Prostate cancer refers to cancer that occurs in prostate gland which is present in all men. Prostate is essentially a small, walnut-shaped gland which produces the seminal fluid that transports the sperm.
One of the most common types of cancer in men, Prostate cancer generally grows and spreads slowly and often remains confined to the prostate gland. In such cases, it may not cause much danger. However, there are certain other types of Prostate cancer which are very aggressive and can spread rather quickly.
Early detection of Prostate cancer offers better chances for successful treatment.
Prostate cancer is mainly caused when some of the cells in the prostate become abnormal. Due to the mutations in the DNA of these abnormal cells, they tend to develop and divide very rapidly in comparison to the normal cells. While the abnormal cells multiply, the normal cells begin to die. The faster accumulation of abnormal cells could result in a tumor that can spread to the nearby tissues, thus damaging them too. Certain abnormal cells can metastasize i.e. break off and spread to various other parts of the body.
Who are at risk ?
- Advanced age: Prostate cancer is common in men who are above 65 years.
- Black men are at a greater risk of prostate cancer when compared to men of other races. In black men, prostate cancer tends to be more advanced.
- Family history of prostate cancer
Prostate cancer doesn't usually cause any symptoms. Most prostate cancers tend to start in the outer part of the prostate gland. This means that to cause symptoms the cancer needs to be big enough to press on the tube that carries urine from your bladder out of your body and is very unusual. This tube is called the urethra.
It is very unusual to have symptoms to do with passing urine. These are much more likely to be caused by the prostate gland becoming enlarged as one gets older. As part of investigating the cause of urinary symptoms one might have a blood test called a PSA test. This is one of the tests doctors use to diagnose prostate cancer.
So, the following urinary symptoms are much more likely to be due to an enlargement of your prostate gland but can include:
- Passing urine more often
- Getting up during the night to empty your bladder (nocturia)
- Difficulty passing urine – this includes a weaker flow, not emptying your bladder completely and straining when starting to empty your bladder
- Blood or semen in your urine
Patients with advanced staged prostate cancer may experience symptoms like:
- Swelling or inflammation in the legs
- Discomfort in the pelvic region
- Bone pain
If you are suffering from either of these symptoms, consult your family doctor or a general practitioner or urologist. If your physician suspects that you are having a problem with your prostate, you would be referred to urologist. Urologist will perform detailed examination with few investigations including blood tests and MRI depending upon the clinical findings.
Diagnosis of Prostate Cancer
Digital Rectal Examination (DRE)
The rectum is located close to the prostate gland. Prostate is hence examined through rectum. If your prostate gland is cancerous, it may feel very hard and knobbly. In an individual who is suffering from Benign Prostatic Hyperplasia (BPH), the prostate is generally enlarged, firm and smooth. However, very often, the prostate may feel quite normal, even though cancer cells are present.
Prostate-specific antigen (PSA) tests
A sample of your blood is taken to check for prostate-specific antigen (PSA). Prostate-specific antigen is a protein produced by the prostate. A small amount of PSA is generally found in blood. Men who have Prostate cancer tend to have more amount of PSA in their blood. However, the PSA test cannot be always relied upon and sometimes, men who have prostate cancer will have normal PSA. The increase in the PSA level could be also due to several other factors such as urine infections, recent prostate biopsies, having a urinary catheter, prostate or bladder surgery or a prostatic massage. PSA levels higher than normal could be mostly due to prostate cancer and a biopsy would often be recommended. Men who have PSA levels of 5 ng/ml or above are mostly referred for further tests.
MRI(Magnetic Resonance Imaging)
In patients with high PSA or normal PSA with suspicious clinical findings, MRI of prostate is recommended. It acts as a guide map so as to decide whether to perform biopsy and if yes, which areas within the prostate should be targeted to gain the correct samples.
Trans-rectal Ultrasound Scan (TRUS)
Ultrasound scans make use of sound waves to create an image of a certain region or organ inside the body. A small probe is inserted into the rectum and an image of the prostate gets displayed on a screen. The TRUS scan is mainly used to assess the size and density of the prostate. It also rules out any infection or abscess in prostate which also can cause increases PSA levels.
If the initial tests reveal that there is a possibility of cancer, you may be recommended a biopsy. In this process, numerous samples of tissue (generally around 12) are extracted from the prostate for careful inspection under a microscope. The biopsy is usually performed under guidance of ultrasound and is an outpatient procedure doenw under local anaesthetics.
Diagnosis of advanced prostate cancer
If the biopsy shows the presence of prostate cancer, several tests may be required to determine whether the disease is confined to prostate gland or has spread to other organs/regions in the body. These tests include:
- Isotope bone scan
- MRI scan
- CT scan
Treatment options for early prostate cancer
The major treatment options for early prostate cancer include:
- Watchful waiting
- Active surveillance
- Surgery or removal of the prostate gland
- External beam radiotherapy
If the prostate cancer is likely to develop and spread slowly and if you are elderly and not fit for treatment such as surgery or radiotherapy, you may be recommended watchful waiting. In case the symptoms start developing, you may required to undergo treatment, such as hormonal therapy, For older men, hormonal therapy may be recommended after radiotherapy.
Young people who have low-grade early prostate cancer may be recommended active surveillance. It involves regular examinations and investigations including PSA, MRI and biopsy to track any progress of disease. If the cancer starts to progress, they will be asked to undergo surgery or radiotherapy.
People who have moderate- to high-grade cancer are likely to be recommended Radical Prostatectomy or surgery to completely remove the prostate gland or radiotherapy of the prostate. These treatments help to eliminate all the cancer cells and thus cure the cancer.
Conventionally surgery is performed as open technique resulting in big scars and delayed recovery. However with advanced techniques we perform these surgeries as laparoscopic or robotic involving vary small cuts, minimising the blood loss, ealy recovery and early return to normal activities and no compramise in oncological outcome.
The radiotherapy can be given to the patient using an external machine(External Beam Radiotherapy) or directly into the prostate gland(Brachytherapy).
Although for some people these treatments will cure the cancer, in certain others some of the cancer cells may still be left behind after the treatment. In some others, the treatment may help to keep patients cancerfree for a certain period of time, but the cancer may regenerate in the future. And hence to keep proper follow up with your doctor is necessary.
Treatment options for men with locally-advanced prostate cancer
There are numerous factors which need to be taken into account prior to deciding the best treatment options. This includes:
- Your physical health
- The stage and grade of the prostate cancer
- The PSA level
- The potential risks or side effects of treatment
- Whether you had treatment before.
The treatment options for locally-advanced prostate cancer mainly include Radiotherapy, Hormonal therapy, Watchful waiting and Surgery. Sometimes, different combination of treatments will be provided to the patient.
It is extremely important for you to be fully aware of the benefits, disadvantages and side effects of each of these treatments before you decide on the treatment. Your doctor or specialist nurse will provide you detailed information on the various treatments.
Treatment for Advanced Prostrate Cancer
The treatment options for advanced prostate cancer mainly include Hormonal therapy, Surgery, Chemotherapy, Radiotherapy and controlling symptoms. Surgery to remove the prostate gland is not recommended for men with advanced prostate cancer. However, a transurethral resection of the prostate (TURP) can help to relieve problems associated with passing urine.
Unfortunately, if prostate cancer has spread beyond the prostate gland and has severely affected other parts of the body, it cannot be cured. However, you can undergo treatment to control the cancer for several years and relieve the symptoms if any. This will help to improve the quality of your life.