Prostate Cancer: know it to fight it
The month of September every year is celebrated as “prostate cancer awareness month”. The idea is to share knowledge and experience about this disease; which has a very high potential for cure, if detected and treated early. Cancers are never good, but this one has certain reassuring things about it; the most important being the presence of a blood marker, which can give us an indicator of its presence at a very early stage, a stage where it can be cured…. yes you heard it right… cured. So, the affirmative things about cancer prostate are:
- Early detection by blood marker called PSA
- Cure is possible by early surgery/radiotherapy
- Surgery is usually done by laparoscopy/robotically and has minimal morbidity
- Survival even in late stages is way better than many other cancers
Let us understand prostate and its diseases in a bit of detail.
What is prostate?
Prostate is a walnut-shaped gland found encircling the male urethra at the bladder neck. It is an important part of the male reproductive system and its main function is to secrete a fluid that goes into semen; which is essential for male fertility.
What are the diseases that affect the prostate gland?
Broadly, two types of diseases can affect the prostate gland; benign enlargement of the prostate called BPE or BPH, and cancer of the prostate (CaP). Both the diseases affect elderly males. It is important to differentiate between the two as the treatments differ substantially.
What are the symptoms of prostatic enlargement? Can we differentiate between BPE and CaP based on the symptoms?
Patients usually present with urinary symptoms like difficulty in passing urine, frequency of urination, straining to pass urine etc. It is difficult to differentiate between the two entities, just based on the symptoms. You need to see a urologist, who will examine you and prescribe some investigations to reach the diagnosis and plan further treatment.
So, it is my sincere advice to everyone who is experiencing urinary symptoms, to seek an expert opinion and refrain from starting a pill just because your friend is taking it for similar symptoms and he is relieved of his symptoms.
What are the investigations done to diagnose CaP?
The diagnostic evaluation starts with an examination of the prostate by inserting the finger in the anal canal (digital rectal examination, DRE). Usually, the prostate is smooth on finger examination and irregular, firm to hard prostate may suggest the presence of cancer. This is followed by blood sampling for PSA. An elevated level needs further evaluation by MRI of the prostate. All these tests give us a reasonably good idea about the presence or absence of cancer; however final confirmation is only by prostate biopsy. Once biopsy-proven, a PSMA PET scan is done for staging purposes.
How prostate biopsy is done?
It is done as a day-care procedure under local anesthesia. It is done through a trans-rectal route using a pen-shaped ultrasound (USG) probe. Usually, 12-cores are taken and sent for pathological examination. It is a very safe procedure and some patients may pass some blood in urine and/or stools for a brief period.
What are the treatment options available?
A number of treatment options are available, which include surgery, radiation therapy, hormonal therapy and chemotherapy. The treatment depends on multiple factors like PSA levels, disease stage, pathological grading, patient’s age/co-morbidities, life-expectancy etc. The treatment of CaP is highly individualized and even for the same stage and grade, two individuals may receive different treatments. The physician will assess all the above factors and will outline the best treatment for you.
Dr. Vikas Jain | Director & Senior Consultant – Kidney Transplant – Adult, Kidney Transplant – Paediatric, Urology | Dharamshila Narayana Superspeciality Hospital, Delhi