.
– Sudden inability to urinate.
– Weight loss
How is prostate cancer diagnosed
Rectal examination: it consists of an examination of the rectum through which the doctor inserts a lubricated finger into the rectum and palpates the prostate through the rectal wall in search of nodules or abnormal areas. This test is uncomfortable, but it is not painful and takes few seconds to complete. It is sometimes useful for detecting malignant tumors in patients with normal levels of prostate antigen (PSA).
MRI – magnetic resonance imaging. A special prostate MRI scan has become the standard of care to image the prostate gland for cancer. A multiparametric prostate MRI can detect areas in the prostate gland and appoint a grade that reflects the likelihood of cancer present. A PiRADS score ( Prostate Imaging Reporting and Data System ) will be provided with every prostate MRI. This is used to assist the Urologist in the management and potentially biopsy technique used.
Determination of blood levels of PSA: It is a laboratory test that measures the concentrations of this marker (PSA) in blood. It is a substance produced specifically by the prostate that can be found in greater amounts in the blood of men who have prostate cancer. However, it should be borne in mind that PSA levels can also be raised in infections or inflammation of the prostate such as benign prostatic hyperplasia (enlargement of the prostate of non-cancerous origin).
Transrectal ultrasound guided biopsy: a procedure that involves inserting a probe about the size of a finger into the rectum to examine the prostate and extraction of a portion of prostatic tissue to which a histological study is performed to determine the existence of malignant cells. The Biopsy needle can be placed through the perineum ( skin area between the rectum and scrotum ) or through the rectum. This test will confirm the diagnosis of cancer and provides an idea of the tumour volume and the degree of aggressiveness
Gleason score 7 to 10
Gleason 6 – low-grade tumours.
Gleason 7 – intermediate-grade tumours.
Gleason 8-10 – high-grade tumours.
A more contemporary grading system is the International Society of Urological Pathologist ( ISUP ) grade group 1 to 5.
Grade group 1 = Low grade.
Grade group 2,3 = Intermediate grade
Grade group 4,5 = High grade