Introduction:-

Prostate is a glandular organ present only in males. It surrounds the neck of bladder & the first part of urethra and condributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter.It has got five lobes anterior,posterior,two lateral and a median lobe.Since the first part of the urethra pass through it any lesion in the prostate will produce difficulty in passing urine.

Diseases of the prostate gland:-

1) Prostatitis:-

This is the inflamation of the prostate gland due to bacterial infection.

2) Benign enlargement of the prostate:-

This is a non cancerous tumour of the prostate seen after the age of 50. 3,Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males.

Cancer of the prostate.

Cancer of the prostate is directly linked with the male sex hormones(androgens).If the levels of sex hormone increases the growth rate of cancer also increases.It is found that after the removel of testes there is marked reduction in the size of tumour.

Site of tumour:-

Prostate cancer is seen mainly in the posterior lobe.Non cancerous enlargement is seen in other lobes.

Changes in the gland in cancer:-

The gland becomes hard with irregular surface with loss of normal lobulation .Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland)

Growth :-

Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.

Spread of tumour:-

Metastasis in cancer of prostate is very early.

1) Local spread:-

From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles.Tumour cells also move to the neck and base of the urinary bladder.

2) Lymphatic spread:-

Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes.From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest)

3) Spread through the blood:-

Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae.

Signs and symptoms of prostate cancer:–

Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.

1) No symptoms:-

Tumour is small and only in the posterior lobe. This is diagnosed accidentely.

2) Slight difficulty in urination:-

Here the tumour is enlarged and urethra is slightly compressed.Shortly there will be frequent urge for urination with difficult urination.

3) When the tumour spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding.Urine comes drop by drop.

4) Retention of urine:-

When the urethra is completely compressed there will be retention of urine.This can lead to hydronephrosis, renal failure ect.In this condition patient may get convulsions due to renal failure and finally coma.

5) Signs of metastasis:-

Some patients come with the signs and symptoms of metastasis.

a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.

b) Fracture of spine due to cancerous growth in the spine.

c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.

d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.

e) General weakness due to spread of cancer to different parts of the body.

f) Anaemia due to involment of bone marrow and increased destruction of RBCs.

Clinical examination :-

Includes per rectal examination to feel the prostate gland,palpation of abdomen to feel the swelling in kidneys and any tumours.Patient is examined from head to foot to find out any lesions.

Investigations:-

1) Complete blood investigations;-

RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.

2) Urine analysis:-

Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.

3) Renal function tests:-

Blood urea level,serum creatinine level,electrolyte level ect.

4) Serum acid phosphatase:-

Increased in cancer of prostate.

5) x-ray of the spine:-

To detect any tumour or fracture.

6) Ultra sonography;-

Gives idea about prostate,bladder,kidney ect.

7) C T scan:-

More detailed information about organs and tumour.

8) MRI of the spine:-

Gives detailed information about spine ,disc and nearby soft tissues.

9) Lymphangiography:-

Gives idea about lymphatic spread of cancer.

10) Biopsy to confirm cancer:-

Biopsy is taken from the tumour and is send for histopathological examination under the microscope.This will detect the presence of cancer cells.

Treatment:-

1) If there is retention of urine catheterisation is needed.
2) Dialysis if kidney failure.
3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.
4) Specific treatment is prostatectomy(removal of prostate)

Partial prostatectomy :-

Here only the affected lobe is removed.

Radical prostatectomy :-

Total removal of prostate along with nearby lymphnodes.

5, Hormone therapy :-

Stilbestrol is given to reduce tumour growth.Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.

6) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given.

7) Radiotherapy is also done for some cases.

8) Homoeopathy:-

Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms.Constitutional homoeopathic medicine will give great relief and can increase the life span.

9) Yoga and meditation is also healpful.

One fact attendant on habitual drinking stands out so prominently that none can call it in question. It is that of the steady growth of appetite. There are exceptions, as in the action of nearly every rule; but the almost invariable result of the habit we have mentioned, is, as we have said, a steady growth of appetite for the stimulant imbibed. That this is in consequence of certain morbid changes in the physical condition produced by the alcohol itself, will hardly be questioned by any one who has made himself acquainted with the various functional and organic derangements which invariably follow the continued introduction of this substance into the body.

But it is to the fact itself, not to its cause, that we now wish to direct your attention. The man who is satisfied at first with a single glass of wine at dinner, finds, after awhile, that appetite asks for a little more; and, in time, a second glass is conceded. The increase of desire may be very slow, but it goes on surely until, in the end, a whole bottle will scarcely suffice, with far too many, to meet its imperious demands. It is the same in regard to the use of every other form of alcoholic drink.

Now, there are men so constituted that they are able, for a long series of years, or even for a whole lifetime, to hold this appetite within a certain limit of indulgence. To say “So far, and no farther.” They suffer ultimately from physical ailments, which surely follow the prolonged contact of alcoholic poison with the delicate structures of the body, many of a painful character, and shorten the term of their natural lives; but still they are able to drink without an increase of appetite so great as to reach an overmastering degree. They do not become abandoned drunkards.

No man safe who drinks. ———————-

But no man who begins the use of alcohol in any form can tell what, in the end, is going to be its effect on his body or mind. Thousands and tens of thousands, once wholly unconscious of danger from this source, go down yearly into drunkards’ graves. There is no standard by which any one can measure the latent evil forces in his inherited nature. He may have from ancestors, near or remote, an unhealthy moral tendency, or physical diathesis, to which the peculiarly disturbing influence of alcohol will give the morbid condition in which it will find its disastrous life. That such results follow the use of alcohol in a large number of cases, is now a well-known fact in the history of inebriation. The subject of alcoholism, with the mental and moral causes leading thereto, have attracted a great deal of earnest attention. Physicians, superintendents of inebriate and lunatic asylums, prison-keepers, legislators and philanthropists have been observing and studying its many sad and terrible phases, and recording results and opinions. While differences are held on some points, as, for instance, whether drunkenness is a disease for which, after it has been established, the individual ceases to be responsible, and should be subject to restraint and treatment, as for lunacy or fever; a crime to be punished; or a sin to be repented of and healed by the Physician of souls, all agree that there is an inherited or acquired mental and nervous condition with many, which renders any use of alcohol exceedingly dangerous.

The point we wish to make with you is, that no man can possibly know, until he has used alcoholic drinks for a certain period of time, whether he has or has not this hereditary or acquired physical or mental condition; and that, if it should exist, a discovery of the fact may come too late.

Dr. D.G. Dodge, late Superintendent of the New York State Inebriate Asylum, speaking of the causes leading to intemperance, after stating his belief that it is a transmissible disease, like “scrofula, gout or consumption,” says:

“There are men who have an organization, which may be termed an alcoholic idiosyncrasy; with them the latent desire for stimulants, if indulged, soon leads to habits of intemperance, and eventually to a morbid appetite, which has all the characteristics of a diseased condition of the system, which the patient, unassisted, is powerless to relieve since the weakness of the will that led to the disease obstructs its removal.

“Again, we find in another class of persons, those who have had healthy parents, and have been educated and accustomed to good social influences, moral and social, but whose temperament and physical constitution are such, that, when they once indulge in the use of stimulants, which they find pleasurable, they continue to habitually indulge till they cease to be moderate, and become excessive drinkers. A depraved appetite is established, that leads them on slowly, but surely, to destruction.”