Prostate cancer is a serious disease that develops in the prostate – a little walnut-like organ in men producing a seminal liquid that fosters and ferries sperm.
Prostate cancer is common among men. Prostate cancer develops gradually and is at first restricted to the prostate, where it may not cause much damage. While some prostate cancers develop gradually and need little or no treatment, other, more aggressive cancer can spread more quickly than the rest and therefore need aggressive and early treatment.
Prostate cancer that is diagnosed early — but still confined to the prostate — has a higher chance of being cured.
In the early stages of the disease, there are hardly any signs or symptoms of prostate cancer. In the advanced stages following symptoms may be seen –
- Trouble urinating
- Decreased force in the stream of urine
- Blood in urine or semen (rare)
- Discomfort in the pelvic area
- Bone pain
- Erectile dysfunction
It is not clear what causes prostate cancer. Doctors are certain that prostate cancer starts when a few cells in the prostate become irregular/abnormal. Changes in the abnormal cells’ DNA cause it to grow and divide more than the normal cells do. The abnormal cells keep living while the other cells die. The gathering of abnormal cells develops into a tumor that can grow to attack close-by tissues. Some abnormal cells can likewise separate and spread (metastasize) to different parts of the body.
Following factors can increase the risk of prostate cancer –
- Age: With age, the risk of prostate cancer increases.
- Race: For some unknown reasons, Afro-Caribbean men are at a higher risk of prostate cancer than men of other races. It is likely to be more aggressive or advanced in them.
- Family history: Past family history can increase the risk of developing prostate cancer. Also, a strong family history of breast cancer or even the genes that increase the risk of breast cancer can put you at risk of developing prostate cancer.
- Obesity: Obese men are at higher risk of developing prostate cancer and have a worse prognosis with treatment unless they take active measures to lose weight and get fitter.
Some medical associations suggest men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer such as the family history of prostate/ breast cancer. It is wise to discuss the advantages of screening with your Urologist/ Primary care physician, together, you can choose whether prostate cancer screening is right for you.
Prostate screening tests include –
1. Digital rectal exam (DRE)
During a DRE, the physician inserts a gloved, lubricated finger into the rectum to look at the prostate, which borders the rectum. In case of abnormalities in surface, shape or size or the organ, the doctor may ask you to get further tests done.
2. Prostate-specific antigen (PSA) blood test
A blood test is performed on the vein in your arm and is inspected for PSA, a substance that is produced by the prostate gland. A little quantity of PSA in the bloodstream is normal. But a higher level of PSA might indicate prostate infection, inflammation, enlargement, or cancer.
If any abnormality is found on the PSA test, the doctors should recommend further tests to determine whether you have prostate cancer:
These include an MRI scan of the prostate followed by transrectal ultrasound-guided prostate biopsies, in some centres a more advanced form of prostate biopsies called as an MRI fusion biopsy will be offered as this provides a much accurate way to obtain tissue samples. This is carried out on an out-patient basis under local anesthesia and is very well tolerated by patients.
Once a biopsy specimen is obtained, it is sent for evaluation by a pathologist or preferably an Uro-pathologist, who look at the tissue sample and decide how much it differs from the normal cells.
The most well-known scale used to assess prostate cancer cells is known as a Gleason score. Gleason scoring joins two numbers and can go from 2 (nonaggressive cancer) to 10 (very aggressive).
Your prostate cancer treatment alternatives rely upon a few components, for example, how quickly your disease is developing, how much it has spread and your general well being, and your age. You may be recommended one of the following treatment choices:
1. Active surveillance –
Especially for elderly men (more than 70 years age) diagnosed with low-risk prostate cancer, treatment may not be required immediately. A few men may never need treatment. Rather, doctors suggest active surveillance. In active surveillance, follow-up PSA blood tests, rectal examination, and annual MRI scan with or without biopsies might be performed to screen the progression of your cancer. In the event, where the tests show your cancer growth is advancing, you may opt for prostate cancer treatment such as surgery or radiation.
2. Surgery to remove the prostate –
Radical Prostatectomy or removal of the entire prostate gland along with some circling tissue and lymph nodes is a very effective form of treatment for prostate cancer, especially in men diagnosed with the disease when they are young. Radical prostatectomy can be performed in different ways including open surgery or laparoscopic surgery or robot-assisted surgery. These days with the availability of robotic-assisted radical prostatectomy, one is able to preserve some vital nerves and blood vessels that help with early recovery of sexual function and continence. It is generally believed that this form of treatment should be reserved for men who are less than 70 years of age.
3. Other treatments –
- Radiation therapy
High-powered energy is used to kill cancer cells in radiation therapy. This therapy can be delivered in two ways, external beam radiation, and brachytherapy. Side effects of radiation therapy can involve, frequent or urgent urinating sensations, as well as rectal symptoms like loose stools or pain when passing stools. Likewise, erectile dysfunction can happen too. The side effects of radiation do tend to subside with time and very rarely can they persist.
- Hormone therapy
This form of therapy is reserved for those individuals where the disease is advanced and therefore surgery or radiation is not going to help in controlling the disease. Hormone therapy is a treatment to prevent your body from producing testosterone. Prostate cancer cells rely on testosterone for their growth. Removing the supply of testosterone may make the cancer cells die or grow at a much slower pace. Hormone therapy options include –
- Medications that stop your body from producing testosterone
- Medications that block testosterone from reaching cancer cells
- Surgery to remove the testicles (orchiectomy)
Hormone therapy is administered in men with advanced prostate cancer to shrivel the disease and to slow the development of tumors. In men with locally advanced prostate cancer, hormone therapy might be administered to shrivel tumors before radiation therapy, which can improve the probability that radiation treatment will be effective.
The side-effects of this therapy may include erectile dysfunction, hot flushes, loss of bone density, and weight gain.
- Freezing prostate tissue
Cryosurgery or cryoablation includes freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, tiny needles are inserted in the prostate with the help of ultrasound images as guidance. Freezing gas is set in the needles, which causes the surrounding tissue to freeze. A subsequent gas is then set in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some encompassing healthy tissue. Due to its potential side effects and efficacy, this treatment is not offered as a standard of care.
Chemotherapy utilizes medications to kill developing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, a pill, or both. Chemotherapy might be a treatment of choice for men with prostate cancer that has spread to remote body areas. Chemotherapy may also be utilised for cancers that don’t react to hormone therapy.
- Biological therapy
Biological therapy(immunotherapy) utilizes the body’s immune system to battle cancer cells. One kind of biological treatment called sipuleucel-T (Provenge) has been created to treat advanced, recurrent prostate cancer. This treatment takes your very own immune cells, genetically engineers them in a lab to battle prostate cancer and then infuses the cells again into your body through a vein. A few men do react to this treatment with some improvement in their cancer growth, but the procedure is rather expensive and requires numerous treatments.