Prostate Cancer

Prostate Cancer

About Prostate Cancer

Prostate is a small walnut-sized gland, which is a part of the male reproductive system. The main function of the prostate is to produce the seminal fluid, which forms a major part of the ejaculate. This contains substances which helps in liquefying the ejaculate hence helping the sperms to reach the female reproductive tract. Like other parts of the body, cancer can also develop in the prostate gland. It is the most common cancer amongst men affecting about 1 million males in India every year. If detected early it can be treated. But, any delay in its diagnosis enables it to spread across the bones and lymph nodes of the body.

What are the symptoms of prostate cancer?

In most cases, prostate cancer does not cause any symptoms. In fact, these days more and more cases of early prostate cancers are being detected because of the routinely prescribed PSA test by physicians as part of the annual health check up after a certain age.
If prostate cancer does cause any symptoms they are indistinguishable from benign prostate hyperplasia, the non-cancerous enlargement of prostate, which causes urinary trouble.

The symptoms are:

  • Decreased force of urination or a weak urinary stream
  • Straining to pass urine 
  • Sense of incomplete emptying
  • Frequency of micturition
  • Urgent desire to pass urine, which may also be associated with incontinence at times
  • Nocturia that is frequent passing of urine in the night
  • Blood in semen or urine

In advanced cases when the disease has spread to the bones or lymph nodes other symptoms may occur, such as:

  • Bone pains (legs, back, hips etc.)
  • Fractures may occur in bones weakened by the spread of the cancer
  • Weakness in the legs due to compression of the spinal column
  • Incontinence of urine due to compression of the spinal column

How can you treat prostate cancer?

Depending on the stage of the cancer, age of the patient and the overall fitness levels of the patient, there are various prostate cancer treatment options available such as:
 A) Active surveillance and watchful waiting
In some patients particularly with an early stage and grade of the disease, prostate cancer grows very slowly. So much so that they may never need any treatment for the disease. For such patients their urologists may recommend either watchful waiting or active surveillance for a period of time. 

WATCHFUL WAITING: No treatment is advised and no further tests are recommended. Patients are treated if only any symptoms show up due to an enlarged prostate.

ACTIVE SURVEILLANCE: No treatment is indicated but the patient is kept under observation. A PSA test and digital rectal examination is done every 6 months and once a year a repeat prostate biopsy is done. If the results signify an increase in the quantum of the disease than the treatment is initiated.
 
B) Prostate cancer surgery (radical prostatectomy)
In early stages and grades of prostate cancer, surgery for removal of the prostate gland is an option. The entire prostate gland and seminal vesicles are removed and in selected cases lymph node dissection is done. This can be done by:

  • Open surgery
  • Laparoscopic surgery
  • Robot assisted laparoscopic surgery

C) Radiation therapy
In this treatment modality high energy rays or particles are used to kill the cancer cells. 

  • It is used as a first line of treatment for the cancer confined to the prostate
  • As a first line treatment along with hormonal therapy for tumors that have spread outside the prostate involving adjacent organs such as seminal vesicles
  • After surgical removal of the prostate (radical prostatectomy) if the biopsy report suggests that some amount of tumor is still left behind (positive margins), then Intensity Modulated Radiation Therapy (IMRT) or Image Guided Radiation Therapy (IGRT) are used to guide radiation delivery specifically to diseased cells to kill the cancerous tissue.

D) Hormonal therapy
Prostate cancer cell growth is stimulated by androgens secreted in the body mainly by the testicles but also in a small amount by the adrenal glands. Androgen deprivation therapy is used to deprive the cancer cells of the stimulus to grow. A combined androgen blockade is given that is both androgen deprivation (medical or surgical castration) as well as the use of anti-androgens.

Hormone therapy is usually used if:

  • The disease has spread outside the prostate that is the disease has metastasised.
  • If the disease comes back after the surgery or the radiation therapy.

E) Chemotherapy
Chemotherapy drugs are anti-cancer drugs given either orally or by injections. They are mainly used when prostate cancer has spread beyond the prostate involving other parts of the body. The intent is not to cure the patient but to halt the further spread of disease and to palliate symptoms caused by the spread of the disease.

F) Treating prostate cancer spread to the bones
Prostate cancer tends to spread to the bones. This can lead to bone ache, which can be very severe. Also, pathological fractures can happen in the affected bones. In such cases, drugs called bisphosphonates are used to relieve the pain, halt the spread of the disease and strengthen the bones to prevent pathological fractures. At times, even radiation therapy needs to be used to decrease the pain.

Stage-by-stage treatment options for prostate cancer:

STAGE I
1. If the patient wishes for a non-invasive treatment:

  • Active surveillance
  • Watchful waiting

 2. If patient desires an active treatment:

  • Radical prostatectomy
  • Radiation therapy

STAGE II

  • Radical prostatectomy
  • Radiation therapy

STAGE III

  • Radiation and hormonal therapy
  • Radical prostatectomy in selected cases

STAGE IV

  • Hormone therapy
  • Hormone plus radiation therapy
  • Chemotherapy
  • Surgery (TURP) to relieve the symptoms of the enlarged prostate. 

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