prostate cancer

A man's prostate gland is a solid organ found immediately below the bladder, and it surrounds the "urethra" -- which is a tube connecting the bladder and the penis through which a man urinates. The other important parts of the male urogenital system are the seminal vesicles and the testicles.

Prostate has two important functions: one is to help control urination and the other is to help sexual activity. The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra. The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the mobility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.

The normal prostate in a young adult man is about the size of a walnut. However, its size can change over time, and in many men the prostate gets larger as they get older, particularly when a man gets over the age of 40 or 50 years. This can affect the ability to urinate.

Preoperative dimensions of prostate gland (Please refer to the
following figure for the definition of Length, Width, etc.)

Prostate cancer is the most common internal (non-skin) cancer in American men and the second most common cause of cancer deaths, after lung cancer. The American Cancer Society estimates that well more than 300,000 men will be diagnosed with the disease in 1997, and that more than 40,000 will die of it. In Singapore, prostate cancer is the sixth common cancer (1988-1992, Singapore Cancer Registry).

The predisposing factors for clinical prostate cancer are shown in the following table

Predisposing factors for clinical prostate cancer
Genetic	Familial autosomal dominant in some
Racial	Commoner in blacks, Scandinavians, US whites and Western Europeans
Age	Commoner with increasing age
Sexual history	Commoner in men with early sexual experience and multiple sexual partners
Diet	Animal fats Low intake of yellow/green vegetables
Pollution	Urban dwelling Cadmium exposure Exposure to radioactive agents

The strongest predetermining factor for the development of prostate cancer is age. As shown in Table 1.3, prostate cancer is rarely found in the under 50s but is increasingly common with rising age. The racial characteristics outlined above are also quite strong predisposing factors with North American blacks, having roughly twice the lifetime risk of the disease compared with their white counterpart.

As the average age of men continues to increase, the number of new cases each year is expected to increase markedly. Caught early, usually before any noticeable symptoms appear, the disease can be cured. Unfortunately, reluctance to undergo routine screening has meant that many men do not learn they have prostate cancer until it has already become incurable. The American Cancer Society recommends that every man over the age of 50 be screened annually due to results of statistics proving high risk for older men.

There are no clear symptoms of prostate cancer that can be easily assessed by the patient himself. This makes prostate cancer very different from breast cancer or testicular cancer in which regular self examination can be important in finding early signs of the disease. A big problem with prostate cancer is that many of the early signs of the disease can be caused by other disorders or, worse still, are just among the normal consequences of growing older. Another big problem is that usually prostate cancer does not cause signs or symptoms for many years after the disease starts to develop.

	Mean (mm)	Range (mm)
Length	41	29-59
Width	52	48-80
Anteroposterior (AP) diameter	35	33-60

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